Internal Bracing Research Articles

Comparison of Suture Anchor Repair and Suture Tape Augmentation for Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Study.

Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all-inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing. Eighteen fresh-frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness. The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL. In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL.

Right knee ACL, PCL and MCL reconstruction with sports-related anxiety

Introduction: JM, a 20-year-old male professional ice hockey player, presented with a 2-week history of lack of range of motion, weakness, and pain in his right knee, after a 2-year post-medical collateral ligament repair of the right knee and 3 year-post anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament reconstruction of the right knee. Case Description: In the course of history taken, it was revealed that 5 months prior to admission the patient had been informed by a psychiatrist that he had sport-related anxiety. With an unremarkable psychiatric history prior to age 18, the competitive nature of his sports career in addition to financial pressure may have contributed to his sports-related anxiety. His examination findings were consistent with a diagnosis of complete tears of the right anterior cruciate ligament and posterior cruciate ligament along with grade III medial collateral ligament injury. Discussion: The biopsychosocial model was used to explicate JM's case. JM's current injuries prompted reconstruction of the anterior cruciate, posterior cruciate, and medial collateral ligaments. Psychologically, JM's sports-related anxiety is not a rare phenomenon as recent studies have discovered an increased risk of sports-related anxiety amongst young professional athletes. Sports-related anxiety, along with competitive trait anxiety, may be factors that contribute to sports injury occurrence. Other psychological stressors can add to sports-related or competitive trait anxiety, further increasing the risk of sports injury reoccurrence. Summary: JM was admitted for a right knee open medial collateral ligament repair with internal bracing, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, and platelet rich plasma injection. As part of a holistic patient-centered treatment plan, a referral to psychiatry was made to address JM's sports-related anxiety with the goal of decreasing future risk of sports injury. Patient's Consent Obtained: Yes

Return to play after UCL injury in gymnasts

ABSTRACT Background Injuries to the ulnar collateral ligament (UCL) are commonly reported in traditional overhead sports. Conversely, there is a lack of evidence outlining management and return to play (RTP) outcomes for gymnasts. This study aimed to evaluate RTP and patient reported outcomes (PROs) in gymnasts after operative and non-operative treatment of UCL injuries. Methods Gymnasts who presented with UCL injury and underwent operative and non-operative treatment were evaluated. Patient reported outcomes were collected via telephone: Conway-Jobe Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score, Mayo Elbow Performance (MEP) Score, quick DASH (qDASH) and Timmerman-Andrews (TA) Elbow Score. Results Nine patients met inclusion criteria and were available for follow-up. Five were initially treated operatively and 4 were initially treated non-operatively. The operative group initially consisted of 3 ulnar collateral ligament reconstructions (UCLR) and 2 UCL repairs with internal bracing. One patient crossed over to the operative group after failing non-operative treatment and underwent UCLR 4 months post injury. Overall, 66.7% and 100% of operatively and non-operatively treated gymnasts were able to return to play, respectively. At final follow-up, the operative groups’ mean KJOC, MEP, TA and qDASH scores were: 68.4 ± 7.7, 97.5 ± 2.7, 90.8 ± 10.7 and 1.9 ± 3.0, respectively. For the non-operative group, the mean scores were 67.4 ± 9.0, 71.7 ± 5.8, 71.7 ± 14.4 and 11.4 ± 9.9, respectively. Treatment satisfaction for the operative group was 81.7 ± 27.5 compared to 80.6 ± 34.5 in the non-operative group. Odds ratios indicated no differences between groups. Conclusion Both operative and non-operative interventions for UCL injuries in gymnasts can provide favorable outcomes with respect to return to play and subjective patient-reported outcomes. Further research is warranted to determine optimal treatment, especially regarding indications for operative vs. nonoperative treatment, of UCL injury based on injury severity and location in gymnasts. Level of Evidence Level III

Stability analysis of deep foundation pit with a double-row cast-in-place piles and diagonal steel lattice braces under sloped excavation conditions

