Complex Tears Research Articles

Epidemiology of Injuries in National Collegiate Athletic Association Men's Tennis: 2014-2015 Through 2018-2019.

The National Collegiate Athletic Association (NCAA) has sponsored men's tennis programs since 1982. The popularity of tennis has grown, as has sponsorship of men's tennis within NCAA institutions. Continued monitoring of athletic injuries is important for identifying emerging temporal patterns. Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates. The overall injury rate was 4.41 per 1000 athlete-exposures. Lateral ligament complex tears of the ankle (8.5%) were the most reported injury. Trunk (15.1%) and shoulder (13.2%) injuries accounted for the largest proportions of all injuries. Noncontact and overuse were the most common mechanisms of injury among all reported injuries, together accounting for 69.4% of all injuries. Findings of this study differed slightly from previous studies, most notably in specific injuries reported. Continued monitoring of specific injury incidence as well as greater participation in injury surveillance is needed to inform the development of nuanced injury prevention strategies for this population.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Volleyball: 2014-2015 Through 2018-2019.

Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level. Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population. Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 athletic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates. The overall injury rate was 6.73 per 1000 athlete-exposures. Knee (14.6%) and ankle (13.8%) injuries accounted for the largest proportion of all reported injuries, and most injuries were attributed to overuse (26.1%) or noncontact (22.7%) mechanisms. Lateral ankle ligament complex tears (11.1%) and concussions (7.3%) were the most commonly reported specific injury. Results indicate an increasing burden of practice-related injuries and the need to further examine overuse injuries. Lower-extremity injury prevention strategies and mechanisms of concussion also warrant further attention.

Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do!

Meniscal tears are common concomitant injuries seen in up to 65% of anterior cruciate ligament (ACL) deficient knees. The goal of ACL reconstruction (ACL-R) is to restore mechanical stability to the knee and to prevent further damage to the menisci, which act as secondary knee stabilizers for both anterior-posterior translation and rotational laxity. Delayed ACL-R and chronic ACL insufficiency have been associated with secondary meniscal tears that are more likely to be complex tears. Excluding graft failure, another common cause of reoperation in ACL reconstructed knees is meniscal surgery. Therefore, addressing meniscal tears at time of primary ACL-R is important to restore joint mechanics, protect the ACL graft for successful healing, and prevent long-term osteoarthritis. Current management options include leaving tears in-situ, meniscectomy, or meniscus repair. However, inconsistent findings have identified the need for well-defined treatment recommendations. Surgical decision making is reliant upon multiple factors such as adequate understanding of meniscal anatomy, biomechanics, tear pattern, and patient factors. This review focuses on the impact of meniscus injuries in ACL deficient knees and addresses current surgical indications and outcomes.

Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs

Background: Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing. Purpose: To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively. Results: A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively (P < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; P = .04) and SANE (84.1 vs 50.5; P = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus (P = .024). Conclusion: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.

Establishing the Minimal Clinically Important Difference and Patient-Acceptable Symptomatic State After Arthroscopic Meniscal Repair and Associated Variables for Achievement

