Capsule Repair Research Articles

Biomechanical tensile test for capsule repair comparing suturing methods including interrupted, continuous, and barbed sutures

BackgroundCapsule repair plays an important role in total joint arthroplasty. However, no biomechanical studies have indicated the optimal suturing methods and materials in capsule repair. This study aimed to evaluate the effectiveness of the suturing methods (interrupted and continuous sutures) and materials (Vicryl and Stratafix) for capsule repair using porcine skin specimens. MethodsThree groups with eight porcine skin specimens were used as a surrogate for human capsules. The VI group with 1-Vicryl interrupted sutures, VC group with 1-Vicryl continuous sutures, and S group with 1-Stratafix continuous sutures were analyzed by tensile test to investigate the maximum failure load. Eight pieces of 1-Viclyl and nine pieces of 1-Stratafix were used to analyze the suture material's strength. Corrected maximum failure load was calculated by taking the ratio of the mean maximum tensile strengths of Vicryl and Stratafix sutures. FindingsThe maximum failure loads were 275.52 ± 62.45 N, 465.81 ± 57.91 N, and 303.08 ± 37.16 N in VI, VC, and S groups, respectively. Regarding the suture material's strength, 1-Vicryl showed significantly higher maximum failure load than 1-Stratafix (47.37 ± 4.58 N vs 35.62 ± 4.35 N). When normalizing the influence of different suture materials on tensile strength, the corrected maximum failure load was 207.17 ± 46.96 N in VI group and 350.27 ± 43.55 N in VC group. InterpretationOur findings showed that Stratafix, barbed continuous suture, could be an alternative option to conventional Vicryl suture for capsule repair.

Using an Intraoperative Stress Exam to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.

To examine the results of a treatment algorithm incorporating an EUA performed intraoperatively after fixation of the femoral head through a Smith Petersen approach to determine need for posterior wall or capsule repair. Design: Retrospective review. Two Level 1 trauma centers. All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017-2022. Injuries were classified according to the Pipkin system. The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty. Studied were 63 males and 22 females with mean age 32.5 (range 18-71). 79 of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included 7 patients with wall involvement >20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow up, 16 of 65 (26.4%) developed radiographic evidence of AVN and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to total hip arthroplasty over the study period. When comparing patients with a single exposure with those with additional KL exposure, they did not vary in their rate of AVN (27.1% vs. 0.0%, P=0.3228), HO formation (30.5% vs. 50.0%, P=0.3788), or conversion to total hip arthroplasty (10.2% vs. 16.7%, P=0.510). This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA accurately identifies residual instability. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study.

This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence. A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors. Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05). Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.

Progressive Loss of Acromioclavicular Joint Reduction Correlated with Progressive Clavicular Tunnel Widening after Coracoclavicular Stabilization in Acute High-Grade Acromioclavicular Joint Injury.

Objectives: This study aimed to compare 24-month radiographic follow-ups of clavicular tunnel widenings (CTWs) and coracoclavicular distances (CCDs) and examine correlations between these measurements in patients following combined coracoclavicular stabilization and acromioclavicular capsule repair in treatment of acute high-grade acromioclavicular joint injury. Methods: This retrospective study reviewed the records of patients with acute Rockwood type V acromioclavicular joint injury who underwent surgery within 3 weeks after their injury. All patients had follow-ups at 3 and 6 months and 1 and 2 years. The CTWs were measured on anteroposterior radiographs between the medial and lateral borders at the superior, middle and inferior levels of the tunnels. On anteroposterior radiographs of both clavicles, the CCDs were measured at the shortest distance between the upper border of the coracoid process and the inferior border of the clavicle and reported as the CCD ratio, which was defined as the ratio of the affected and unaffected clavicles. At the final follow-ups, clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) scores. Results: This study included seventeen men and six women with a mean age of 47.26 ± 10.68 years. At the final follow-ups, the mean ASES score of all patients was 95.28 ± 3.62. We found a significant correlation between the increase in the CTWs and the increase in the CCD ratios (Spearman's rho correlation coefficient range 0.578-0.647, all p-values < 0.001). Conclusions: We found long-term postoperative widening of the clavicular tunnels, which correlated positively with a gradual postoperative decline in the acromioclavicular joint alignment reductions.