Existing deep foundation pit support structures are commonly composed of external earth-retaining structures, internal horizontal bracings, and vertical columns. A closed bracing system, often formed by a horizontal support through a bracket board, frequently impedes vertical excavation and soil removal operations in the foundation pit, and the processes of assembly and dismantling are complex and time-consuming. This study presents a combined support system and construction method consisting of cast-in-place piles and diagonal steel lattice braces. For sloped excavation, diagonal braces were constructed by slotting through the reserved soil, allowing the use of a single layer of support within the excavation depth. This approach significantly optimizes the construction process, reducing both project duration and overall cost. The field monitoring results indicated that the support method effectively controlled the lateral displacement of the pile bodies. Field monitoring results demonstrated that the proposed support system effectively controlled the lateral displacement of the pile bodies. The adoption of a support-first, excavation-second approach significantly controlled the settlement of the ground surface around the foundation pit, thereby preventing excessive increments in the axial force of the supports due to the large longitudinal depth excavation. The calculation results of the three-dimensional finite element model for foundation pit excavation and support indicate that the proposed support method results in a decreasing ratio of the maximum lateral deformation depth of the pile body, denoted as δh-m, to the excavation depth He as the excavation depth increases. This implied that the displacement of the pile body was strictly controlled. When the depth of the foundation pit excavation exceeded 10 m, the maximum lateral deformation occurred below 10 m along the pile shaft. The diagonal steel lattice braces transferred the load to the top of the cast-in-place piles at the bottom of the pit, where the stress concentration occurred. During construction, special attention must be paid to the strength of the connection between the pile top and the connecting beams.

Use of Internal Bracing in Multi-ligamentous Knee Injury Reconstruction: A Systematic Review.

Multi-ligament Knee Injuries (MLKI) are often caused by a high-energy impact resulting in dislocation of the knee joint. Given the higher degree of instability associated with these MLKIs, surgical fixation with adjunctive internal bracing and the use of suture augmentation have been proposed with the intention of better restoring knee stability and improving the long-term outcomes of surgery. This systematic review seeks to appraise the current literature in relation to the role of internal bracing in the management of MLKI. All randomised control trials, observational studies, cohort studies, and cross-sectional studies containing patients with multi-ligamentous knee injuries managed with the use of internal bracing or suture tape augmentation were included in this review. The primary outcomes of interest were re-operation and failure rates, with secondary outcomes focussed on patient-reported outcome measures (PROMs) and examination findings of knee stability. 282 studies were identified for screening, 13 of which were suitable for inclusion and five of these had injuries with Schenck grade III or above. Of the studies identified, failure rates ranged from 0 to 13.6%. Lysholm score was the most commonly utilised PROM tool with scores ranging from 61.8 to 95. Stiffness requiring MUA ± adhesiolysis was a common complication identified across studies. The use of internal bracing in Multi-ligament Knee Injuries appears to be as effective as not using an internal bracing technique. The post-operative PROMs and relatively low failure rates reflect promising outcomes for the ongoing use of internal bracing in MLKI. However, further prospective studies directly comparing braced versus non-braced ligamentous repairs are required in order to definitively determine if the use of the internal brace does allow for increased joint stability and early rehabilitation.

ACL reconstruction demonstrates better stability compared to ACL repair for patients with Schenck III and IV knee dislocations.

This study compared mid-term outcomes of two anterior cruciate ligament (ACL) restoration techniques within an early total surgical care of acute knee dislocation: repair with additional internal bracing (ACLIB) and reconstruction with autograft (ACLR). Initial results at 12 months demonstrated that ACLR offered superior stability compared to ACLIB. Retrospective clinical study of patients with acute type III or IV KD. ACLIB or ACLR procedures were performed accompanied by simultaneous suture and internal bracing of the posterior cruciate ligament (PCL) and repair with lateral augmentation of the medial and lateral complex injuries utilizing Arciero's reconstruction technique. Patient-reported outcome measurements (PROMs), instrumental stability assessment via the Rolimeter-Test, and stress radiographs were analyzed. The study involved 20 patients (5 IIIM, 5 IIIL, and 10 IV injuries) with an average follow-up of 35.2 ± 7.4 months. Notable differences in anterior tibial translation on stress radiography favouring ACLR persisted at 24-month follow-up in side-to-side difference (SSD) (ACLIB 2.8 ± 2.5mm vs. ACLR 0.3 ± 2.6mm; p = 0.0487), but Rolimeter test variance diminished (SSD ACLIB 2.5 ± 0.9mm vs. ACLR 1.8 ± 1.7mm). Both groups showed excellent PROMs (Lysholm Score: ACLIB 84.4 ± 15.8 vs. ACLR 89.9 ± 9.0; IKDC Score: ACLIB 77.1 ± 16.2 vs. ACLR 77.7 ± 8.6). Our results indicate improved anterior stability at 12 months, which persisted at 24 months after ACL reconstruction compared with ACL repair by stress radiography. Both groups showed favourable patient-reported outcomes throughout the follow-up period. Notable rates of postoperative knee stiffness were observed in both groups. These were successfully managed with early, one-time arthroscopic arthrolysis within the first seven months of treatment, resulting in no major range of motion limitations at the 24-month follow-up. Retrospective cohort study, III.

