Cortical Fixation Research Articles

Corrective osteotomy of the distal radius with palmar locking plate osteosynthesis without bone grafting and without cortical contact.

The aim of this study was to assess bone healing and secondary fracture displacement after corrective osteotomy of the distal radius without any cortical contact using palmar locking plates without bone grafting. Between 2009 and 2021, 11 palmar corrective osteotomies of extra-articular malunited distal radius fractures and palmar plate fixations without the use of bone grafts and without cortical contact, were assessed. All patients showed complete osseous restoration and significant improvement in all radiographic parameters. Except for one patient, there were no secondary dislocations or loss of reduction in the postoperative follow-up. Bone grafts may not be mandatory for bone healing and prevention of secondary fracture displacement after palmar corrective osteotomy without cortical contact and fixation with palmar locking plate.Level of evidence: IV.

Arthroscopic Assisted Anterior Cruciate Ligament Tibial Spine Avulsion Reduction and Cortical Button Fixation

Tibial spine avulsion fractures, or tibial eminence fractures, are intra-articular knee injuries that affect the bony attachment of the anterior cruciate ligament (ACL). It is commonly seen in children and adolescents aged 8 to 15 years old and can be caused by noncontact pivot shift injuries or by traumatic hyperextension knee injuries, as seen in adult ACL patients. A thorough history and physical exam is important in these patients alongside proper imaging that will confirm the diagnosis of a tibial spine avulsion. Proper imaging may also demonstrate other associated conditions or injuries to the cartilage, meniscus, or ligamentous structures. Following diagnosis, treatment can be both nonoperative versus operative, depending upon the degree of displacement and reducibility of the fragment, as well as other concomitant injuries. For nondisplaced or minimally displaced, and reducible injuries, the patient can be immobilized in full extension for several weeks. For displaced fragments that are unable to be reduced by closed methods, open reduction internal fixation or arthroscopic fixation is recommended. In this Technical Note, we describe an arthroscopy-assisted reduction and internal fixation with suture tape through 2 transtibial tunnels with a cortical suture button fixation technique.

The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta-analysis.

A meta-analysis investigation was performed to measure the influence of cortical bone trajectory screw fixation (CBTSF) and traditional pedicle screw fixation (TPSF) on surgical site wound infection (SSWI) in posterior lumbar fusion (PLF). A comprehensive literature inspection till February 2023 was applied and 1657 interrelated investigations were reviewed. The 13 chosen investigations enclosed 1195 individuals with PLF in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the CBTSF and TPSF on SSWI in PLF by the dichotomous approaches and a fixed or random model. No significant difference was found between individuals using CBTSF and TPSF in SSWI (OR, 0.68; 95% CI, 0.35-1.33, P = .26), superficial SSWI (OR, 0.62; 95% CI, 0.22-1.79, P = .38), and deep SSWI (OR, 0.30; 95% CI, 0.06-1.50, P = .14) in PLF. No significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF. However, care must be exercised when dealing with its values because of the small sample sizes of several chosen investigations for this meta-analysis and the low number of selected investigations for a certain type of SSWI.

Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial.

Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery. Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening. Randomized controlled trial; Level of evidence, 1. In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively. The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698). Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year. NCT03462823 (ClinicalTrials.gov identifier).

Superior clinical results for early arthroscopic treatment of grade IIIb and V acromioclavicular joint instability compared to delayed operative treatment.

