Bony Tunnel Research Articles

Morphological characteristics of the cubital tunnel as indication for anterior interosseous nerve supercharge end-to-side transfer in treating advanced cubital tunnel syndrome

BackgroundCubital tunnel syndrome (CuTS) is a prevalent compressive neuropathy addressed through various treatments, including the anterior interosseous nerve (AIN) supercharge end-to-side (SETS) transfer for advanced CuTS. Decision to add AIN-SETS is based on various indicators and protocols, but deciding on the appropriate method for borderline cases can be challenging. Therefore, this study aims to non-invasively examine the cubital tunnel anatomy of patients using CT scans and compare the findings with existing indicators and measurements, to determine if they can serve as supplementary indicators to aid in treatment decisions. HypothesisThe bony cubital tunnel volume is correlated to other traditional indicators and can be used as an additional indication for deciding whether to perform AIN-SETS in treating advanced CuTS. Patients and MethodsThis is a single-center retrospective cohort study from South Korea, including 91 patients aged 20–70 years with CuTS. Participants were classified into Group A (n = 43), who underwent both cubital tunnel release (CuTR) and AIN-SETS, and Group B (n = 48), who underwent only CuTR. Preoperative elbow CT data were analyzed for cubital tunnel morphology analysis, with follow-up assessments such as grip strength and electromyography/ nerve conduction velocity (EMG/NCV) tests at 3, 6, and 12 months postoperatively. ResultsGroup A and B showed no significant differences in demographic parameters, except for a longer disease duration in Group A (p = 0.032). Group A had a smaller cubital tunnel volume (CTV) compared to Group B (1150.6 ± 52.8 mm3 vs. 1173.5 ± 56.2 mm3, p = 0.014) and a smaller cross-sectional area (40.9 ± 10.2 mm2 vs. 45.1 ± 11.7 mm2, p = 0.033). Pearson correlation analysis revealed statistically significant positive correlations between CTV measurements and pre-operative grip strength, as well as EMG results, a key indicator for AIN-SETS (R2 = 0.48, 0.23, p = 0.01). DiscussionMeasuring the cubital tunnel anatomy using CT can aid in determining the treatment approach for advanced CuTS patients and assist in deciding whether to perform AIN-SETS surgery, serving as a supplementary indicator for cases at the borderline limits of other indicators. Future research may be necessary to establish control groups without symptoms and determine appropriate cut-off values. Level of evidenceIV.

ATTACHMENT WITH SUTURE VIA BONE TUNNELS IS COMPARABLE BIOMECHANICALLY TO SINGLE-ROW ANCHOR SUTURE FOR REATTACHMENT OF ACHILLES TENDON TO BONE

Insertional Achilles tendinitis with considerable degeneration that failed non-operative treatment typically requires tendon debridement and reattachment to bone. It is common practice for tendons to be reattached back with anchor sutures, but this poses a challenge to patients who are not able to afford them. Bony anchorage of tendons may be performed by passing sutures through tunnels, but the strength of repair compared to by using anchors is not known. We investigated the load at clinical and catastrophic failure of these two methods of reattachment. Sixteen paired Achilles tendons along with the calcaneus were harvested from eight fresh frozen cadavers. Paired randomization was done. For the anchor suture group, two 5’0 anchors with polyethylene #2 sutures were used for reattachment whereas for the suture only group, tendons were reattached to bone using braided polyester #2 sutures via two bony tunnels. All samples were mounted on a materials testing system and preloaded at 50N for 60sec before load to failure at a rate of 1mm/sec. With the assumption that preloading has removed tendon crimp and any subsequent extension is a result of gapping at the repair site, loads at 5mm, 10mm, 15mm, and 20mm of extension were noted as well as the maximal load at failure. We found higher loads were needed to cause an extension of 5 to 20mm in the suture only group compared to the anchor suture group but these data were not significant. On the other hand, the anchor suture group required higher loads before catastrophic failure occurred compared to the suture only group, but this again is not significant. We conclude that suture only reattachment of the Achilles tendon is comparable in strength with anchor suture reattachment, and this method of reattachment can be considered for patients who do not have access to anchor sutures.