Structure optimization and contact law study for transmission linkage of manipulator grasping fragile parts

According to the grasping requirements for fragile workpieces with cylindrical inner walls, a manipulator with internal bracing has been designed. The manipulator utilizes a constant-speed push cylinder to drive the linkage mechanism and accomplish the related works. Considering the fragile nature of the workpieces, reducing the impact velocity between the manipulator finger and the workpiece is a primary objective in the mechanism design. To achieve this, an optimization design is carried out, which maintains the overall average speed of the manipulator, while reducing the average speed only during the contact between the finger and the workpiece. The goal of optimization is to minimize the impact velocity at the contact point, using the linkage structure parameters as variables. The genetic algorithm (GA) is employed for the optimization process. The results show that optimization reduces the impact velocity at the contact point by 44.80%. To gain further insight into the influence of the process, a finite element model of a finger grasping a fragile object was created using joint modeling with the SolidWorks, Hyper Mesh, and LS-DYNA software. Simulations reveal that, after optimization, the maximum internal stress of three workpieces with thicknesses of 2.00 mm, 1.00 mm, and 0.50 mm was reduced by 47.42%, 41.53%, and 44.20%, respectively. To study the general law of the mechanical hand grasping fragile workpieces, the relationship between the cylinder driving speed and the impact speed is established. Based on the simulation results of maximum contact impact velocity, workpiece wall thickness, and maximum contact force, a prediction model of workpiece internal force is established using the Kriging prediction model theory. Additionally, the feasible range of grasping parameters under different wall thickness conditions is determined and discussed. The reliability of the designed structure is experimentally verified, providing valuable insights for ensuring the lifting work reliability of manipulators handling fragile workpieces.

Experimental and numerical investigation of the load-bearing capacity of bolt-fastened wedge active joints for prestressed internal bracing in subway excavations

The present study develops a novel type of active joint node-bolt fasten wedge (BFW) active joints, aiming to investigate the load-bearing capacity of a BFW joint in a quantitative way and put forward precise formulas for its yield load and compression rigidity. To achieve this, indoor axial loading tests were conducted on two BFW joints, accompanied by a set of numerical simulations with the finite element approach (FEA) implemented in ABAQUS. Parametric research was then conducted to assess the impact of various factors on the yield load and initial compression rigidity of BFW joints, leading to the derivation of precise calculation formulas for accurate prediction of these parameters. The key findings indicate that enhancing the bolt strength from 10.9 to 12.9 significantly improves mechanical performance. Under axial compression, the final bearing force, yield load, and initial compression rigidity increase by 0.86, 1.06, and 0.15 times, respectively. Numerical models accurately predict joint behavior under axial force, confirming their reliability. Parameter studies reveal that increasing web and eaves thickness, bolt strength, and diameter improves bearing capacity, while splint thickness has little effect. The fitting formulas introduced can precisely estimate yield load and rigidity, providing practical value for engineering applications.