Arthroscopy-assisted cortical fixation devices have been increasingly used in the operative management of both acute and chronic cases of acromioclavicular joint instability (ACJI). It has been hypothesized that delayed surgical management leads to inferior clinical and radiologic outcomes compared to acute treatment. The purpose of this study is to compare clinical and radiologic outcomes, scapula dyskinesia, and failure or revision rates of arthroscopically treated acute and chronic ACJI. This retrospective study of prospectively collected data included all surgically treated patients with grade IIIb and V chronic ACJI between 2013 and 2017, matched 1:1 to a group of acute grade IIIb and V ACJI patients treated during the same time period. Chronic ACJI was defined as delayed surgical treatment >21 days after injury. Chronic cases received an additional hamstring autograft next to the suture pulley systems. Follow-up was obtained at an average of 3.2 years (range: 1.4-6.2). Clinical outcome scores included the Constant-Murley Score (CMS), Taft Score (TF), Nottingham Clavicle Score (NCS), ACJI Score, Sick Scapula Score (SSS), Subjective Shoulder Value (SSV), Subjective Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and the visual analog scale pain score. Radiologic follow-up was obtained pre- and postoperatively and at final follow-up. The 2-year results were compared to the results of a 1:1 matched-pair group comprising patients who were treated with an acute ACJI during the same period. Thirty-three (80.5%) of 41 chronic ACJI cases were available for follow-up and were compared with 33 matched-pair cases of acute ACJI (of 41). The clinical scores were significantly better in the acute cohort for the CMS (92±8 vs. 88±8, P=.030), ASES (91±13 vs. 85±13, P=.002), SSS (1.4±1.6 vs. 3.4±2.5, P=.0004), NCS (86±13 vs. 81±13, P=.049), TF (9.9±1.9 vs. 9.0±2.1, P=.030), and ACJI (83±13 vs. 75±1, P=.003). In contrast to the chronic cohort, the acute cohort illustrated a significant loss of reduction at follow-up (P=.020). Based on the results of this study, early arthroscopy-assisted operative treatment of grade IIIb and V ACJIs seems superior to delayed surgical intervention of grade IIIb and V ACJIs. Furthermore, an additional autograft loop leads to less loss of reduction compared with suture pulley/suspensory loop fixation standalones.

Safety and Efficacy of Cortical Bone Trajectory Screw Fixation Combined with Facet Fusion for the Treatment of Lumbar Degenerative Disease.

The mainstream lumbar fusion surgeries have various shortcomings, such as complex operation, much invasion, and loss of lumbar function. How to minimize the surgical injury and to achieve better therapeutic effects has become the goal pursued by spine surgeons. This study introduces a cortical bone trajectory (CBT) screw fixation combined with facet fusion (FF), evaluates its safety and efficacy, and explores its advantages, in order to provide a reference for treatment of patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis. We retrospectively analyzed the clinical, radiological, and operative data of 167 patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis who underwent FF or transforaminal lumbar interbody fusion (TLIF) from January 2013 to September 2019 in the spine surgery department of the Second Hospital of Shandong University. Patients were divided into four groups according to surgical method: group CBT-FF, CBT screw combined with FF; group PS-FF, pedicle screw (PS) combined with FF; group CBT-TLIF, CBT screw combined with TLIF; and group PS-TLIF, PS combined with TLIF. The operation time, estimated intraoperative blood loss, complications after surgery, visual analog scale (VAS), and Oswestry disability index (ODI) of the four groups were compared. The fusion was evaluated by anteroposterior and lateral X-ray, CT scan, and three-dimensional reconstruction. Twelve months after surgery, the fusion rate of four groups had no significantly statistical differences (p = 0.914). VAS and ODI scores were lower after surgery than before. Low back pain VAS scores 1 week after surgery in group CBT-FF and group CBT-TLIF were significantly lower than those in group PS-FF and group PS-TLIF (pCF/PF = 0.001, pCF/PT = 0.000, pPF/CT = 0.049, pCT/PT = 0.000). Low back pain VAS score 3 months after surgery was significantly lower in group CBT-FF than group PS-FF and group PS-TLIF (pCF/PF = 0.045, pCF/PT = 0.008). ODI score 1 week after surgery was significantly lower in group CBT-FF than group PS-FF, group CBT-TLIF, and group PS-TLIF (pCF/PF = 0.000, pCF/CT = 0.005, pCF/PT = 0.000, pCT/PT = 0.015). ODI score 3 months after surgery was significantly lower in group CBT-FF than group PS-FF, group CBT-TLIF, and group PS-TLIF (pCF/PF = 0.001, pCF/CT = 0.002, pCF/PT = 0.000). Incidence of complications did not significantly differ among the groups. CBT screw fixation combined with FF is a safe and efficacious procedure for patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis. This minimally invasive approach of lumbar fusion can be simply and easily performed. Patients who undergo CBT screw fixation combined with FF recovered faster than TLIF.