Loop technique for anterior cruciate ligament reconstruction combined with anterolateral structure reinforcement: technical description and clinical results

PurposeWe describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results.MethodsThe semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy’s tubercle, a bony tunnel is created from the anterior to Gerdy’s tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6–12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient’s maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured.ResultsPatients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient’s operated side and the healthy side.ConclusionThe Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient’s subjective perception was significantly improved from the preoperative period and knee stability was restored.Level of evidenceIV, therapeutic study.

Paper 37: Peri-Operative Complications, Safety, and Early Outcomes of a Novel ACL+ALL Reconstruction Technique using Iliotibial Band Autograft vs. Patellar Tendon ACL Reconstruction: A Retrospective Pilot Study of the SATURN (Skeletally-Mature ACLR Technique Using Reinforcement Network) Study Group

Objectives: The iliotibial band (ITB) autograft has been historically used for physeal-sparing ACL reconstructions (ACLR) in skeletally immature children (Modified-Macintosh/Micheli-Kocher technique), with an extra-articular component that replicates an anterolateral ligament reconstruction (ALLR). The procedure has demonstrated excellent return to sports (RTS), patient-reported outcomes (PROs), and relatively lower ACL graft rupture rates than other techniques in children and adolescents. However, there is only minimal evidence regarding the effectiveness of the ITB technique, or similar modifications thereof, in skeletally mature athletes. The purpose of the current study was to assess the peri-operative complications, safety, and early outcomes of a novel ITB-ACLR+ALLR technique modified for skeletally mature patients and compare it to the current gold standard of patellar tendon/bone-tendon-bone autograft technique (BTB-ACLR). The study hypothesis was that the techniques would be associated with comparably low rates of peri-operative complications, good to excellent early PROs in skeletally mature adolescents and young adults. Methods: Patients aged 13-25 years-old with closing or closed physes who underwent either primary ITB-ACLR+ALLR or primary BTB-ACLR by one of three surgeons at a single institution over a one-year period were included. The ITB-ACLR+ALLR technique utilized a 20mm wide central strip of ITB autograft, transected 100-120mm proximal to the lateral epicondyle, tubularized with whipstitches in 40mm of the free end proximally and left attached to Gerdy’s tubercle distally. The graft was passed from outside in through a complete tunnel in the lateral femoral condyle that spanned the anatomic ALL footprint extra-articularly and the anatomic ACL footprint extra-articularly, then passed through a standard tibial tunnel. The graft was affixed with outside-in cortical interference screws within both femoral and tibial tunnels. All intra-operative and post-operative complications were retrospectively recorded. Physical exam findings were collected at baseline, 3 and 6 month follow up visits, return to sport (RTS) testing was performed at 6 and 9 months, post-operatively, and patient-reported outcomes (PROs), including the Pedi-IKDC, HSS-Pedi FABS, KOOS, and EQ-VAS, were collected at baseline and 6 month follow-up visits, with ongoing collection of 12 month and 24 month follow-up PROs underway. Results: 71 patients (36 ITB, 35 BTB) were included in the current analysis. There were no significant differences in age, sex, BMI, pre-operative/baseline PROs, operative time, tourniquet time, or RTS time between the two treatment groups (Table 1). Peri-operative complications for ITB-ACLR+ALLR included 1 case of graft rupture 8 months post-operatively, which was associated with patient non-compliance with post-operative rehabilitation protocols/limitations (subsequently treated with revision BTB-ACLR), 1 case of medial meniscus tear 11 months post-operatively (subsequently treated with partial meniscectomy), 1 case of lateral thigh cramping at 6 weeks post-operatively (resolved spontaneously within 1 week), one cases of stiffness at 3 months post-operatively (resolved with dynamic bracing and PT), and one superficial wound infection at 2 weeks post-operatively (resolved with oral antibiotics). Peri-operative complications for BTB-ACLR included 4 cases of arthrofibrosis 3-5 months post-operatively (subsequently treated with arthroscopic lysis of adhesions). All 3-month Lachman and pivot-shift tests demonstrated symmetry with the contralateral knee, within 1 IKDC grade. All PROs at 6 month follow up visits were not statistically different between treatment groups (Table 2). Conclusions: Preliminary safety and clinical results suggest that a novel ACLR+ALLR technique utilizing an ITB autograft may be safe and effective for restoring knee stability and returning skeletally mature adolescents to sports, with comparable early complications and function to ACLR-BTB. Given the advantages of the ITB-ACLR+ALLR—which include technically simple graft harvest/preparation/passage/fixation, optimization of both translational and rotational stability, preservation of both the dynamic knee extensor and flexor muscle groups, and relatively smaller bony tunnels—ongoing monitoring of graft rupture rates and PROs in the current cohort and future randomized, prospective clinical trials are warranted to assess the technique in methodologically rigorous, multicenter fashion.

Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs

Background: Tibial spine fractures are common in the pediatric population because of the biomechanical properties of children’s subchondral epiphyseal bone. Most studies in porcine or adult human bone suggest that suture fixation performs better than screw fixation, but these tissues may be poor surrogates for pediatric bone. No previous study has evaluated fixation methods in human pediatric knees. Purpose: To quantify the biomechanical properties of 2-screw and 2-suture repair of tibial spine fracture in human pediatric knees. Study Design: Controlled laboratory study. Methods: Cadaveric specimens were randomly assigned to either 2-screw or 2-suture fixation. A standardized Meyers-Mckeever type 3 tibial spine fracture was induced. Screw-fixation fractures were reduced with two 4.0-mm cannulated screws and washers. Suture-fixation fractures were reduced by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament. Sutures were secured through bony tunnels over a 1-cm tibial cortical bridge. Each specimen was mounted at 30° of flexion. A cyclic loading protocol was applied to each specimen, followed by a load-to-failure test. Outcome measures were ultimate failure load, stiffness, and fixation elongation. Results: Twelve matched pediatric cadaveric knees were tested. Repair groups had identical mean (8.3 years) and median (8.5 years) ages and an identical number of samples of each laterality. Ultimate failure load did not significantly differ between screw (mean ± SD, 143.52 ± 41.9 7 N) and suture (135.35 ± 47.94 N) fixations (P = .760). Screws demonstrated increased stiffness and decreased elongation, although neither result was statistically significant at the .05 level (21.79 vs 13.83 N/mm and 5.02 vs 8.46 mm; P = .076 and P = .069, respectively). Conclusion: Screw fixation and suture fixation of tibial spine fractures in human pediatric tissue were biomechanically comparable. Clinical Relevance: Suture fixations are not biomechanically superior to screw fixations in pediatric bone. Pediatric bone fails at lower loads, and in different modes, compared with adult cadaveric bone and porcine bone. Further investigation into optimal repair is warranted, including techniques that may reduce suture pullout and “cheese-wiring” through softer pediatric bone. This study provides new biomechanical data regarding the properties of different fixation types in pediatric tibial spine fractures to inform clinical management of these injuries.

Arthroscopic Remnant Preserving 3-Portal Posterior Cruciate Ligament Reconstruction With Reverse Passage of the Graft

The posterior cruciate ligament (PCL) is the largest and strongest ligament of the knee, with a tremendous role as the primary posterior stabilizer of the knee. Surgical management of PCL injuries is very demanding, due to the fact that the PCL tear usually is a part of multiligamentous knee injury. Moreover, PCL anatomy, especially its course and attachment points to femur and tibia, makes reconstruction of the PCL technically challenging. The main pitfall is the sharp angle between created during reconstruction surgery bony tunnels, which forms so called “killer turn”. The authors present a technique of the remnant-preserving PCL arthroscopic reconstruction that simplifies the procedure and uses the method of reverse passage of the PCL graft to overcome the killer turn.

Clinical and radiological outcome of arthroscopic Bankart repair in traumatic anterior glenohumeral instability with all-suture anchors