Long-term Survivorship and Outcomes of Patients Without Dysplasia Undergoing Capsular Repair During Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: There is a paucity of literature evaluating long-term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS). Purpose: To report 10-year survivorship and patient-reported outcomes (PROs) after primary hip arthroscopy with capsular repair for FAIS and evaluate the effect of capsular repair in patients at the highest risk for conversion to arthroplasty. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with a minimum 10-year follow-up on the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale for pain (VAS) scores were selected. The preoperative and minimum 10-year follow-up Hip Outcome Score—Sports Specific Subscale (HOS-SSS) scores were also reported, if available. Patients with ipsilateral hip surgery, worker’s compensation, Tönnis osteoarthritis grade >1, and hip dysplasia (lateral center-edge angle <25°) were excluded. Survivorship, PROS, and clinical benefit—minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS)—were reported. An additional propensity-matched subanalysis was performed on patients at the highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair to patients with unrepaired capsules. Results: A total of 145 (n = 130 patients) out of 180 eligible hips (n = 165 patients) had a minimum 10-year follow-up (80.6%). Also, 126 hips (86.9%) belonged to women, and 19 hips (13.1%) belonged to men. The mean patient age was 30.3 ± 12.9 years. The survivorship rate was 91% at the 10-year follow-up. The cohort experienced significant improvements (P < .001) in the mHHS, NAHS, HOS-SSS, and VAS for pain scores. Moreover, the cohort achieved high rates of the PASS for the mHHS (89.8%), high rates of the MCID for the mHHS (82.4%), and high rates of the MCID for VAS for pain (80.6%) scores. In the propensity-matched subanalysis performed on patients with the highest risk for arthroplasty, 29 hips with capsular repair were matched to 81 hips with unrepaired capsules. While both groups experienced significant improvements in all PROs (P < .05), the group without capsule repair trended toward a higher conversion to arthroplasty rate when compared with the repair group. In addition, an odds ratio was calculated for the likelihood of converting to arthroplasty after having an unrepaired capsule compared with capsular repair (2.54 [95% CI, 0.873-7.37]; P = .087). Conclusion: Patients undergoing primary hip arthroscopy with capsular repair experienced a high survivorship rate of 91% at a minimum 10-year follow-up. Patients who did not convert to arthroplasty saw favorable improvements in PROs and achieved high clinical benefit rates. In addition, among those patients at the highest risk for conversion to arthroplasty, a trend toward greater survivorship was observed with capsular repair.

The use of arthroscopy in diagnosing and treating sports-related cartilage lesions

Background: Sports-related cartilage lesions pose challenges for athletes. Cartilage, vital for smooth joint movement, can be damaged. Arthroscopy, a minimally invasive procedure, allows precise diagnosis and treatment of joint issues, offering quicker recovery and minimal scarring, enhancing orthopedic interventions. This study aimed to assess the use of arthroscopy in diagnosing and treating sports-related cartilage lesions. Methods: This prospective observational study was conducted at the department of orthopaedics and traumatology, Life Line Hospital Moulovibazar, Mount Adora Hospital Sylhet, MAG Osmani Medical College Hospital Sylhet, Bangladesh from January 2022 to December 2023. As the study subjects, a total of 58 patients with non-surgically treated acute or chronic sports-related cartilage lesions were enrolled by using a purposive sampling technique. After 6 months, a follow-up report was recorded. Data were analyzed by using Microsoft Office tools. Results: In this study, 72% of participants underwent cuff repair, with the remaining 28% opting for loop repair. The arthroscopic assessment revealed anterior medial cartilage lesions in 34% and anterior lateral lesions in 28%. Posterior medial, posterior lateral, and mid-talus dome cartilage lesions were observed in 17%, 5%, and 16%, respectively. Capsule repair was employed in 86% of cases. Significant improvement in hip range of motion, as well as radiological parameters like lateral center-edge angle, alpha angle (anteroposterior), and alpha angle (Dunn), was observed 6 months postoperatively (p&lt;0.001). Conclusions: In detecting and treating sports-related cartilage lesions, arthroscopy is an effective method. This minimally invasive less painful treatment approach contributes to faster rehabilitation and a quicker return to normal activities.