Cortical suspensory button fixation has superior biomechanical properties to knotless anchor suture in anterior cruciate ligament repair: a biomechanical study

The purpose of our biomechanical study was to assess load-to-failure, stiffness, gap formation following cyclic loading, and the failure mechanism for anterior cruciate ligament (ACL) repair comparing the cortical suspensory button and knotless anchor suture. Eight Thiel’s embalmed paired cadaveric knees from four cadavers were dissected. The specimens were assigned to undergo ACL repair either with cortical suspensory button or with knotless anchor suture. The Instron machine replicates cyclic loading and then determines the gap formation. Traction was applied until failure. The load-to-failure, stiffness, and modes of failure in both groups were recorded. The load-to-failure, stiffness, and gap formation were compared between the two groups using the student's t-test. The mean load-to-failure in the cortical suspensory button group was significantly higher than the knotless anchor suture group (212.96 ± 54.57 vs 44.57 ± 20.80, p value < 0.01). No statistically significant difference was found regarding gap formation following cyclic loading and stiffness between the cortical suspensory button group and the knotless anchor suture group. This biomechanical study showed a higher load-to-failure for the ACL repair with cortical suspensory button compared to ACL repair with knotless anchor suture, while no statistically significant difference was found regarding the gap formation following cyclic loading and the stiffness. The load-to-failure in both cortical suspensory button and knotless anchor suture are below regular daily activity load. Thus, an internal brace or external support is recommended during rehabilitation.

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon–Patellar Bone Autograft

Multiple surgical techniques for posterior cruciate ligament reconstruction have been described and subsequently scrutinized. We describe a surgical technique using full-thickness quadriceps tendon–patellar bone autograft in single-bundle, all-inside posterior cruciate ligament reconstruction that offers the following advantages over traditional technique: This technique mitigates the risk of tunnel widening and convergence while preserving bone stock, eliminating the killer turn, allowing for suspensory cortical fixation to optimize stabilization, and using a bone plug that allows for faster graft incorporation.

Biomechanical Evaluation of TensionLoc Versus the Double Spike Plate for ACL Graft Tibial Fixation.

The optimal tibial fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts remains controversial. The purpose of this study was to compare the biomechanical characteristics of the TensionLoc (TL) cortical fixation device with the Double Spike Plate (DSP) fixation device for ACL tibial fixation using both bone-patellar tendon-bone (BTB) and quadriceps grafts. It was hypothesized that there would be no differences in biomechanical characteristics between the fixation devices regardless of graft type. Controlled laboratory study. ACLR was performed on 14 matched-pair cadaveric knee specimens-7 pairs using quadriceps grafts (n = 3 male cadaveric knee specimens; n = 4 female cadaveric knee specimens; age, 51 ± 8 years) and 7 pairs using BTB grafts (n = 3 male cadaveric knee specimens; n = 4 female cadaveric knee specimens; age, 50 ± 7 years). One side of each pair was randomized to receive DSP fixation, and the contralateral side received TL fixation. Specimens underwent cyclic ramp loading (10 cycles each at 50-100 N, 50-250 N, and 50-400 N), followed by load-to-failure testing, with the tensile force in line with the tibial tunnel. Results between the 2 fixation types were compared with a paired t test. For the quadriceps graft, there were no significant differences in cyclic loading or load-to-failure characteristics between fixation types (P≥ .092 for all parameters). For the BTB graft, TL fixation resulted in higher stiffness than DSP at all cyclic testing cycles except for cycle 1 during 100-N loading and had lower displacement at 250-N loading (3.4 ± 0.1 vs 5.4 ± 0.3 mm; P = .045). For load to failure, TL fixation resulted in higher stiffness than DSP fixation (232 ± 3.1 vs 188.4 ± 6.4 N/mm; P = .046); however, all other load-to-failure parameters were not statistically different (P≥ .135 for all parameters). With the quadriceps tendon graft, there were no significant differences in biomechanical characteristics between TL and DSP ACL tibial fixations; however, with BTB grafts, the TL tibial fixation demonstrated greater biomechanical integrity than the DSP tibial fixation. The TL fixation device may provide an alternative ACL tibial fixation option for BTB and soft tissue grafts.