Background: Arthroscopic Bankart repair has evolved as an excellent treatment option in the management of recurrent shoulder instability as includes minimally invasive approach and significant reduction in perioperative morbidity. Anchor-related complications such as secondary cartilage damage and proud implant position are well described in literature. An all-suture anchor was developed and approved by the Food and Drug Administration in 2010. These anchors are placed into 1.4 mm diameter drilled holes which are smaller than the drill holes used for previously available anchor therefore minimize invasiveness and avoid complication related to metallic and bioabsorbable anchors. Aims and Objectives: This study to assess early radiological and clinical outcome after labral repair using all-suture anchors with specific consideration for bony reactions at the anchor site on magnetic resonance imaging. Materials and Methods: Twenty patients underwent labral repair using all-suture anchors were followed up for minimum of 1 year. Functional outcome was assessed on the basis of Rowe score, Constant and Murley score, and the American Shoulder and Elbow Surgeons score. The radiological appearance of bony reaction around the anchor site was judged by the presence of bony edema, tunnel widening (>3 mm), and cyst formation. Results: A total number of 56 all-suture anchors were implanted in 10 patients. The total Rowe score significantly improved from a mean of 24.4 preoperatively to 92.5 postoperatively. The American Shoulder and Elbow Surgeons score improved from a mean of 47.1 preoperatively to 88.6 postoperatively and the Constant and Murley score improved from a mean of 57.3 preoperatively to 90.6 postoperatively. On post-operative MRI out of 56 anchors implanted, 35 anchors did not display any reactive bone changes around anchor site. In 17 anchors, bone edema around a suture anchor was seen. Tunnel widening >3 mm was seen in four anchors. None of the anchors showed cyst formation around anchor site. Conclusion: Clinicoradiological outcome after arthroscopic shoulder instability using all-suture anchors was excellent at 1 year follow-up and radiological imaging revealed a good labral healing.

Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique

Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is implanted, which should obviate the risk for subsequent bony failure through a fracture, nor require subsequent hardware removal. In addition, the combination of suspensory and allograft fixation should impart sufficient stability to maintain an adequate reduction even in the face of failure of one of the fixation methods.

The anterior talofibular ligament: A thin-slice three-dimensional magnetic resonance imaging study

PurposeThe aim of this study was to provide an accurate and improved understanding of anterior talofibular ligament (ATFL) anatomy, and to determine the exact positioning and diameter of the bony tunnel during ATFL repair and/or reconstruction surgery. MethodA total of 58 healthy asymptomatic volunteers were examined, wherein 38 underwent bilateral ankle 3D MRI, and 20 underwent unilateral ankle 3D MRI (10 left and 10 right ankles). Data from a total of 96 MRI datasets were collected. The MRI data from these cases were exported into Mimics to enable reconstruction of 3D ATFL models. The resulting image quality was evaluated using a 5-point subjective scoring system. In addition, the length, width, thickness, and positioning of each ATFL and the area of the ATFL footprints were identified within the 3D model using Mimics and SolidWorks. ResultsThe image quality score was 4.48 ± 0.50. The ATFL formed one (65.6%), two (31.3%), or three (3.1%) bundles forms. The footprint area was 31.25 ± 6.29 mm2 on the fibular side, and 17.48 ± 4.49 mm2 on the talar side. ConclusionThin-slice 3D MRI aids in the reconstruction of the 3D ATFL model, and it provides reference for the accurate anatomy of the area and location of the ATFL. This technology will facilitate diagnosis of ATFL injuries and choice of surgical methods. Level of Evidencelevel IV.

Analyse des facteurs anatomiques associés au syndrome du tunnel ulnaire

BackgroundPrevious studies demonstrated that soft tissues, such as retinaculum, fibrous band, and anconeus, cause ulnar nerve compression, whereas other studies showed that the bony structures strain the ulnar nerve that runs directly behind the medial epicondyle constituting the boundary of the cubital tunnel during elbow flexion. However, no studies have reported the association of the shape of the bony structure with cubital tunnel syndrome symptoms. Are computed tomography (CT) and magnetic resonance imaging (MRI)-measured parameters of the bony cubital tunnel related to idiopathic cubital tunnel syndrome symptoms? HypothesisWe hypothesized that CT and MRI-measured parameters of the bony cubital tunnel were related to idiopathic cubital tunnel syndrome symptoms. We aimed to investigate the relationship between the radiographic parameters based on CT and MRI and idiopathic cubital tunnel syndrome symptoms. Patients and methodsWe analyzed 224 elbows (77 affected elbows of patients with idiopathic cubital tunnel syndrome, 77 unaffected elbows of patients with cubital tunnel syndrome, 70 elbows of patients without cubital tunnel syndrome symptoms) using CT and MRI. Cubital tunnel cross-sectional area, cubital tunnel volume, and ulnar nerve cross-sectional area were measured in the three groups at flexion and extension. A new cubital tunnel center with a new boundary was proposed that could play a role in ulnar nerve compression symptoms. ResultsThe cross-sectional areas and volumes of the cubital tunnel measured in the elbow flexion state were the smallest among the group with the affected elbows in patients. There was no difference between unaffected elbows and the non-patient group. The cross-sectional area of the ulnar nerve highly correlated with cubital tunnel symptoms in the flexion state. DiscussionThe shape of the cubital tunnel is an important factor in cubital tunnel syndrome, and normal variations in the volume and cross-sectional area of the cubital tunnel and ulnar nerve could influence the occurrence of idiopathic cubital tunnel syndrome. Level of evidenceIII, Therapeutic study.