To establish the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) after arthroscopic meniscal repair and identify the factors associated with achieving these outcomes. This is a retrospective study with prospectively collected data. Patient-reported outcome measures (PROMs) were collected from April 2017 to March 2020. All patients who underwent arthroscopic meniscal repair and completed both preoperative and postoperative PROMs were included in the analysis. MCID and PASS were calculated via half the standard deviation of the delta PRO change from baseline (for International Knee Documentation Committee Score [IKDC]) and via anchor-based methodology (Knee Injury and Osteoarthritis Outcome Score [KOOS] subscales). Sixty patients were included in the final analysis. The established MCID threshold values were 10.9 for IKDC, 12.3 for KOOS Symptoms, 11.8 for KOOS Pain, 11.4 for KOOS Activities of Daily Living (ADL), 16.7 for KOOS Sport, and 16.9 for KOOS Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 69.0 for IKDC, 75.0 for KOOS Symptoms, 80.6 for KOOS Pain, 92.7 for KOOS ADL, 80.0 for KOOS Sport, and 56.3 for KOOS QoL. Higher preoperative PRO scores were associated with lower likelihood of achieving MCID. Concomitant ligament procedures were associated with a higher likelihood of achieving PASS. Tears to both menisci were associated with decreased likelihood of achieving MCID and PASS for IKDC. Horizontal tears were associated with decreased likelihood of achieving PASS for IKDC and KOOS. Complex tears were associated with decreased likelihood of achieving MCID for KOOS. Clinically meaningful outcomes such as MCID and PASS were established for meniscal repair surgery using selected PROMs for IKDC and KOOS subscales. Variables more likely to be associated with achieving these outcomes include lower preoperative PRO score and concomitant ligament procedure, whereas higher preoperative PRO score, tearing of both medial and lateral menisci, and horizontal and complex tear classifications were associated with decreased likelihood of achieving these outcomes. IV, retrospective case series.

Traumatic triangular fibrocartilage complex tears: "state of the art" from diagnosis to treatment

Traumatic triangular fibrocartilage complex tears: "state of the art" from diagnosis to treatment

Intraoperative Findings and Clinical Outcomes Associated With Arthroscopic Management of Subspine Impingement: A Propensity-Matched, Controlled Study

(1) To investigate intra-articular damage in the hip joint associated with subspine impingement (SSI); (2) to evaluate clinical outcomes of arthroscopic treatment of hips with SSI; and (3) to compare the findings and outcomes to a control group without SSI. Eligible patients had arthroscopic treatment for femoroacetabular impingement (FAI) concurrent with SSI between January 2015 and December 2017. Inclusion criteria consisted of preoperative and minimum 2-year patient-reported outcomes and preoperative measurements for Tönnis, lateral center edge angle, and alpha angle. Included patients were propensity-matched in a 1:3 ratio to patients who had FAI without SSI. Patient-reported outcomes were compared between groups. Minimal clinically important difference was calculated for modified Harris Hip Score (mHHS) and Hip Outcome Score-Sports Specific Subscale (HOS-SSS). Fifty SSI cases were matched to 150 patients who had FAI without SSI. A greater proportion of the SSI cohort required labral reconstruction (P= .010). The size and locations for labral tears and chondral defects were comparable between groups (P > .05). Both groups demonstrated similar minimum 2-year outcomes for mHHS (P= .103), Nonarthritic Hip Score (P= .200), HOS-SSS (P= .119), visual analog scale (P= .231), international Hip Outcome Tool-12 (P=.300), Short Form-12 Mental (P=.426), Short Form-12 Physical (P= .328), Veterans RAND 12-Item Health Survey, Mental (P= .419), and Veterans RAND 12-Item Health Survey, Physical (P= .316). The percentage of patients achieving minimal clinically important difference for mHHS and HOS-SSS was similar (P > .05). Survivorship was 96.0% and 98.7% for the SSI and control cohorts at 2 years, respectively. Arthroscopic treatment of hips with SSI with subspine decompression and concomitant treatment of labral tears and FAI yielded significant improvement in patients' outcomes, which compared favorably with the control group. SSI may correlate with more complex labral tears, not amenable to repair, and complete tears of the ligamentum teres. Other findings, such as location and size of intra-articular damage, were similar between the cohorts. III, case-control study.

A TRIATHLETE WITH MEDIAL MENISCUS TEAR AND SUBCHONDRAL INSUFFICIENCY FRACTURE

Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. If diagnosed early, SIFK can be treated conservatively with non-weight bearing ambulation. If left untreated, this disease may lead to catastrophic complications such as subchondral fragment detachment and fragmentation or subchondral collapse which will warrant the need for surgical intervention. The author reports a 44-year-old triathlete that presented with complaint of a trivial left anteromedial knee pain for one-year duration. This disease presented at an unusual site of the medial tibial condyle. Moreover, the patient is a healthy triathlete that does not have any predisposing factors for SIFK. Magnetic resonance imaging showed subchondral insufficiency fracture of the medial tibial condyle with a complex multi-directional medial meniscus tear in the same knee. Could the undiagnosed medial meniscus injury be the causation leading to the development of SIFK? Here, the author will summarize the literature on various clinical features, work-up and management of SIFK.