Posterior Medial Meniscus Root Repair With Peripheral Stabilization Stitch

Background: Posteromedial meniscal root tears occur when the meniscal root detaches from the tibial plateau, which limits the native functionality of the meniscus, alters tibiofemoral contact forces, and can progress to meniscal extrusion. Untreated meniscal root tears with meniscal extrusion have been associated with significant articular cartilage loss and accelerated progression of osteoarthritis. Recent biomechanical evidence suggests restoring the contact area with the use of a peripheral stabilization suture at the posteromedial aspect of the tibial plateau. Indications: Meniscal root repair with a peripheral stabilization suture is indicated by clinical and radiographic evidence of complete detachment of the posteromedial meniscus root with significant meniscal extrusion outside the joint. Technique Description: This technique uses 2 tunnels for the meniscal root repair as well as a single additional transtibial tunnel for the peripheral stabilization suture. The described technique demonstrates a peripheral release along the meniscocapsular junction to allow the meniscus to be reapproximated to its anatomical attachment site. This is followed by transtibial tunnel preparation to allow suture passage for the meniscal root repair and an additional transtibial tunnel is created for the peripheral stabilization suture. After stabilization of the extruded meniscus, the suture is tied down over a cortical fixation device on the anteromedial tibia. Results: Significant improvement has been reported by clinical studies after the transtibial pullout repair method; however, structural outcomes have shown conflicting results. Kaplan et al reported patients treated with transtibial suture pullout technique with 2 locking cinch sutures had improved clinical outcomes, but increased extrusion of the medial meniscus compared with the preoperative state, whereas Kim et al reported a decrease in meniscal extrusion following pullout suture repair technique. Discussion: Posteromedial meniscus root repair using a peripheral stabilization suture is an effective surgical technique to restore the contact pressures of the knee and limit the amount of meniscal extrusion. This allows for appropriate correction of hoop stress to prevent further cartilage loss and progression of osteoarthritis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Although cortical bone trajectory (CBT) screw fixation has been used for several years, the number of studies on its fusion effects is limited. Furthermore, several studies report conflicting outcomes. We aimed to compare the fusion rates and clinical efficacy of CBT screw fixation and pedicle screw (PS) fixation for L4-L5 interbody fusion. This study was a retrospective cohort control study. Patients with lumbar degenerative disease who underwent L4-L5 oblique lumbar interbody fusion (OLIF) or posterior decompression using CBT screws between February 2016 and February 2019 were included. Patients in whom PS was used were matched for age, sex, height, weight, and BMI. Record the operation time, blood loss. All enrolled patients underwent lumbar CT imaging at one-year follow-up to evaluate the fusion rate. At the two-year follow-up the visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association scores (JOA) were used to identify symptom improvement. Independent t-test was used for the comparison, and score data were analyzed using the χ2 and exact probability tests. A total of 144 patients with were included. All patients were followed-up postoperatively for 25-36months (average 32.42 ± 10.55months). Twenty-eight patients underwent OLIF and CBT screw fixation, 36 underwent OLIF and PS fixation, 32 underwent posterior decompression and CBT screw fixation, and 48 underwent posterior decompression and PS fixation. The fusion rates following CBT screw and PS fixations in OLIF were 92.86% (26/28) and 91.67% (33/36), respectively (P=1). The fusion rates following CBT screw and PS fixations in posterior decompression were 93.75% (30/32) and 93.75% (45/48), respectively (P > 0.05). Regardless of OLIF or posterior decompression, there were no significant differences in the VAS, ODI, and JOA scores between patients treated with CBT and PS (P > 0.05). CBT screw fixation can achieve a satisfactory interbody fusion rate with a clinical efficacy similar to that of PS in patients with lumbar degenerative disease, regardless of whether OLIF or posterior decompression was performed.