Implant-Free, Transtibial, Bone Bridge Fixation for Knee Surgery Including Tibial Spine and Meniscal Root Fixation

Fixation over bone bridge is commonly performed during transosseous pullout knee surgeries. This technique requires the drilling of 2 bony tunnels separately. Herein, we describe our technique in which bone bridge fixation is performed with a single bony tunnel. Our technique is described in 4 simple steps. Step 1: A short accessory tunnel is created from a point at least 1 cm away from the aperture of primary bone tunnel and opening into the lumen of the primary tunnel. Step 2: A shuttle suture (PROLENE) loop is passed from the accessory tunnel to the primary tunnel, and the loop is retrieved out of the primary tunnel using an 18-G epidural needle and arthroscopy probe. Step 3: Complimentary limbs of the pullout suture is then shuttled through the accessory tunnel using shuttle suture loop. Step 4: The knots are tied over the intervening bone bridge. Since the sutures are tied over the bone bridge, it has to be strong enough to provide support. This method of fixation is contraindicated when there is severe osteoporosis or if the tunnels are located in metaphysis. A supplemental video demonstration of the technique is included with this article.

A new mini-open technique of arthroscopically assisted Latarjet

BackgroundThe aim is to describe a new arthroscopically assisted Latarjet technique.MethodsWe evaluated the clinical and radiological findings of 60 patients with chronic recurrent anterior gleno-humeral instability who underwent, between September 2013 and November 2014, an arthroscopically-assisted Latarjet procedure with double round endobutton fixation. Inclusion criteria were: chronic anterior recurrent instability, Instability Severity Index Score (ISIS) greater than three points, a glenoid bone defect > 15% or a Hill Sachs lesion with concomitant glenoid bone defect > 10%. During surgery the joint capsule and the anterior glenoid labrum were detached. Two drill tunnels perpendicular to the neck of the glenoid were made through a guide. An accessible pilot hole through the glenoid was created to allows the passage of guidewires for coracoid guidance and final fixation onto the anterior glenoid. Through a restricted deltopectoral access a coracoid osteotomy was made. Finally, the graft was prepared, inserted and secured using half-stitches.ResultsThe mean follow-up was 32.5 months (range 24–32 months). At a mean follow-up, 56 of the 60 subjects claimed a stable shoulder without postoperative complaints, two (3.3%) had an anterior dislocation after new traumatic injury, and two (3.3%) complained of subjective instability. At the latest follow-up, four subjects complained of painful recurrent anterior instability during abduction-external rotation with apprehension. At 1 year, the graft had migrated in one patient (1.7%) and judged not healed and high positioned in another patient (1.7%). Moreover, a glenoid bony gain of 26.3% was recorded. At the latest follow-up, three patients had grade 1 according to Samilson and Prieto classification asymptomatic degenerative changes. Nerve injuries and infections were not detected. None of the 60 patients underwent revision surgery. Healing rate of the graft was 96.7%.ConclusionsThis technique of arthroscopically assisted Latarjet combines mini-open and arthroscopic approach for improving the precision of the bony tunnels in the glenoid and coracoid placement, minimizing any potential risk of neurologic complications. It can be an option in subjects with anterior gleno-humeral instability and glenoid bone defect. Further studies should be performed to confirm our preliminary results.Trial registrationTrial registration number 61/int/2017Name of registry: ORSDate of registration 11.5.2017Date of enrolment of the first participant to the trial: September 2013 ‘retrospectively registered’Level of evidenceIV