Hip Capsular Repair Affect on Joint Laxity in Total Hip Arthroplasty

Purpose: Loss of tissue tension around the hip is a cause of hip dislocation. The shuck test is a simple intraoperative test for soft tissue tension. This study evaluated the soft tissue tightness around the hip joint after capsule repair and compared the joint tension resulting from different capsule repair approaches. Methods: Fifty-three patients underwent a non-cemented total hip replacement using image-free computer-assisted surgery. The patients were divided into the posterior and the anterolateral approach groups. After the hip was reduce, a computer navigation plan was devise to restore proper leg length. The shuck test was applied to determine the soft tissue tension before and after capsule repair. The leg length was recorded after hip reduction and the shuck test. Data from the computer navigation were collected for analysis. Results The results of this study showed that after the shuck test, the leg length increased by up to 5.98±1.75 mm. (6.73±1.64 mm. and 5.26±1.56 mm for the posterior and anterolateral approach, respectively). After capsule repaire, the leg was shortened by 4.78±1.31 mm. (5.42±1.10 mm. and 4.15±1.20 mm for posterior and anterolateral approach, respectively). The study found that the leg shortening from the posterior approach was significantly higher than the anterolateral approach (p-value &lt;0.001). There were no hip dislocations in this series. Conclusions: Hip capsule repair improves the soft tissue tension around the hip joint. This helps reduce the risk of hip dislocation. Hip capsule repair using a posterior approach has a better outcome.

Thumb Carpometacarpal Stabilization With a Dorsal Capsule Repair Augmented With an Internal Brace.

Optimal surgical treatment of first carpometacarpal joint instability remains a subject of debate. Consensus on thumb carpometacarpal stability originating with the dorsoradial ligamentous complex has shifted reconstruction techniques towards stabilization dorsally. We describe a dorsal stabilization technique with internal brace augmentation of the dorsoradial ligamentous complex. A single fellowship-trained hand surgeon treated 10 women, average age 34 years (range, 21 to 52y) and 1 man, age 34 years, between 2019 and 2022. Average patient follow-up was 2 years. Patient satisfaction was high. Further trials are needed to determine whether the procedure will prevent or delay the presentation of thumb carpometacarpal arthrosis.

The Examination of the Benefits of the Usage of Barbed, Knotless Suture in Capsule Repair During Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study.

In today's world, high-cost procedures are being examined, and alternative procedures are being developed. In this context, one frequently examined procedure is total knee replacement. This study aims to examine the three different closure techniques used in total knee replacement. This study is a prospective randomized controlled study. Two hundred participants who underwent total knee replacement surgery, were included in the study. Participants were randomly divided into three groups. Arthrotomy was performed using a medial parapatellar approach with a midline incision. Standard femoral and tibial cuts were followed by the implantation of a Smith and Nephew genesis II implant for all participants. Complications, joint range of motion, pain scores, certain movement degrees, and functional scores were investigated. Pre-op and post-op range of motion, knee society score, oxford knee score, certain movement degree values have shown no significant difference. Visual analogue scale values were different significantly between the groups. There is a statistical difference between the range of motion, knee society score, oxford knee score, certain movement degree and visual analogue scale values in repeated measurements. The most common complication was a hematoma. This was observed most frequently in the continuous vicryl suture group. The closure time in the Barbed group was significantly lower than in the other groups. Treatment for total knee replacement is a heavy economic burden. Health systems and hospitals are under pressure. The results obtained in our study show that there is no superiority of one closure technique over the other.

Effects of anterior capsule repair during total hip arthroplasty using the anterolateral approach in the supine position

PurposeSoft-tissue tension is an important factor for preventing dislocations after total hip arthroplasty. The purpose of this study was to evaluate the effects of anterior capsule repair for preventing dislocation during primary total hip arthroplasty using the anterolateral approach in the supine position (ALS). MethodsThis study retrospectively compared the clinical and radiographic outcomes between patients who underwent total hip arthroplasty via the ALS with or without anterior capsule repair at our institute. The cup (radiographic inclination and radiographic anteversion) and stem alignment, operative time, clinical score, and complication were evaluated. ResultsAmong the 393 hips evaluated, 193 and 200 belonged to the resection and repair groups, respectively. There were significant differences in the inclination and anteversion of the cup and flexion insertion of the stem (42.3° vs. 40.3°, 15.8° vs. 19.8°, and 27.5% vs. 34.0%, respectively). No significant differences in operative time and postoperative Japanese Orthopedic Association hip score were noted. Early dislocation was more common in the resection group compared to the repair group (2 hips vs. 0 hip, respectively), albeit not significantly (1.03% vs. 0%, p ​= ​0.241). ConclusionOur results demonstrated that the clinical benefit of the anterior capsule repair for preventing dislocation was limited in ALS.