Complications after operative treatment of high-grade acromioclavicular injuries

Treatment of Rockwood type III-V acromioclavicular (AC) joint injuries remains controversial. Numerous reconstruction techniques have been proposed. The purpose of this study was to describe the complication profile in a large cohort of patients who underwent surgical management of AC joint separations using a variety of reconstruction strategies. All patients who underwent surgery for AC joint injuries from 2013 to 2019 at a single institution were identified. Chart review was performed to capture patient demographics, radiographic measurements, operative techniques, postoperative complications, and revision surgery. Structural failure was defined as a radiographic loss of reduction of greater than 50% when comparing immediate and final postoperative imaging. Logistic regression analysis was performed to identify risk factors for complications and revision surgery. Of the 279 patients included in the study, 66 (24%) had type III separations, 20 (7%) type IV, and 193 (69%) type V. Fifty-three percent underwent surgery acutely (<6 weeks of injury), and 40% were chronic (>3 months). A total of 252 of the 279 surgeries (90%) were performed open and 27 (10%) were arthroscopically assisted. Allograft was used in 164 of 279 (59%) cases. Specific operative techniques (with or without allograft) included hook plating (1%), modified Weaver Dunn (16%), cortical button fixation (18%), and suture fixation (65%). At mean 28-week follow-up, 108 complications were identified in 97 patients (35%). Complications were identified at mean 20±21 weeks. Sixty-nine structural failures (25%) were identified. Persistent AC joint pain requiring injection, clavicle fracture, adhesive capsulitis, and hardware complications were the other most common complications. Twenty-one patients (8%) underwent unplanned revision surgery at mean 38±28 weeks after the index procedure, with the most common indication for structural failure, hardware complications, or fracture of the clavicle or coracoid. Patients who had surgery after 6 weeks from injury had a significantly greater risk of having a complication (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.34-7.77, P=.009) and a significantly greater risk of having structural failure (OR 2.65, 95% CI 1.38-5.28, P=.004). Patients who had an arthroscopic technique had a greater risk of structural failure (P=.002). Complications, structural failure, and revision surgery were not significantly correlated with use of allograft or specific operative techniques. Surgical management of AC joint injuries is associated with a relatively high complication profile. Loss of reduction in the postoperative period is common. However, the revision surgery rate is low. These findings are important for patient preoperative counseling.

A new type of elastic fixation, using an encircling and binding technique, for tibiofibular syndesmosis stabilization: comparison to traditional cortical screw fixation

BackgroundThe distal tibiofibular syndesmosis (DTS) is a complex fibrous joint that contributes to the stability and weight-bearing function of the ankle. As such, repair of DTS injury is required, providing fixation strength while maintaining ankle range of motion. The aim of this study was to compare a new elastic fixation technique, using an encircling and binding technique, for DTS stabilization, compared to the traditional cortical bone screw fixation.MethodsThis was a retrospective analysis of 67 patients treated for a DTS injury at our hospital, between June 2019 and June 2021. Of them, 33 were treated with encircling and binding (EB group) and 34 using a cortical screw (CS group). The following outcomes were compared between groups: time to inferior tibiofibular fixation; length of hospital stay; time to partial weight bearing; time to complete weight bearing; complications; imaging data; and functional scores.ResultsSuccessful stabilization was achieved in all cases, with a mean follow-up period of 15.78 ± 2.97 months. Time to fixation and time to partial and complete weight bearing were shorter for the EB than that for the CS group. The length of hospital was not different between groups. With regard to complications, a superficial infection developed in one patient in each group, with wound healing achieved after active treatment. Screw fracture occurred in two patients in the CS group. At 3 months post-surgery, the American Foot Surgery Association Ankle-Hindfoot score (AOFAS) was higher and the pain score lower for the EB than that for the CS group, but with no between-group difference at the final follow-up. On imaging, the tibiofibular clear space and tibiofibular overlap were not different between groups.ConclusionsDTS fixation using encircling and binding yielded better clinical and functional outcomes than did cortical screw fixation at 3 months post-surgery, with no difference at the final follow-up. This novel fixation technique provides firm fixation, combined with earlier return to postoperative exercise and recovery of ankle function.

Clinical efficacy of midline lumbar interbody fusion arthrodesis with neuronavigation-guided cortical bone trajectory screws in the treatment of degenerative lumbar spondylolisthesis:a prospective randomized controlled trial