Analysis of the Anatomical Factors Associated with Cubital Tunnel Syndrome

BackgroundPrevious studies demonstrated that soft tissues, such as retinaculum, fibrous band, and anconeus, cause ulnar nerve compression, whereas other studies showed that the bony structures strain the ulnar nerve that runs directly behind the medial epicondyle constituting the boundary of the cubital tunnel during elbow flexion. However, no studies have reported the association of the shape of the bony structure with cubital tunnel syndrome symptoms. Are computed tomography (CT) and magnetic resonance imaging (MRI)-measured parameters of the bony cubital tunnel related to idiopathic cubital tunnel syndrome symptoms? HypothesisWe hypothesized that CT and MRI-measured parameters of the bony cubital tunnel were related to idiopathic cubital tunnel syndrome symptoms. We aimed to investigate the relationship between the radiographic parameters based on CT and MRI and idiopathic cubital tunnel syndrome symptoms. Patients and methodsWe analyzed 224 elbows (77 affected elbows of patients with idiopathic cubital tunnel syndrome, 77 unaffected elbows of patients with cubital tunnel syndrome, 70 elbows of patients without cubital tunnel syndrome symptoms) using CT and MRI. Cubital tunnel cross-sectional area, cubital tunnel volume, and ulnar nerve cross-sectional area were measured in the three groups at flexion and extension. A new cubital tunnel center with a new boundary was proposed that could play a role in ulnar nerve compression symptoms. ResultsThe cross-sectional areas and volumes of the cubital tunnel measured in the elbow flexion state were the smallest among the group with the affected elbows in patients. There was no difference between unaffected elbows and the non-patient group. The cross-sectional area of the ulnar nerve highly correlated with cubital tunnel symptoms in the flexion state. DiscussionThe shape of the cubital tunnel is an important factor in cubital tunnel syndrome, and normal variations in the volume and cross-sectional area of the cubital tunnel and ulnar nerve could influence the occurrence of idiopathic cubital tunnel syndrome. Level of evidenceIII, Therapeutic study.

Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft.

Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature. The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times. At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3mm. One persistent distal hypoesthesia at 2-year follow-up was observed. The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed. Retrospective case series, level IV.

Validity of computed tomographic measurements and morphological comparison of cubital tunnel in idiopathic cubital tunnel syndrome

BackgroundUlnar neuropathy is a common reason for referral to hand surgeons, and 10 to 30% of cubital tunnel syndrome (CuTS) is idiopathic. We hypothesized that the cause of idiopathic CuTS is in the bony structure.MethodsWe analyzed 79 elbows (39 idiopathic CuTS and 40 without CuTS symptom) using computed tomography and Materialize Mimics software to compare the differences between the two groups. We proposed a new bony cubital tunnel with a new boundary that could play a role in ulnar nerve compression symptom.ResultsThe mean cubital tunnel volume was 1245.6 mm3 in all patients, 1180.6 mm3 in CuTS patients, and 1282.3 mm3 in the control group. A significant difference (p = 0.015) between two groups was found. Bony cubital tunnel cross-sectional area, cubital tunnel depth, and cubital tunnel angle also showed significant differences.ConclusionThe shape of the bony cubital tunnel is an important cause of CuTS, and the normal variation of the volume and cross-sectional area of the cubital tunnel and cubital tunnel angle could influence the occurrence of idiopathic CuTS.

Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. Systematic review. This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21years. Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.

Modified arthroscopic remplissage for Hill-Sachs lesions with high-strength sutures

The aim is to present amodified arthroscopic remplissage for shoulder Hill-Sachs lesions with high-strength sutures instead of suture anchors, to achieve better tendon-bone healing and avoid failure of remplissage due to anchor detachment. A total of seven patients with recurrent anterior shoulder dislocation combined with a Hill-Sachs lesion were included in this study. Firstly, anteroinferior glenoid labrum complex damage was treated then 2-3bone tunnels were punched with asighting device from the bony defect of the humeral head to the inside of lesser tubercles of the humerus. The bony defect was filled by stitching the infraspinatus tendon through the bony tunnels with high-strength sutures. After the operation, the filling and healing of the infraspinatus tendon in the Hill-Sachs lesion were assessed using magnetic resonance imaging (MRI). Patients were followed up for 12months. The results of MRI showed that all of the filled tendons healed well. Postoperative external rotation of the shoulder joint increased on average from 67° to 87°. Compared with the preoperative level, the Oxford Shoulder Instability Score (OSIS) was 18.50 ± 1.04 points higher and the Rowe score was increased by 66.755 ± 0.914 points. Arthroscopic remplissage of ashoulder Hill-Sachs lesion with high-strength sutures carries the benefits of secure fixing and good tendon-bone healing without the risk of anchor detachment.