Paper 03: The Anterior Labral Circumferential Onlay Technique (ALCOT) serves to reconstruct the anterior labrum and biomechanically restores anterior glenohumeral joint stability

Objectives: The standard of care for treating anterior shoulder instability caused by a labral detachment is the Bankart repair. In the case of a deficient labrum with significant antero-inferior glenoid bone loss, the latarjet technique can be used instead. However, when the labrum is deficient and the bone loss is minimal, labral reconstruction has been recently proposed as an alternative. A new technique called Anterior Labral Circumferential Onlay Technique (ALCOT) was developed, which reconstructs the labrum using the long head of the biceps tendon. The purpose of this study was to biomechanically evaluate the efficacy of the ALCOT to stabilize the shoulder joint against anterior dislocation in the setting of a deficient labrum with no glenoid bone loss. Methods: Ten fresh-frozen cadaveric shoulders were tested in 5 consecutive states using a 6-degrees-of-freedom robotic arm: (1) Native, (2) Capsular Repair, (3) Labral Tear (4) ALCOT (5) Latarjet. The capsule repair state used as a control because the joint capsule needed to be opened and repaired to perform the other states. This state ensured that any differences were due to the surgical procedure being tested, and not because of any iatrogenic damage to the capsule. The Labral Tear was performed by detaching the labrum from the glenoid between 3-6 o’clock and removing it from the joint. For the ALCOT, the biceps tendon was shortened at the distal portion and pulled into the joint. Three knotless all suture anchors were placed at 3, 4:30 and 6 o’clock position on the glenoid rim, and the biceps tendon was secured to the suture anchors using mattress stitches. For the latarjet, a coracoid autograft was cut 25 mm from the tip, keeping the conjoint tendons intact, and secured to the glenoid using two screws. In the native state, each specimen underwent an initial test to determine the appropriate amount of anterior and inferior displacement for future tests. In this test, a 50N compressive load was maintained while an 80N force was applied in the sagittal plane at a 45° angle between the anterior and inferior axes. The corresponding anterior and inferior displacements were recorded. Then, in each state including native, a dislocation test was performed. In this test, a 50N compressive load was maintained while the joint was driven in position control to the previously recorded positions on the anterior and inferior axes. The amount of force needed to displace the shoulder and the lateral displacement of the humeral head were recorded throughout the motion. Higher lateral translation was considered more stable, because it corresponded to a larger obstacle to overcome during the dislocation. To account for variation in the amount of compressive load during the test, antero-inferior dislocation load was normalized by compressive load to create a force ratio. This metric accounts for the fact that the amount of force required to dislocate depends on the amount of stabilizing compressive load provided by the robot in vitro, and by muscle tension in vivo. Results: No significant differences were found between the native and capsular repair states. Compared to native, the labral tear significantly decreased the lateral translation of the humeral head during dislocation from 6.5mm to 5.4mm (p&lt;0.001) and decreased the force ratio from 1.8 to 1.1 (p=0.002), corresponding to a decrease from 90N to 55N at 50N of compressive load. The ALCOT restored these values to 6.4 mm and 1.4, respectively, showing no significant difference from native. The latarjet restored the force ratio to 1.3 (not significant from native) but failed to restore lateral translation with a value of 5.6 mm (p=0.003 from Native, not significantly different from the labral tear). The force ratio is shown on figure 1 and the lateral translation is shown on figure 2. Conclusions: The ALCOT is a novel technique for labral reconstruction that can be considered as a treatment option for anterior instability in the setting of a deficient labrum. Compared to the latarjet technique, the ALCOT involves less morbidity and represents a more anatomic glenoid surface by replacing the labrum without changing the bony morphology. In this study, the ALCOT also showed superior stabilization by restoring native force ratio and lateral humerus translation. Further research is necessary to clinically validate this technique, and possibly to expand indications to small degrees of glenoid bone loss. [Table: see text]

Anterior capsulectomy versus repair in direct anterior total hip arthroplasty.