Poster 163: Direct Comparison of Modified Jobe and Docking Reconstructions to UCL Repair with Internal Brace at Mid-Term Follow-Up

Objectives: The modified Jobe and Docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques with prior research demonstrating successful and equivalent outcomes at midterm follow-up. More recently, UCL repair augmented with the Internal Brace (IB) has been investigated as a possible alternative with cadaveric studies demonstrating improved time-zero biomechanics and favorable clinical results at early follow-up, with possible earlier return to play. However, there has been no comparison between UCL repair with IB and these reconstruction techniques, nor has longer term follow-up been reported. The purpose of this study was to directly compare clinical outcomes at mid-term follow-up of these three surgical techniques: the modified Jobe, Docking, and repair with IB when performed by a single surgeon. Methods: Nineteen UCL repair with IB surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Patients were matched by age, gender, and handedness to patients from previously published modified Jobe and Docking cohorts. Conway Scale, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, and need for additional surgery were compared between groups. Continuous variables are displayed as mean ± standard deviation unless otherwise indicated, with groups compared using a Kruskal-Wallis test. Categorical variables are displayed as count (percentage total), with pairwise comparison between groups performed using a Fisher’s exact test. When there were greater than 2 categorical variables, groups were compared with chi square test for trend. For multiple comparisons of categorical variables, the lowest P value is shown in Tables 1 and 2, with no comparison reaching P < 0.05, which was considered significant. Results: Patients were similar with respect to age ( p=0.52), gender ( p>0.60), handedness ( p>0.17), sport ( p>0.16), position ( p>0.07), years played ( p=0.69), level of competition ( p>0.26), future shoulder surgery ( p>0.65), and future elbow surgery ( p>0.48) (Table 1). The mean follow-up was 5.7 ± 3.5 years, 7.4 ± 4.7 years, and 5.4 ± 1.2 years in the modified Jobe, Docking, and repair with IB groups, respectively ( p=0.55). No difference was identified between techniques in KJOC scores (modified Jobe, 73.5 ± 23.6; Docking, 74.5 ± 25.5; repair with IB, 75.5 ± 25.3) or Conway Scale (return to play, any level: 73% vs. 84% vs.78%, p>0.11) (Table 2). Conclusions: No differences in outcomes scores or return to play were found when the modified Jobe and Docking UCL reconstruction techniques were compared with the UCL repair with internal brace technique at greater than 5-year average follow-up. Given the similar outcomes between groups, all three techniques are viable treatment options for UCL injuries. Sufficient clinical equipoise exists in surgical decision making, with repair being a durable option in the proper patient.

Paper 21: Anatomic Medial Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation in Throwing Athletes

Objectives: Injury to the Medial Ulnar Collateral Ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12-18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL which may contribute to the prolonged course of rehabilitation. In recent years, we described an anatomic MUCL reconstruction with internal brace augmentation which demonstrated improved biomechanical strength when compared to the docking technique in cadaveric specimens. The purpose of this study was to evaluate the postoperative course of both amateur and professional throwing athletes that underwent anatomic MUCL reconstruction with internal brace augmentation. We hypothesized that throwers would return to the same level of play and that return to play (RTP) would be a shorter duration compared to current reported outcomes. Methods: In this surgical technique, the native MUCL is formally repaired. The graft and a suture tape are folded over a suspensory loop and secured in a socket of the medial epicondyle of the humerus to maximize tendon to bone contact. On the ulnar side, the graft and internal brace are secured proximally by two suture anchors on either side of the sublime tubercle and further secured across the sublime tubercle ridge distally to re-create the anatomic triangular insertion of the native ligament. All surgeries were performed by a single surgeon. Patient reported outcomes in addition to date of RTP, level of play, and functional outcomes were retrospectively gathered. All patients initially followed an Accelerated Rehabilitation Protocol and were converted to a Standard Paced protocol if setbacks were encountered. Results: A total of 26 baseball players underwent primary (n=23) or revision (n=3) MUCL reconstruction with the Anatomic Technique. Of these, 15 were professional and 11 were amateur athletes. 92% of throwers returned to play at a mean of 9.9 months following reconstruction. 89% were able to advance through the accelerated postoperative protocol without issues and 85% returned to the same role and level of play. Post injury KJOC scores improved from 41 to 86.9 and SANE scores improved from 32.5 to 95.5. No significant difference was identified in pre-injury versus post-reconstruction throwing velocity, ball spin rate, or horizontal/vertical ball movement. Conclusions: Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries. Advantages include increased tendon-bone contact of the reconstruction, multiple fixation points, and anatomic restoration of the MUCL. This technique allowed an expedited return to sport for these baseball athletes.