Biocompatibility and Osteogenic Capacity of Mg-Zn-Ca Bulk Metallic Glass for Rabbit Tendon-Bone Interference Fixation.

Mg-based alloys have great potential for development into fixation implants because of their highly biocompatible and biodegradable metallic properties. In this study, we sought to determine the biocompatibility of Mg60Zn35Ca5 bulk metallic glass composite (BMGC) with fabricated implants in a rabbit tendon–bone interference fixation model. We investigated the cellular cytotoxicity of Mg60Zn35Ca5 BMGC toward rabbit osteoblasts and compared it with conventional titanium alloy (Ti6Al4V) and polylactic acid (PLA). The results show that Mg60Zn35Ca5 BMGC may be classed as slightly toxic on the basis of the standard ISO 10993-5. We further characterized the osteogenic effect of the Mg60Zn35Ca5 BMGC extraction medium on rabbit osteoblasts by quantifying extracellular calcium and mineral deposition, as well as cellular alkaline phosphatase activity. The results of these tests were found to be promising. The chemotactic effect of the Mg60Zn35Ca5 BMGC extraction medium on rabbit osteoblasts was demonstrated through a transwell migration assay. For the in vivo section of this study, a rabbit tendon–bone interference fixation model was established to determine the biocompatibility and osteogenic potential of Mg60Zn35Ca5 BMGC in a created bony tunnel for a period of up to 24 weeks. The results show that Mg60Zn35Ca5 BMGC induced considerable new bone formation at the implant site in comparison with conventional titanium alloy after 24 weeks of implantation. In conclusion, this study revealed that Mg60Zn35Ca5 BMGC demonstrated adequate biocompatibility and exhibited significant osteogenic potential both in vitro and in vivo. These advantages may be clinically beneficial to the development of Mg60Zn35Ca5 BMGC implants for future applications.

Long head of biceps tenodesis ; indications and techniques : systematic review

The long head of the biceps (LHB) tendon is often implicated in various shoulder pathologies because of its anatomic course and its close relation to the rotator cuff and the superior labrum of the glenoid. Nonoperative treatment continues to have a role for patients who have mild symptoms with tendinopathy or partial tears of the biceps tendon. Surgical treatment is considered for patients with partial tears of the biceps tendon, biceps pulley lesions and SLAP lesions. The choice of treatment whether repair, tenotomy or biceps tenodesis remains controversial. Biceps tenodesis is the preferred technique to manage LHB lesions especially in younger patients, laborers, athletes and patients who want to avoid a cosmetic deformity. This systematic review suggested that the most commonly used and studied indications for LHB tenodesis were LHB tearing, LHB instability, and LHB tenosynovitis. Biceps tenodesis can be performed by arthroscopic or open techniques, using either soft tissue or bony fixation, and the fixation devices varies from screws to anchors to buttons to just bony tunnels with no hardware. According to our review, both arthroscopic and open biceps tenodesis showed similar pain relief and clinical outcomes and either of these methods may be recommended for patients with disorders of the biceps tendon and there is no consensus about the best fixation technique.

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

Osteoarthritis of the thumb carpometacarpal joint is common, especially in postmenopausal women. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been introduced. Suspensionplasty combined with trapeziectomy has been introduced to prevent proximal subsidence of the first metacarpal. To prevent excessive release of periarticular capsuloligamentous tissues, resection of the proximal part of the trapezium, and the cosmetically unappealing bump, arthroscopic partial trapeziectomy has been used as a less-invasive treatment option. With advanced techniques and devices, arthroscopic suspensionplasty with the autograft can be performed; thus far, there have been no series reporting on arthroscopic treatment options for this common condition. The purpose of this article is to present a technique for arthroscopic-assisted suspensionplasty using the palmaris longus tendon to reinforce the graft–bone interface, based on the concept of the tension slide technique to treat thumb carpometacarpal osteoarthritis.