The Hook Test Is More Accurate Than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist

To evaluate the accuracy of the trampoline and hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared with arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). In total, 135 patients (97 male, 38 female, mean age 43.5 years) were divided into 2 groups: (1) 80 patients with chronic ulnar-sided wrist pain and positive fovea sign and (2) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy and by the trampoline and hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity, and likelihood ratio of the 2 diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference. The trampoline and the hook tests showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the trampoline test was similar for distal (69%), proximal (66%), and complete (73%) TFCC tears. The hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for the trampoline and hook tests was 75.00% and 0.00% (P < .001) for distal tears and 78.85% and 100.00% (P < .001) and 58.33% and 100.00% (P < .001) for complete or isolated proximal tears, respectively. Specificity for the trampoline and hook tests was 67.27% and 96.36% (P < .001) respectively. The trampoline and hook tests can assure accurate diagnosis of peripheral TFCC tear. The hook test shows greater specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a greater probability to detect foveal laceration of peripheral TFCC for the hook test than for the trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal incompetence of the TFCC, if the hook test is positive. Level II, retrospective diagnostic trial.

Role of ABER Positioning in Evaluation of Anteroinferior Labroligamentous Lesions in Shoulder MR Arthrograms

Background: MR arthrography in the abduction and external rotation (ABER) position has been demonstrated to enhance the diagnostic ratio of anterior labro-ligamentous complex tears. Meanwhile, the diagnostic and discriminatory rates of MR arthrography in this position in various types of the antero-inferior labro-ligamentous lesions have not been completely discovered. Aim: This study aimed to perform comparison between ABER MR and the conventional MR arthrography considering the diagnostic rate and discriminatory precision of various anteroinferior labro-ligamentous lesions. Methods: We studied 38 patients who suffered from shoulder conditions and evaluated the results of both conventional MR and ABER MR arthrography. An antero-inferior labro-ligamentous lesion was diagnosed with the detection of absence, fray, detachment, displacement of the antero-inferior labrum or detection of the contrast material inside the labrum, or avulsion, rupture of the inferior glenohumeral ligament at the humeral or labral attachment. All study subjects have undergone shoulder arthroscopy after MR technique. Results: ABER MR arthrography was associated with significant increased accuracy and diagnostic sensitivity than that of conventional MR regarding the diagnostic rate of various types of the antero-inferior labro-ligamentous lesions (p < 0.05). Conclusion: Based on our results, ABER MR arthrography would add more value to the diagnosis if the conventional MR were doubtful in suspected antero-inferior labro-ligamentous complex injuries.

Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair.

Triangular fibrocartilage complex (TFCC) tears, whether acute or chronic, can result in persistent ulnar-sided wrist pain. Although diagnosis and nonsurgical management of TFCC tears is well described, there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic. This article reviews the most up-to-date literature regarding TFCC injury including demographics, risk factors for TFCC injury, classification of acute and chronic TFCC tears, history and physical examination, appropriate diagnostic imaging, surgical indications, pertinent surgical anatomy, open and arthroscopic TFCC repair, fixation biomechanics and techniques, postoperative rehabilitation, and clinical outcomes.

Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study

BackgroundDespite tibial plateau fractures are often associated with meniscal tears, the association between meniscal tears and Schatzker classification remains unclear. The purpose of this study was to assess the frequency and patterns of meniscal tears in operatively treated tibial plateau fractures following immediate arthroscopic evaluation after internal fixation of tibial plateau fractures and to reveal the association between these concomitant meniscal tears and Schatzker classification.MethodsA total of 252 consecutive patients (166 males and 86 females, mean age 46.7 (19–80) years) with operatively treated tibial plateau fractures admitted to our hospital from January 2016 to May 2019 were performed. Arthroscopic examination for frequency and patterns of meniscal tears was evaluated and documented at the time of surgery, and the association between the frequency and patterns of meniscal tears with Schatzker classification was then analyzed.ResultsThe overall frequency of meniscal tears in TPFs was 67% (168 of 252) with 33% (84 of 252) of these being lateral meniscal tears, and 10% (26 of 252) medial meniscal tears, while 23% (58 of 252) had bilateral meniscal tears. Schatzker II was most commonly associated with meniscal tears, occurring in 72% (71 of 99) of our series. There is no significant difference between the frequency of meniscal tears and Schatzker classification (p > 0.05). The most common patterns of meniscal tears were longitudinal tears in 23% of tibial plateau fractures (59 of 252), and it occurred at a significantly higher frequency in Schatzker II with 43% (43 of 99). Schatzker IV had significantly higher prevalence of bucket-handle tears than other fracture patterns (p < 0.05), and Schatzker VI fractures had significantly higher prevalence of complex tears than other fracture patterns (p < 0.05). For other Schatzker classification, the patterns of meniscal tears demonstrated no statistical difference (p > 0.05).ConclusionThe results identified that meniscal tears are commonly seen in each Schatzker classification. Although various patterns of meniscal tears occurred in tibial plateau fractures, the most common patterns were longitudinal tears. Importantly, we suggest that the status of meniscal tears associated with TPFs should be considered at the time of surgery in addition to fracture fixation.

Posterior Lateral Meniscal Root Tears Increase Strain on the Reconstructed Anterior Cruciate Ligament: A Cadaveric Study

PurposeTo quantify the amount of strain across an anterior cruciate ligament reconstruction (ACLR) before and after a lateral meniscus (LM) posterior root complex tear and determine whether a meniscal root repair effectively protects the ACLR against excessive strain.MethodsFresh-frozen cadaveric knees were tested with an 88-N anterior drawer force and an internal and external torque of 5-Nm applied at 0°, 15°, 30°, 60°, and 90° of flexion. A simulated pivot shift was also applied at 0, 15, and 30° of flexion. Rotation and translation of the tibia, and strain across the ACL graft were recorded. Testing was repeated for the following four conditions: ACL-intact, ACLR with intact LM, ACLR with LM posterior root complex tear, and ACLR with root repair.ResultsThe kinematic data from 12 fresh frozen cadaveric knees underwent analysis. Only 11 specimens had usable strain data. Sectioning the meniscofemoral ligaments and the LM posterior root increased rotational and translational laxity at 30° of knee flexion. ACLR graft strain significantly increased when an anterior load and internal torque were applied. Repair of the LM posterior root reduced strain when the knee was internally rotated but was unable to normalize strain when an anterior force was applied.ConclusionsThis cadaveric biomechanical study suggests injury to the LM posterior root complex increases rotational and anterior laxity of the knee and places increased strain across reconstructed ACL grafts. Subsequent root repair did not result in a statistically significant reduction in strain.Clinical RelevanceThis study provides quantitative data on the implications of a LM posterior root injury in the setting of an ACL reconstruction to help guide clinical decision-making.

Accuracy of magnetic resonance imaging of the wrist for clinically important lesions of the major interosseous ligaments and triangular fibrocartilage complex; correlation with radiocarpal arthroscopy.