Poster 169: Preliminary Outcomes of Revision UCL Repair With Suture Tape Augmentation for Failure of Primary UCL Reconstruction in Professional and Collegiate Pitchers

Objectives: Injury of the ulnar collateral ligament (UCL) is common in baseball players and pitchers, in particular. The gold standard surgical treatment has been UCL reconstruction with autograft, although, UCL repair with collagen-coated suture tape has shown promise as an alternative recently. The outcomes of UCL reconstruction and UCL repair are well-studied, demonstrating high rates of return to sport and a predictable postoperative course of recovery. However, revision UCL reconstructions with allografts do not demonstrate comparable outcomes when compared with primary procedures. This pilot case series reports on the preliminary outcomes of collegiate and professional pitchers who underwent revision UCL repair with collagen-coated suture tape following failure of primary UCL reconstruction. Methods: We performed a retrospective query of a prospectively collected data repository to identify patients at our institution who had undergone UCL repair with internal brace. Additional inclusion criteria included: 1) prior failed UCL reconstruction with autograft; 2) aged between 15 and 45 years; 3) at least 1-year post-operative. From the included cohort, we collected demographic, clinical, and surgical data from the electronic health record. We further collected patient-reported outcomes data using either a web-based database platform or via telephone, including the American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E; satisfaction, pain, and function subscales), the Kerlan Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOC), Andrews Carson score, and information on return-to-sport timing and success. To evaluate outcomes, we reported the proportions of athletes that were able to successfully return-to-sport at the preinjury level or higher as well as return-to-sport timing and level of competition. Additionally, we reported summary statistics for patient-reported questionnaires evaluated at follow-up (ASES-E, KJOC, and Andrews Carson). Results: A total of 10 patients met inclusion criteria, and all were professional or collegiate pitchers at the time of their revision UCL repair surgery (40% professional and 60% collegiate). The mean follow-up time was 3.0 years (Table 1; range: 1-5 years). Table 1 shows complete return-to-sport data. All patients were able to return-to-sport at the same or higher level, and the mean time from surgery to return-to-sport was 9.3 months. Table 2 shows complete patient-reported outcomes data. Mean scores on elbow-related function questionnaires were high (ASES-E Function = 35.8 out of a maximum best of 36; KJOC = 88.3 out of a maximum best of 100; Andrews Carson = 94.5 out of a maximum best of 100) and mean pain scores were low (ASES-E Pain = 1 out of a maximum worst score of 50). Conclusions: This pilot case series demonstrated promising results of a novel UCL repair approach utilizing collagen-coated suture tape for high-level pitchers with recurrent medial elbow instability following initial UCL reconstruction with autograft. Specifically, we found excellent return-to-sport success and patient-reported outcomes in this preliminary cohort. Further study is warranted with larger sample sizes to further evaluate outcomes following revision of UCL reconstruction with UCL repair utilizing internal bracing.

No difference in laxity, proprioception and neuromuscular control after suture-tape augmented ACL repair of acute proximal avulsions versus ACL reconstruction using hamstring autografts in young, active population.

The purpose of this study is to compare results of suture-tape augmented anterior cruciate ligament (ACL) repair (internal bracing [IB]) and ACL reconstruction (ACLR) with hamstring autograft in terms of laxity, proprioception and neuromuscular control. The hypothesis was that with strict indications IB may provide better results in proprioception and neuromuscular control. Patients with unilateral ACL injury treated with IB or ACLR with hamstring autograft were enroled in this retrospective study. Anterior tibial translation (ATT) in 30° and 90° of flexion was measured with Rolimeter. The joint position sense (JPS) test was performed in 30° and 60° of flexion using Biodex System 4Pro. The time-synchronized motion capture system and surface electromyography set were used during dynamic tasks to assess knee valgus and semitendinosus (ST) and biceps femoris (BF) activities. Comparisons between both techniques and operated versus contralateral healthy knees were performed. The study groups involved 28 patients after ACLR (21.8 ± 4.8 years) and 20 patients after IB (25.8 ± 10.5 years) with the average follow-up 30 ± 18 and 28 ± 15 months, respectively. The ATT did not differ significantly between operated groups. In 30° of flexion ATT for ACLR was significantly higher in operated than in contralateral knee (5.8 ± 2.4 mm vs. 4.3 ± 1.3 mm, p < 0.001). The JPS test and dynamic knee valgus presented no significant differences. The ACLR group presented significantly higher ST (p = 0.048) and BF (p = 0.012) activity comparing operated to contralateral knee in dynamic tasks. Suture-tape augmented ACL repair and ACLR with hamstring autograft yield similar results in terms of laxity, proprioception and neuromuscular control. Level III: Retrospective comparative study.

