Partial Avulsion Research Articles

Aquarium Portal Technique for PASTA Lesion Repair

The simultaneous arthroscopic exposure of the subacromial and intra-articular space of the shoulder is challenging in the presence of only partial-thickness rotator cuff tears. We present our experience and method of entering the joint through the opened rotator cuff interval from an anterosuperior portal between the coracoid process and anterior acromion. With moderate (approximately 30°) abduction and external rotation, the rotator interval opens readily, offering a view with the camera toward the anterior edge of the supraspinatus tendon. An anterior view on the anterior leading edge of the supraspinatus tendon is obtained, showing the subacromial space above and the glenohumeral space below the tendon, similar to the view in an aquarium. The rotator cuff can be elevated using a rod inserted intra-articularly from posterior, whereas anchors and other instruments may be inserted from lateral. This approach offers the advantages of full exposure of the posterior undersurface of the rotator cuff insertion; a convenient approximately 90° angle between the camera and instruments; and no need to change portals for anchor placement, tendon stitching, or suture handling. The objective of this Technical Note is to describe our arthroscopic repair approach (aquarium technique) to PASTA (partial articular supraspinatus tendon avulsion) lesions.

The PASTA Bridge: A Technique for the Arthroscopic Repair of PASTA Lesions

PASTA (partial articular supraspinatus tendon avulsion) lesions of greater than 50% thickness are usually repaired, whereas those of less than 50% thickness receive subacromial decompression and debridement. However, tears of greater than 25% thickness of the tendon result in increased strain of the adjacent, intact tendon fibers. Re-creating the tendon footprint at the greater tuberosity is the goal of a repair. Transtendon repairs have been considered the gold standard in repair but have shown varying outcomes and are technically difficult procedures. This report details the PASTA bridge—a technique for the arthroscopic, percutaneous repair of PASTA lesions. The PASTA bridge uses a spinal needle to ensure the repair includes the leading edge of the good tissue and is at the appropriate angle and area. Most procedures use a knife or trocar blindly to access the joint to place anchors, which has the potential to damage surrounding tissues and result in poor anchor and suture placement. The PASTA bridge is a safe, reliable procedure that is easily reproducible and appropriate for surgeons of all experience levels and should be strongly considered when repairing PASTA lesions.

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.

Background:Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery.Purpose:To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve–related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively.Results:The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve–related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients’ sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive.Conclusion:Sciatic nerve–related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment.

The Effectiveness of Matrix Cauterization With Bichloracetic Acid in the Treatment of Ingrown Toenails.

Chemical matricectomy is performed mainly by 2 agents, phenol and sodium hydroxide. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results, but it produces extensive tissue destruction and can result in drainage and a delayed healing time. These adverse effects have brought forward the use of chemical agents such as sodium hydroxide and trichloroacetic acid for matricectomy. This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 90% bichloracetic acid (BCA) in the treatment of the ingrown nails. A total of 30 patients with 58 ingrown toenail edges were included in this study. All of the patients underwent chemical matricectomy with 90% BCA after partial nail avulsion. Adverse effects such as postoperative pain and drainage were minimal in most of the patients. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at the 12th month of the follow-up. No recurrence was observed in 29 patients during mean follow-up period. This was considered to be statistically significant (p < .001). This is the first study to use BCA for the treatment of ingrown toenail. Partial nail avulsion followed by BCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success. Therefore, partial nail avulsion and BCA matricectomy can be used as an alternative treatment method for the treatment of ingrown toenails.

Scarring of the C8-T1 roots with partial avulsion in situ in total obstetric brachial plexus palsy

BackgroundPrimary exploration of the brachial plexus in infants with obstetric palsy may reveal scarring of the lower roots with evidence of partial avulsion-in-situ. As we have been treating this lesion by neurolysis only, we aimed to investigate the recovery of hand function following such approach.MethodsA series of 14 cases of total obstetric palsy with with evidence of partial avulsion-in-situ of the lower roots were included. All lesions were treated by neurolysis only (with no neurotization of the lower roots). Management of the injured upper roots was done by neurotization. Recovery was assessed as per our motor grading system.ResultsAfter a minimum follow-up of 4 years, hand functional recovery was considered good in 7 patients and excellent in the remaining 7 patients.ConclusionsWe highlight the scarring of lower roots with evidence of partial avulsion-in situ in obstetric palsy. We also document that neurolysis is an acceptable approach to such lesions.Level of Evidence: Level IV, therapeutic study.