Introduction. Currently, the standard treatment of degenerative spondylolisthesis involves pedicle screw fixation to enhance the success of intervertebral fusion. The traditional pedicle screw techniques require extensive lateral muscle dissection, resulting in significantly increased surgical-related morbidity. To address some of these shortcomings, the Midline Lumbar Interbody Fusion (MIDLIF®) technique has recently been developed. It involves the combination of the cortical bone trajectory screw fixation of the spine with intervertebral cage placement to achieve a solid interbody fusion. So far, the clinical efficacy of the MIDLIF technique in the treatment of low-grade degenerative spondylolisthesis is still unknown. All existing publications are studies with a low level of relevance or scientific evidence. Materials and methods. A prospective randomized controlled trial was conducted between 2017 and 2022. The study analyzed the clinical and radiological effectiveness of the MIDLIF arthrodesis technique compared to the traditional lumbar interbody fusion techniques, used exclusively in the treatment of degenerative lumbar spondylolisthesis. Results. The study enrolled 112 eligible patients with degenerative low-grade spondylolisthesis, randomly assigned into two groups. At 1 year post-operatively, MIDLIF provided a significantly better improvement in postoperative relief of low back pain and radiating pain, as well as a significantly better functional recovery. Additionally, MIDLIF resulted in lower surgical morbidity compared to traditional fusion techniques. Conclusions. The success rate of MIDLIF arthrodesis is similar to that associated with traditional fusion techniques. At the same time, MIDLIF offers all the specific benefits of a minimally invasive approach, such as less postoperative pain, faster functional recovery, less bleeding, and fewer blood transfusions. Thus, MIDLIF might be a good alternative to the traditional intervertebral fusion techniques in the treatment of degenerative low-grade spondylolisthesis.

Comprehensive comparison of three techniques for the treatment of adjacent segment degeneration after lumbar fusion.

Adjacent segment degeneration (ASD) following lumbar fusion is technically challenging for spine surgeons. Posterolateral open fusion surgery with pedicle screw fixation is an effective way to treat symptomatic ASD with favorable clinical outcomes; however, it is associated with an increased morbidity rate. Therefore, minimally invasive spine surgery is advocated. This study was designed to compare clinical outcomes among patients with symptomatic ASD who underwent percutaneous transforaminal endoscopic discectomy (PTED) with the transforaminal approach, posterior lumbar interbody fusion (PLIF) with cortical bone trajectory screw fixation (CBT-PLIF), and PLIF with traditional trajectory screw fixation (TT-PLIF). A retrospective study was conductedon 46 patients (26 men and 20 women; average age 60.8 ± 6.78 years) with symptomatic ASD. The patients were treated with three approaches. The operation time, incision length, time to return to work, complications, and the like were compared among three groups. Intervertebral disc (IVD) space height, angular motion, and vertebral slippage were obtained to assess spine biomechanical stability following surgery. The visual analog scale (VAS) score and Oswestry disability index were evaluated at preoperation and 1-week, 3-month, and the latest follow-ups. Clinical global outcomes were also estimated using modified MacNab criteria. The operation time, incision length, intraoperative blood loss, and time to return to work for the PTED group were significantly decreased compared with those for the other two groups (P < 0.05). The radiological indicators in the CBT-PLIF group and TT-PLIF group had better biomechanical stability compared with those in the PTED groups at the latest follow-up (P < 0.05). The back pain VAS score in the CBT-PLIF group was significantly decreased compared with those in the other two groups at the latest follow-up (P < 0.05). The good-to-excellent rate was 82.35% in the PTED group, 88.89% in the CBT-PLIF group, and 85.00% in the TT-PLIF group. No serious complications were encountered. Two patients experienced dysesthesia in the PTED group; screw malposition was found in one patient in the CBT-PLIF group. One case with a dural matter tear was observed in the TT-PLIF group. All three approaches can treat patients with symptomatic ASD efficiently and safely. Functional recovery was more accelerated in the PTED group compared with the other approaches in the short term; CBT-PLIF and TT-PLIF can provide superior biomechanical stability to the lumbosacral spine following decompression compared with PTED; however, compared with TT-PLIF, CBT-PLIF can significantly reduce back pain caused by iatrogenic muscle injury and improve functional recovery. Therefore, superior clinical outcomes were achieved in the CBT-PLIF group compared with the PTED and TT-PLIF groups in the long term.

Preoperative planning to preserve glenoid subchondral bone in anatomical total shoulder replacement