Utilization of the direct anterior approach for total hip arthroplasty (DAA THA) has increased over the last ten years. The preservation and repair of the anterior hip capsule has been recommended, while anterior capsulectomy has been described by others. In contrast, the higher risk of posterior dislocation using the posterior approach improved significantly after capsular repair. No studies to date have investigated outcome scores based on capsular repair versus capsulectomy for the DAA. Patients randomized to anterior capsulectomy or anterior capsule repair. Patients were blinded to their randomization. Maximum hip flexion was measured both radiographically and clinically with a goniometer. Using a one-sided t test assuming equal variance with an effect size, Cohen's d, of 0.6 and an alpha of 0.05, 36 patients in each group (total 72 patients) needed for a minimum 80% power. Median goniometer measurements preoperatively were 95° for repair (IQR 85-100) and 91° for capsulectomy (IQR 82-97.5) (p = 0.52). Four-month and one-year goniometer measurements also had no significant difference, 110° (IQR 105-120) and 110° (IQR 105-120) for repair and 105° (IQR 96-116) and 109° (IQR 102-120) for capsulectomy (p = 0.38 and p = 0.26). Median change in flexion as measured by goniometer at 4months and one year was 12 and 9 degrees for repair and 9.5 and 3 degrees for capsulectomy (p = 0.53 and p = 0.46). X-ray analysis showed no differences in pre-op, 4-month, and one-year flexion with median one-year flexion of 105.5° (IQR 96-109.5) for repair and 100° (IQR 93.5-112) for capsulectomy (p = 0.35). VAS scores were the same for both groups at all three time points. HOOSscores improved equally for both groups. There are no differences in surgeon randomization, age, or gender. Both capsular repair and capsulectomy used in direct anterior approach THA result in equal maximum clinical as well as radiographic hip flexion with no change in postoperative pain or HOOSscores.

Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation.

This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. The external rotation in arm adduction at 3 and 6months after surgery showedsignificantly better results in group I than group II(p = 0.002 at 3months; p = 0.005 at 6months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3months (p = 0.001) and 6months (p = 0.001) after surgery. However, external rotation with arm adduction at 12months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1year after surgery did not show a clinically relevant difference difference between the two groups. Level III.

Does capsular repair make a difference in the integrity and thickness of anterior capsule in the setting of borderline hip dysplasia

BackgroundHip joint capsular ligaments serve a fundamental role in balancing functional mobility and joint stability. However, few studies had focused on postoperative capsule changes in patients with borderline developmental dysplasia of the hip (BDDH).PurposeTo evaluate the integrity and thickness of anterior hip capsular thickness on pre and postoperative MRI in BDDH patients.Study designCase series study; Level of evidence III.MethodsA retrospective analysis was performed using data from BDDH patients who had arthroscopy between 2016 and 2019. Two groups were created and propensity-score matched based on whether the capsule was sutured. The study group comprised patients who have undergone routine capsule repair between 2018 and 2019. The control group includes BDDH patients with unrepaired capsulotomy between 2016 and 2018. Capsular integrity and thickness were measured on MRI before surgery and at least one year postoperatively. Furthermore, analysis was performed on correlations between the presence of a capsular defect and related factors.ResultsPropensity-score matching yielded 37 hips in the repair group and 37 hips in the non-repair group. There were no significant differences detected in age, sex, and BMI between the two groups. MRI detected capsular defects in 3 hips (8.1%) in the repair group and 10 hips (27.0%) in the non-repair group (p = 0.032). The defect was found to be along the interportal capsulotomy line in all capsular defect cases. Moreover, the postoperative anterior capsule thickness in the study group was significantly thinner compared with preoperative (2.9 ± 0.5 mm vs 3.7 ± 0.6 mm; p < 0.001), and no significant difference was detected in the control group. There were no statistically significant correlations between the presence of a defect capsule and demographic characteristics such as patient age, sex, BMI, preoperative alpha angle, or lateral center–edge angle (LCEA).ConclusionThe majority (91.9%) of the repaired hip capsules in BDDH patients remained closed compared with patients without repair (73.0%). The anterior capsule was significantly thinner in the zone of capsulotomy postoperative compared with preoperative in patients with unrepaired capsules. The presence of a defective capsule does not correlate with demographic factors.

Hip arthroplasty dislocation risk calculator: evaluation of one million primary implants and twenty-five thousand dislocations with deep learning artificial intelligence in a systematic review of reviews.