Magnetic resonance arthrography results that indicate surgical treatment for partial articular-sided supraspinatus tendon avulsion: a retrospective study in a tertiary center.

Background Specific findings on magnetic resonance arthrography (MRA) that indicate the need for surgery in patients with partial articular-sided supraspinatus tendon avulsion (PASTA) are not well understood. Purpose To determine which MRA findings are characteristic of patients who undergo surgery for PASTA. Material and Methods From July 2011 to February 2014, MRA findings for patients treated for PASTA were retrospectively reviewed. The patients were divided into two groups: conservative treatment and surgical repair. MRA findings were compared between the groups. The following MRA results were assessed: length grade, width grade, co-existing superior labrum anterior posterior (SLAP) lesions, degenerative changes in the glenohumeral joint, presence of subacromial-subdeltoid bursitis, acromion type, presence of adhesive capsulitis, and tears of the subscapularis or infraspinatus tendon within the rotator cuff. Logistic regression analyses were conducted to identify which MRA findings were significantly associated with surgical treatment. Results Forty-five surgically treated patients and 203 conservatively treated ones were evaluated. The MRA findings showed significant differences between the groups with respect to length grade, width grade, degenerative changes in glenohumeral joint, bursitis, and co-existing rotator cuff tears ( P < 0.05). Multivariate logistic regression showed correlations between surgical repair and both grade 3 length tears (odds ratio, 30.8) and co-existing tears of the subscapularis or infraspinatus tendon (odds ratio, 2.9). Conclusion Surgical treatment is commonly performed in PASTA patients whose lesion lengths are grade 3 or who have co-existing tears in the subscapularis or infraspinatus tendon. Radiologists should pay attention to these MRA signs when evaluating PASTA patients.

Acute Vision Loss Due to Central Retinal Arterial Occlusion, Partial Optic Nerve Avulsion, and Hemorrhage "Spurting Out" from Optic Disc after Blunt Trauma.

Acute Vision Loss Due to Central Retinal Arterial Occlusion, Partial Optic Nerve Avulsion, and Hemorrhage "Spurting Out" from Optic Disc after Blunt Trauma.

Computed tomography of nuchal ligament and semispinalis capitis tendon avulsions in a foal

SummaryHead trauma is a common injury in young horses. This case report describes a 10‐week‐old Thoroughbred foal with an open wound following trauma to the poll region, showing abnormal head carriage and depression. A computed tomography (CT) study was performed under general anaesthetic (GA). This identified a complete avulsion of the nuchal ligament (NL) and partial avulsions of the left and right semispinalis capitis (SS) tendons. Following diagnosis and conservative treatment the foal made a good recovery and 18 months later the filly had no detectable neurological or physical abnormalities. Computed tomography enabled an accurate and rapid diagnosis of a novel injury.

Criticality in the planform behavior of the Ganges River meanders

Abstract The critical point of planform transition from straight to meandering in the wandering Ganges River is identifiable. Recent remote-sensing data indicate that four similar meanders cut off, or attempted to cut off, after ∼31–35 yr, primarily due to channel aggradation. As main channels aggrade, sinuosity is maximized for broad channel widths and small radii of curvature and relaxes for bends of greater radii. Maximized form resistance occurs close to self-organized criticality and promotes cutoffs. Avulsions lead to main channel narrowing and prevent further bend tightening, relaxing the system by reducing sinuosity. Thus, the wandering river oscillates in space and time across the transition from a more ordered to a more chaotic state. Planform behavior is described by the Jerolmack-Mohrig mobility number and the Parker stability criterion, which well define meanders behavior as they approach criticality and then relax via partial or completed avulsions. The results have significance for river engineering and river network and stratigraphic modeling. Such an approach could be of practical value when predicting the behaviors of other major wandering rivers.