To demonstrate the utility of MRI in separating clinically relevant from minor or incidental lesions of the triangular fibrocartilage complex and the major interosseous ligaments in the wrist. In this retrospective study, we identified 89 patients and correlated MRI finding with subsequent arthroscopy. Triangular fibrocartilage complex abnormalities have been subdivided into disc lesions-central and radial-or ulnar-sided tears according to MRI appearances and surgical findings as the clinical and surgical approach is very different. Interosseous ligament tears were subdivided into partial or complete, highlighting the principle of recognising surgically relevant lesions. For simple central to radial tears and perforations of the triangular fibrocartilage complex, MRI was 98.3% accurate. MRI identified all peripheral triangular fibrocartilage complex tears seen at arthroscopy; however, the specificity of 66.7% may reflect partly the use of arthroscopy limited to the radiocarpal joint. MRI proved 95.4% accurate for surgically relevant scapholunate interosseous ligament tears and was highly accurate at separating limited from complete lunotriquetral interosseous ligament tears showing 100% accuracy for complete tears. The study shows excellent correlation between MRI and arthroscopic findings that determine surgical relevance with a very high sensitivity for triangular fibrocartilage complex lesions and accurate separation of minor versus surgically relevant ligamentous tears.

Delayed Presentation of Unstable Triangular Fibrocartilage Complex Tears Treated with Volar Foveal Ligament Repair.

Hypothesis An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC). Methods We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated. Results Mean patient age was 40.5 years (range 16.3-56.2). Average time from injury to surgery was 8.4 months (range 2.9-23.3 months). Average final follow-up was 18.9 months from injury (range 12.0-29.3 months), 10.5 months from surgery (range 3.9-18.6 months), and 8.7 months from pin removal (range 1.7-17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0-9.0) improving to a mean of 0.70 (range 0.0-2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90-160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110-160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal). Conclusion Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament. Level of Incidence This is a Level IV, therapeutic study.

Should all superficial peripheral triangular fibrocartilage complex tears be arthroscopically repaired?

Background Superficial peripheral triangular fibrocartilage complex (TFCC) tears are commonly encountered during diagnostic wrist arthroscopy done for other causes of wrist pain. The authors hypothesized that debridement of these tears in symptomatic post-traumatic superficial tears may be a sufficient alternative to arthroscopic repair. Patients and methods The authors conducted a prospective study including 29 patients with superficial peripheral TFCC tears (with no distal radioulnar joint instability) treated arthroscopically between 2011 and 2014. There were 26 males (89.7%) and three females (10.3%), with a mean age of 32.90 years (range: 21–59 years). The dominant hand was affected in 19 patients (65.5%) and the nondominant in 10 patients (34.5%). Patients were divided into two groups. The first group included 14 patients to whom arthroscopic shaving and debridement (debridement group) were done. The second group included 15 patients for whom arthroscopic repair (repair group) was done using the outside-in technique. Patients were evaluated with the visual analog scale (VAS) for pain, the quick score disability arm shoulder hand (DASH) score, and Mayo modified wrist score. Results There were no statistically significant differences in pain, disability, and functional scoring between both groups in the short-term follow-up. In the first group, the mean follow-up period was 21.87 months. The mean VAS improved from 3.53 to 1.07, the mean quick DASH score improved from 36.33 to 21.60, and the mean Mayo modified wrist score improved from 71.33 to 85.33. In the second group, the mean follow-up period was 19.71 months. The mean VAS improved from 3.86 to 1, the mean quick DASH score improved from 34.43 to 19.79, and the mean Mayo modified wrist score improved from 77.14 to 90. Conclusion Arthroscopic debridement gives comparable short-term results to repair in symptomatic superficial tear of the TFCC presenting with pain and no instability. Debridement group showed less complication and reoperation rate.

A triathlete with medial meniscus tear and subchondral insufficiency fracture

Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. If diagnosed early, SIFK can be treated conservatively with non-weight bearing ambulation. If left untreated, this disease may lead to catastrophic complications such as subchondral fragment detachment and fragmentation or subchondral collapse which will warrant the need for surgical intervention. The author reports a 44-year-old triathlete that presented with complaint of a trivial left anteromedial knee pain for one-year duration. This disease presented at an unusual site of the medial tibial condyle. Moreover, the patient is a healthy triathlete that does not have any predisposing factors for SIFK. Magnetic resonance imaging showed subchondral insufficiency fracture of the medial tibial condyle with a complex multi-directional medial meniscus tear in the same knee. Could the undiagnosed medial meniscus injury be the causation leading to the development of SIFK? Here, the author will summarize the literature on various clinical features, work-up and management of SIFK.