Glenoid loosening remains a concern in anatomical total shoulder replacement. Preoperative planning software allows optimization of the component positioning, but the target orientation remains unclear due to conflicting optimization priorities. Commonly, the component is aligned to the prescribed version and inclination that reflect the population's average anatomy. The freehand technique attempts to secure strong fixation by aiming to preserve the subchondral bone. This study compared the state of the subchondral plate after reaming and compared the results of these two techniques. Two groups of shoulder computed tomography scans were assessed, 34 normal and 34 osteoarthritic. Preoperative planning software was used to place the glenoid component in prescribed adjusted angles, with neutral (0o,0o), retroverted (-10o,0o) and inclined alignment (0o,10o). The computed tomography Hounsfield values at the virtually reamed surface were assessed to determine the percentage of the intended component-bone interface consisting of cortical bone, here termed "cortical bone seating". This was then compared to positioning the component using a freehand technique. The freehand technique improved cortical bone seating in the osteoarthritic group with a mean (standard deviation) of 53.3% (14.3), while neutral alignment resulted in 36.7% (10.8), retroversion 40.4% (13.1), and inclination 39.3% (13.5), P<.001. A similar trend was observed in the normal group. The freehand method resulted in significantly improved cortical bone seating compared to the prescribed adjusted angles. These findings question the use of a one-size-fits-all-orientation and suggest that applying a technique that aims for maximum cortical fixation (freehand) may reduce the risk of aseptic loosening.

Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation.

Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a "dead space" that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain. To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. Case series; Level of evidence, 4. Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables. At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30). Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.

Open reduction, acetabular and femoral head fixation of Pipkin type IV fracture in an adolescent: A case report

AbstractBACKGROUND Femoral head fracture is extremely rare in adolescent. There are few studies that focus on cases treated of pipkin type IVCASE SUMMARY A 15-year-old male adolescent suffered a serious traffic accident when he was sitting on the front seat of car. Several hours after accident at the local hospital, he diagnosed as posterior dislocation of the right hip with drop foot , and treat closed reduction immobilisation with skin traction. After first operation he transferred to another hospital. Pelvic radiograph computed tomography revealed a head femoral fracture and large acetabular rim fracture. This was diagnosed as a Pipkin type IV acetabular and femoral head fracture with dislocation. An open reduction Inion Freedom bioscrew fixation of head femur and 4.5 cortical screw fixation of acetabular fracture was performed via a Kocher Langenbeck approach. After 1-year follow-up, the patient could walk without aid and participate in physical activities. The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction, fixation both acetabular and femoral head is an available therapy to treat Pipkin type IV in adolescent

Adjustable-Loop Cortical Button Fixation Results in Good Clinical Outcomes for Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament

To evaluate the clinical outcomes for arthroscopic treatment of acute posterior cruciate ligament (PCL) avulsion fractures with adjustable-loop cortical button fixation device. Patients with PCL tibial avulsion fractures treated with an adjustable-loop cortical button fixation device between October 2019 and October 2020 were retrospectively identified. Patients with type 1 were treated using plaster fixation as a conservative treatment, whereas patients with type 2 and 3 with displacement were treated using an arthroscopic adjustable-loop cortical button. Operating time, incision recovery, complications, and postoperative fracture healing time were monitored. All patient follow-up was done at 12 months' postoperatively. Lysholm Knee Score and the International Knee Documentation Committee score were used to assess knee function. A total of 30 patients were included in the study (20 male/10 female; mean age 45.5 years, range 35-68 years). The mean operative time was 67.5 minutes (range: 50-90 minutes). The postoperative incision healed at stage A without complications, such as medically induced vascular nerve injury, intra-articular hematoma, or infection. All 30 patients were tracked postoperatively for 12 to 14 months, with a mean follow-up period of 12.6 months. The Lysholm knee function score was 45.93 ± 6.15 before surgery and 87.10 ± 3.71 at 12 months after surgery, and the International Knee Documentation Committee score was 19.27 ± 4.40 before surgery and 95.47 ± 1.87 at 12 months after surgery, with a statistically significant difference. The treatment of PCL avulsion fractures with arthroscopic adjustable-loop cortical button fixation is easy to perform and shows good clinical results in our study. IV, therapeutic case series.

Teres Major and Latissimus Dorsi Repair With Biceps Tenodesis Utilizing Cortical Suspensory Fixation Buttons

Teres major (TM) and latissimus dorsi (LD) ruptures are relatively rare in the general population and have primarily been observed in overhead throwing athletes. Although the gold standard of care has traditionally been nonoperative, surgical repair of TM and LD tendon ruptures has become increasingly prevalent in high-level athletes who fail to return to play. Literature is scarce regarding operative repair of these tendon ruptures. Therefore, our goal is to present a potential technique for open repair to surgeons who may be faced with this unique orthopedic injury. Our technique details an open TM and LD repair, in addition to biceps tenodesis, using cortical suspensory fixation buttons with a combined anterior and posterior approach.