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

A Case Study of The Performance of A Pile-Supported Bracing Method for Basement Building

Deep excavations in urban areas are highly hazardous due to extensive settling of the surrounding soil, which can lead to the failure of retaining wall systems and the consequent collapse of adjoining properties. The retaining wall and bracing system are important for completing deep excavations for a basement building project. This paper evaluates the performance of an alternative, innovative, low-cost pile-supported bracing system (PSBS) method during excavation for two-level basement construction. Assessed PSBS performance in terms of ground settlement, lateral movement of supporting systems, schedule, and cost comparison. The PSBS excavation method was designed and then implemented to construct a two-level basement using the bottom-up method. The total station was utilized to monitor three-dimensionally, like the adjacent school building, ground surface settlement, and lateral movement of supporting systems. A schedule and cost comparison were performed using internal bracing and the PSBS technique. The recorded filed data was analysed, and it found that the lateral movement of the support system, adjacent building, and ground settlement is within the allowable limit. According to the estimated results, the PSBS method reduces construction time by 272 days compared to the internal bracing system. The PSBS approach is also less expensive than internal bracing for a two-level basement.

IS INTERNAL BRACE AUGMENTATION (IBA) BETTER THAN ISOLATED MODIFIED BROSTROM GOULD (MBG) REPAIR FOR CHRONIC LATERAL LIGAMENT INJURY? A RETROSPECTIVE ANALYSIS

IntroductionAcute ankle injuries are commonly seen in musculoskeletal practice. Surgical management is the gold standard for lateral ligament injury in those with failed conservative treatment for a minimum of six months. Several studies have shown good functional outcome and early rehabilitation after MBG repair with an internal brace augmentation which is a braided ultrahigh molecular weight polyethylene ligament used to enhance the repair that acts as a secondary stabiliser. Hence the aim of the study was to compare the results with and without augmentation.MethodsA single centre retrospective review conducted between November 2017 and October 2019 and this included 172 patients with symptomatic chronic lateral ligament instability with failed conservative management. The diagnosis was confirmed by MRI. All patients had an ankle arthroscopy followed by open ligament repair. Patients were grouped into isolated MBG and internal brace groups for analyses and all had dedicated rehabilitation.ResultsA total of 148 patients were available for final follow up with 87 patients in the MBG group and 61 patients in the IBA group. Mean Age was 38 years and mean follow up was 22 months. The internal brace group showed better Manchester Oxford foot and ankle score (19.7 vs 18.2) and more patients returning to preinjury activity levels (73 vs 55) as compared to isolated repair.ConclusionInternal brace augmentation with MBG repair facilitated early rehabilitation and return to pre injury activity level in majority of patients compared to isolated MBG repair.

Ulnar collateral ligament repair in professional baseball players.

While initial reports of surgical repair of ulnar collateral ligament tears are promising, studies detailing post-repair outcomes are lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Our hypothesis is that professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. Publicly available databases were utilized to search for data on professional baseball players who underwent UCL repair from 2016 to 2021. Players undergoing primary UCL repair with an internal brace were included. Amateur players were excluded as were those undergoing revision UCL repair or UCL reconstruction. Of the 11 pitchers who underwent UCL repair, minor league baseball (MiLB) pitchers returned to the sport at an average of 17.5 months. MiLB pitchers had similar earned run averages (ERAs), games played, innings pitched, and walks plus hits per inning pitched ratios (WHIPs) before and after surgery. Four major league baseball (MLB) pitchers (80%) returned to the sport at 9.55 months. MLB pitchers played fewer games and pitched fewer innings than before the surgery, but their ERAs and WHIPs were similar before and after surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The seven positional players who underwent UCL repair showed no differences in batting or fielding performance before and after surgery. UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB levels to play at pre-injury performance levels. Repair can be considered as an option for qualifying injuries in players hoping to maximize performance after surgery with minimal recovery time. Level of Evidence: IV.

Scapholunate Ligament Reconstruction With Internal Brace Augmentation Techniques for Chronic Scapholunate Dissociation: A Clinical Follow-up Study.