This paper aims to provide an overview of the possibility regarding the artificial intelligence application in orthopaedics to predict dislocation with a calculator according to the type of implant (hemiarthroplasty, standard total hip arthroplasty, dual mobility, constrained cups) after primary arthroplasty. Among 75 results for primary arthroplasties, 26 articles were reviews on dislocation after hemiarthroplasty, 40 after standard total hip arthroplasty, seven about primary dual-mobility arthroplasty (DM THA), and two reviews about constrained implants. Although our search method for systematic reviews covers ten years (2012-2022), none for dual mobility was published before 2016, showing a recent explosion of original articles on this subject. A total of 1,069,565 implants and 26,488 dislocations in primary arthroplasties are included in these 75 reviews. We used a supervised learning model in which models assign objects to groups as input and artificial neural network (ANN) with nodes, hidden layers, and output layers. We considered only four implant types as the input layer. We considered the patient's factors (indication for THA, demographics, spine surgery, and neurologic disease) as the second input values (hidden layer). We considered the implant position as the third input (hidden layer) property including head size, combined anteversion, or spinopelvic alignment. Surgery-related factors, approach, capsule repair, etc. were the fourth input values (hidden layer). The output was a post-operative dislocation or not within three months. The accuracy for predicting dislocation with this systematic review was 95%. Dislocation risk, based on the type of implant, was wide-ranging, from 0 to 3.9% (mean 0.31%) for the 3045 DM THA, from 0.2 to 1.2% (overall 0.91%) for the 457 constrained liners, from 1.76 to 4.2% (mean 2.1%) for 895,734 conventional total hip arthroplasties, and from 0.76 to 12.2% (mean 4.5%) for 170,329 hemiarthroplasties. In the conventional THA group, many factors increase the risk of dislocation according to the calculator, and only a few (big head, anterior approach) decrease the risk, but not very significantly. In the hemiarthroplasty group, many factors can increase the risk of dislocation until 30%, but none could decrease the risk. According to the calculator, the DM THA and the constrained liner markedly decreased the risk and were not affected by implant position, spine surgery, and spinopelvic position. To our knowledge, this study is the first to yield an implant-specific dislocation risk calculator that incorporates the patient's comorbidities, the position of components, and surgery factors affecting instability risk.

Comparing the Anatomical Landmarks Versus the Coracoid-Based Landmarks Techniques for Coracoclavicular Stabilization After High-Grade Acromioclavicular Injury: A Biomechanical Study.

In acute high-grade acromioclavicular (AC) joint injuries, the aim of treatment is robust reduction and stabilization of the joint. The anatomical landmarks method is most commonly used for stabilization, but loss of reduction often occurs because of the suture tunnels. The purpose was to evaluate and compare the stability of coracoclavicular (CC) stabilization using the anatomical landmarks and coracoid-based landmarks techniques in treating a high-grade AC joint injury. It was hypothesized that stabilization using coracoid-based landmarks would provide better stability. Controlled laboratory study. Twenty fresh-frozen cadaveric shoulders (8 male and 2 female pairs) were randomized into 2 operative technique groups: 10 shoulders in the anatomical landmarks group and 10 shoulders in the coracoid-based landmarks group. The CC ligaments and AC capsule were cut at the midlevel, and CC stabilization and AC capsule repair were performed. For the anatomical landmarks technique, two 2.5-mm clavicular tunnels were created at 25 and 45 mm from the AC joint, while for the coracoid-based landmarks technique, two 2.5-mm clavicular tunnels were drilled using the medial and lateral borders of the coracoid base to choose the tunnel sites. Before injury creation and after stabilization, each shoulder underwent a loading force of 70 N in the superior and anteroposterior directions, and the displacement distance and stiffness were compared between the 2 techniques using the paired t test. The mean difference in displacement before and after stabilization was higher in the anatomical landmarks technique than the coracoid-based landmarks technique (1.82 ± 3.52 vs -0.18 ± 4.78 mm in the superior direction and 7.47 ± 9.35 vs 1.76 ± 3.91 mm in the anteroposterior direction), but none of the differences in displacement or stiffness were statistically significant between the groups. No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmarks technique and the coracoid-based landmarks technique. Either stabilization technique can be utilized for repair of the CC ligaments in an acute AC injury setting.

Pure Ankle Dislocation Without Associated Fracture: A Series of Cases and Our Clinical Experience.