Prevalence of Subscapularis Tears and One-Year Clinical Outcomes in 593 Rotator Cuff Repairs

To report the prevalence of subscapularis tear repairs in a consecutive series by a single surgeon, and to report the clinical outcomes with regard to persistent disability or reoperation rate utilizing the concept of biceps preservation and early motion rehabilitation. 593 consecutive patients who underwent primary arthroscopic rotator cuff repair by a single surgeon from December 2015 to July 2017 are reported. All tears were graded by the LaFosse subscapularis tear classification . All patients were repaired with the same suture anchors with suture tape and had early motion rehabilitation. Patients with revision surgical repairs and massive cuff repair were excluded. Clinical failure was considered to be the need for repeat surgical procedure with documented repair failure, persistence of preoperative pain symptoms, MRI evidence of repair failure or patient dissatisfaction with the clinical outcome.. 409 out of 593 patients (69%) had subscapularis injury with varying degrees of biceps long head instability or pathology. There were 253 Lafosse grade 1, 107 grade 2, 17 grade 3, 1 grade 4 and no grade 5 tears. The most common pathologic finding was a flattened SGHL pulley attachment. 39 patients underwent biceps tenotomy/tenodesis as part of their treatment due to extensive biceps long head disease. The vast majority of patients had normal biceps morphology, and the biceps was preserved. Biceps pain was alleviated in over 95% of patients at one year follow-up in those treated with biceps preservation. The reoperation repeat repair rate was 5.2% for all patients. Subscapularis tears are much more prevalent than is commonly acknowledged in clinical practice. Repair of even complex subscapularis tears is met with high satisfaction and biceps tenotomy/tenodesis is uncommonly required to achieve superior outcomes.

Arthroscopic triangular fibrocartilage complex repair: A biomechanical comparison of anchor and pull-out techniques in Atzei type II lesions.

Several open and arthroscopic techniques for repair triangular fibrocartilage complex (TFCC) tears have been used. The aim of this study, using a cadaveric model, was to compare the biomechanical resistance to the pronosupination movement of arthroscopic repair with anchor and pull-out techniques in TFCC tears of Atzei type II lesions. Eighteen forearms of cadaveric specimens were evaluated arthroscopically, of which 12 were selected according to the inclusion criteria. All specimens were injured with an Atzei type II lesion and were repaired arthroscopically. Six forearms were repaired using the anchor technique and the other six with the pull-out technique. To assess the biomechanical resistance of the repair, the forearms were tested to 300 cycles of 160° pronosupination. Two evaluators independently assessed the repair status every 10 cycles and the modified Desai classification was used to verify the presence of failure. The mean failure of the repair occurred at 41.6 cycles (SD 7.5) for the pull-out technique and at 28.3 cycles (SD 9.8) for the anchor technique, showing a difference of 13.3 cycles (p = 0.025) in favor of the pull-out technique. In all cases, repair failure occurred at the junction of the fibrocartilage with the suture. Arthroscopic repair with the pull-out technique showed greater biomechanical resistance to pronosupination movement in comparison to the anchor technique. Interestingly, the failure of arthroscopic repair of Atzei type II lesions occurs at the junction between the suture and the fibrocartilage.

Evaluation of Diagnostic Procedures for Ulnar Sided Wrist Pain: 25 Years of Experience

The purpose of this paper was to evaluate the diagnostic tests for USWP defined specifically as a positive diagnosis for triangular fibrocartilage complex (TFCC) tears, lunotriquetral ligament (LT) tears and ulnocarpal impaction syndrome (UIS). The diagnostic measures examined in this study included LT laxity test, bone scintography, radiocarpal (RC) arthogram, and midcarpal (MC) arthogram. All tests were evaluated using arthroscopy as the reference standard.