The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation. This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured. The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively). This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.

Short-term outcomes of 43 dogs treated with arthroscopic suturing for meniscal tears associated with cranial cruciate ligament disease.

To describe short-term outcomes and complications in dogs receiving meniscal suturing and concurrent tibial plateau leveling osteotomy (TPLO) with or without augmentation with an extracapsular suture. Retrospective case series. Forty-three client-owned dogs submitted for cruciate ligament disease. Dogs were included if meniscal suturing was performed during or after a TPLO procedure. Criteria included an unstable medial meniscus without evidence of a tear, a caudal vertical longitudinal tear with or without displacement, or if a bucket-handle tear was debrided and the remaining rim was unstable. Stifle stabilization was performed by either a standard TPLO or an augmented TPLO (TPLO + internal brace [IB]). Outcome measures included physical examination findings, radiographs, subjective gait examination, Liverpool Osteoarthritis in Dogs (LOAD) scores, and second-look arthroscopy. Forty-four meniscal repairs were performed in 43 dogs. Five types of meniscal tears were treated employing eight suture materials. Complications were documented in 15 cases (34%). The stabilization technique had a significant impact on the outcome (p = .049): TPLO + IB had a 93.3% success rate and the success rate was 71.4% in the TPLO-only group. Five types of meniscal pathology were addressed successfully in the study, indicating that currently accepted criteria for meniscal suturing in dogs may be overly conservative. The majority of complications were not related to the meniscal suturing itself and did not compromise the outcome. The stifle stabilization technique had an impact on outcome. The authors found arthroscopic meniscal suturing to be practical and successful in this patient population. Postoperative stifle stability had an impact on successful treatment.

A Randomized Comparison Between Anterior Talofibular Ligament Repair Using Broström Operation with and without an Internal Brace

The aim of the study was to compare the intermediate-term (>24 months) clinical outcomes between anterior talofibular ligament repair using Broström operation with and without an internal brace. Nineteen patients underwent surgery using an arthroscopic traditional Broström repair with an internal brace technique (IB) and Eighteen patients underwent surgery using an arthroscopic traditional Broström repair without an internal brace technique (TB) . All patients were evaluated clinically using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). According to FAAM, sports activity scores of TB and IB groups were 83.33 ± 5.66 and 90.63 ± 6.21 at the final follow-up (p = .02). There were no significant differences in preoperative and postoperative stress radiographs between the two groups. Total medical expense was more in the IB group (p < .001). It also has a significant superiority in the terms of FAAM scores at sports activity. However, there was no difference during daily life.

Operative Treatment of Ulnar Collateral Ligament Injury in Female Athletes.

Ulnar collateral ligament (UCL) reconstruction has been the standard surgical intervention for elite male athletes with UCL insufficiency. Recently, UCL repair and augmentation with an internal brace has been increasingly performed. To evaluate the clinical and functional outcomes as well as return-to-sport rate after UCL repair in female athletes. Case series; Level of evidence, 4. Included were 15 female athletes (mean age, 16.5 ± 3.5 years) who underwent UCL repair between 2011 and 2021 at a single institution. Data collected included age, sport played, competition level, symptom onset, previous surgeries, mechanism of injury, surgical intervention, and return to sport. Patients were contacted via phone at minimum 24-month follow-up, and postoperative outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Of the 15 female athletes, there were 4 cheerleaders, 3 softball players, 2 volleyball players, 2 soccer players, 1 gymnast, 1 tennis player, 1 dancer, and 1 javelin thrower. Ten of the 15 athletes (67%) competed at the high school level, 4 (26%) at the collegiate level, and 1 patient (7%) was a recreational volleyball player. In all patients, there was an acute onset of symptoms after injury. Ten patients underwent UCL repair with an internal brace (67% of athletes), while 5 underwent standard UCL repair. The median MEPS for athletes with and without an internal brace was 100 (range, 80-100). There was no significant difference of MEPS (P = .826) or SANE scores (P = .189) between the patients who received an internal brace and those who did not. Thirteen of the 15 athletes (86.7%) returned to sport. The UCL injuries in the female athletes in this study were the result of acute trauma. Primary UCL repair, both with and without internal bracing, was an effective surgical treatment for returning these athletes to sport.