Pure ankle dislocation without associated fracture is extremely rare. The current study reports eight cases of this type of injury, aiming to add some new material to the published data and present our clinical experience. Six open and two closed posteromedial tibiotalar dislocations without associated fractures treated in our department from 2015 to 2019 were retrospectively analyzed. Emergent reduction was performed for all patients followed by an average of 6weeks of immobilization with external fixators in open cases and a short leg cast in closed cases. No patients underwent ligament or capsule repair except one case. The clinical data were recorded and analyzed. At a mean follow-up of 33months (range 13-61), the average AOFAS score was 91 (range 78-100) with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed pre-injury activity level. The average range of motion (ROM) loss of the ankles was 9 degrees for plantarflexion and 3 degrees for dorsiflexion. Complications included superficial infection, moderate ankle stiffness, ankle degenerative change and residual numbness. None of the eight patients showed obvious ankle instability. Pure ankle dislocation without associated fracture is a rare injury. Emergent reduction, appropriate wound care in open injuries and proper joint stabilisation with a cast or external fixator provide good clinical results and could be the mainstay of treatment.

The Pull String Method: Optimizing Visualization for Arthroscopic Femoroplasty

Capsular management during hip arthroscopy represents an important component to access, visualization, and restoration of hip stability. In the setting of femoroacetabular impingement, the peripheral compartment represents access to the femoral neck where abnormal morphology is commonly addressed with arthroscopic femoroplasty. While various techniques have been described for peripheral compartment visualization, difficulty can arise in creating a wide display of the femoral neck while minimizing subsequent impairment of the capsule. In order to obtain an unobstructed view of the femoral neck, the hip capsule must be managed skillfully. The use of hip flexion to relax the capsule for visualization of the peripheral compartment is a nearly universal practice for hip surgeons. However, differences in management of the capsule have previously included traction sutures and further capsulotomies. In this technical note, we describe our Pull String method for peripheral compartment access using an interportal capsulotomy with strategic traction suture placement and choreography of suture tensioning. This enables full view of the femoral neck for successful femoroplasty, while still allowing for complete capsule repair to help restore stability.

Lunotriquetral Ligament Repair Using Augmented Internal Brace.

Lunotriquetral (LT) ligament tear, usually in combination with an adjacent carpal ligament injury, can result in complete LT dissociation and VISI (Volarflexed Intercalated Segment Instability). Operative techniques for the management of instability are highly variable with many described in literature, although there is little evidence to demonstrate the superiority of one definitive therapeutic technique of repair and reconstruction. In this paper, we discuss our proposed technique for performing LT ligament repair using an augmented internal brace, which addresses triquetral extension and lunate flexion. The internal brace construct also provides biomechanical superiority as it includes the augmentation of the ligament and capsule repair. We use figures and references from our case example to demonstrate this technique.

The Biomechanical Consequences of Arthroscopic Hip Capsulotomy and Repair in Positions at Risk for Dislocation.

Background:The effect of interportal (IP) capsulotomy, short T-capsulotomy, and long T-capsulotomy, and their repairs, on resistance to anterior and posterior “at risk for dislocation” positions has not been quantified.Hypotheses:Our primary hypothesis was that an IP capsulotomy would have a minimal effect on hip resistive torque compared with both short and long T-capsulotomies in the at-risk dislocation positions. Our secondary hypothesis was that capsule repair would significantly increase hip resistive torque for all capsulotomies.Study DesignControlled laboratory study.Methods:We mounted 10 cadaveric hips on a biaxial test frame in an anterior dislocation high-risk position (20° of hip extension and external rotation) and posterior dislocation high-risk position (90° of hip flexion and internal rotation). An axial force of 100 N was applied to the intact hip while the femur was internally or externally rotated at 15° per second to a torque of 5 N·m. The rotatory position at 5 N·m was recorded and set as a target for each subsequent condition. Hips were then sequentially tested with IP, short T-, and long T-capsulotomies and with corresponding repairs randomized within each condition. Peak resistive torques were compared using generalized estimating equation modeling and post hoc Bonferroni-adjusted tests.Results:For the anterior position, the IP and long T-capsulotomies demonstrated significantly lower resistive torques compared with intact. For the posterior position, both the short and long T-capsulotomies resulted in significantly lower resistive torques compared with intact. Repairs for all 3 capsulotomy types were not significantly different from the intact condition at anterior and posterior positions.Conclusion:An IP incision resulted in a decrease in capsular resistive torque in the anterior but not the posterior at-risk dislocation position, in which direction only T-capsulotomies led to a significant decrease. All capsulotomy repair conditions resulted in hip resistive torques that were similar to the intact hip in both dislocation positions.Clinical RelevanceOur results suggest that it is biomechanically advantageous to repair IP, short T-, and long T-capsulotomies, particularly for at-risk anterior dislocation positions.