Percutaneous Salvage After Partial Avulsion of Mitral Clip Repair

Percutaneous Salvage After Partial Avulsion of Mitral Clip Repair

Floodplain morphology, sedimentology, and development processes of a partially alluvial channel

The floodplain morphology, sediment deposits, and development mechanisms of a partially alluvial, low-moderate energy channel flowing over a mixed gravel/cobble-till bed are investigated and compared to existing ideas of floodplain development. The findings partially support the idea of a floodplain developed through lateral accretion capped with vertically accreted sediments as predicted by the energy-based classification scheme of Nanson and Croke (1992), though oblique accretion and partial channel avulsion are also important. Channel migration consists of limited cross-valley migration and downstream meander translation. Because of low channel sinuosity, well-formed neck cutoffs are rare, and instead the channel cuts headward along the insides of confined or underdeveloped meander bends forming a localized anabranching pattern. The floodplain architecture can be divided into gravel bar and bed deposits (GB), lateral accretion deposits (LA), overbank deposits (FF), and abandoned channel deposits (FF(CH)), which are described with four alluvial facies. Owing to the limited supply of coarse and fine sediment, none of the architectural elements are particularly thick, with total floodplain thickness being <3m. Floodplain development for partially alluvial channels is compared within a new floodplain discrimination framework. Comparisons with common facies models of single-thread, coarse-grained channels show important differences that suggest that the floodplain deposits and formative processes described herein represent a subset of single-thread systems that may be common in partially alluvial channels, particularly in slightly sinuous, coarse-grained channels of low-moderate energy with partly confined floodplains.

The Arthroscopic Hill-Sachs Remplissage: A Technique Using a PASTA Repair Kit

The arthroscopic remplissage procedure has gained popularity in recent years and is gaining acceptance as an excellent and safe procedure to perform in patients with large engaging Hill-Sachs lesions. The procedure was introduced as an arthroscopic procedure, but surgeons not familiar with the procedure often encounter many problems, which makes the procedure difficult and frustrating to perform. A technique for this procedure using a commercially available PASTA (partial articular supraspinatus tendon avulsion) repair kit is presented.

Lithium accelerates functional motor recovery by improving remyelination of regenerating axons following ventral root avulsion and reimplantation

Brachial plexus injury (BPI) often involves the complete or partial avulsion of one or more of the cervical nerve roots, which leads to permanent paralysis of the innervated muscles. Reimplantation surgery has been attempted as a clinical treatment for brachial plexus root avulsion but has failed to achieve complete functional recovery. Lithium is a mood stabilizer drug that is used to treat bipolar disorder; however, its effects on spinal cord or peripheral nerve injuries have also been reported. The purpose of this study was to investigate whether lithium can improve functional motor recovery after ventral root avulsion and reimplantation in a rat model of BPI. The results showed that systemic treatment with a clinical dose of lithium promoted motor neuron outgrowth and increased the efficiency of motor unit regeneration through enhanced remyelination. An analysis of myelin-associated genes showed that the effects of lithium started during the early phase of remyelination and persisted through the late stage of the process. Efficient remyelination of the regenerated axons in the lithium-treated rats led to an earlier functional recovery. Therefore, we demonstrated that lithium might be a potential clinical treatment for BPI in combination with reimplantation surgery.

Diagnosis, Evaluation, and Endoscopic Repair of Partial Articular Gluteus Tendon Avulsion

In addition to trochanteric bursitis, gluteus medius and minimus tears (GMMTs) can be a common source of insidious lateral hip pain and dysfunction. Partial-thickness GMMTs are much more common than full-thickness GMMTs but are frequently overlooked by both radiologists and orthopaedic surgeons. GMMTs are commonly identified on magnetic resonance imaging ordered for lateral hip pain unresponsive to conservative management. Imaging can show that high-grade partial articular gluteus tendon avulsion (PAGTA) can occur as either an isolated gluteus medius tear, an isolated gluteus minimus tear, or a combined GMMT. We describe how to identify PAGTA injuries with intraoperative assessment and identification of the interval between the gluteus medius and minimus tendons to allow access to the PAGTA without violating the bursal side of the tendon. PAGTAs can be repaired arthroscopically by single- or double-row suture anchor fixation depending on the size of the tear. The purpose of this article is to guide orthopaedic surgeons in the recognition of PAGTA with magnetic resonance imaging and dynamic examination to allow for accurate repair of GMMTs.

Arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion.

To evaluate the outcomes of arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion (PASTA) in a large study group. A retrospective review of prospectively collected data was conducted. One hundred and eighteen patients with PASTA lesion (grade A2-A3) who underwent arthroscopic transtendon repair were identified, of which 110 were eligible for the study. Ten patients were lost at final follow-up leaving a study group of 100 patients (52 male, 48 female). The average follow-up was 37months (minimum 24months, range 24-50, median 40). Mean age at the time of surgery was 50.4 (range 17-71, median 45). Patients were assessed before surgery and at 24-month follow-up, using the Simple Shoulder Test (SST), UCLA shoulder rating scale and the visual analogue scale (VAS). ROM was measured bilaterally and was evaluated before surgery, at 3-, 6- and 24-month follow-up. The satisfaction rate was calculated. Data were analysed using a paired Student's t test with 95% confidence interval (significance p<0.05). Significant improvement in UCLA, SST and VAS score was observed. Fifty-four cases were rated excellent, 42 good, 2 fair, 2 poor according to the UCLA score. No significant differences in ROM were noted compared to the contra-lateral side (p<0.001) at the 24-month follow-up. Eighteen patients presented with a stiff shoulder at the 3-month follow-up, but they recovered full ROM by the 6-month follow-up evaluation. The arthroscopic transtendon repair of partial articular-sided rotator cuff tears is an effective procedure that leads to significant improvement in pain and shoulder function, with high patients' satisfaction rate, while the complication rate is low. This study demonstrated the effectiveness and safety of this technique in a large homogeneous study group. IV.

Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases.

Background:Subvastus approach used in total knee arthroplasty (TKA) is known to produce an earlier recovery but is not commonly utilized for TKA when the preoperative range of motion (ROM) of the knee is limited. Subvastus approach is known for its ability to give earlier recovery due to less postoperative pain and early mobilization (due to rapid quadriceps recovery). Subvastus approach is considered as a relative contraindication for TKA in knees with limited ROM due to difficulty in exposure which can increase risk of complications such as patellar tendon avulsion or medial collateral injury. Short stature and obesity are also relative contraindications. Tarabichi successfully used subvastus approach in knees with limited preoperative ROM. However, there are no large series in literature with the experience of the subvatus approach in knees with limited preoperative ROM. We are presenting our experience of the subvastus approach for TKA in knees with limited ROM.Materials and Methods:We conducted retrospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 2 years results. There were a total 84 patients (110 knees) with mean age 64 (range 49–79 years) years. The mean preoperative flexion was 72° (range 40°–90°) with a total ROM of 64° (range 36°–90°).Results:Postoperatively knee flexion improved by mean 38° (P < 0.05) which was significant as assed by Student's t- test. The mean knee society score improved from 36 (range 20–60) to 80 (range 70–90) postoperatively (P < 0.05). There was one case of partial avulsion of patellar tendon from the tibial tubercle.Conclusions:We concluded that satisfactory results of TKA can be obtained in knees with limited preoperative ROM using subvastus approach maintaining the advantages of early mobilization.

PASTA-lesions--debridement versus repair

Partial articular supraspinatus tendon avulsions (PASTA) lesions remain challenging with regard to diagnosis and treatment. For the diagnosis of PASTA lesions, arthroscopic evaluation of the supraspinatus tendon is key. Preoperative imaging alone is usually not sufficient to make the treatment decision. For non-significant partial tears of less than 50 % of the tendon thickness a simple debridement is indicated. Two basic repair techniques, a transtendon repair technique and a repair after tear completion, can be distinguished. In PASTA lesions, a repair is generally preferred to debridement. Results in the literature do not favor one repair technique over the other. Prospective randomized trials comparing debridement with repair are lacking in the literature. From a technical standpoint tear completion and repair seem to be a bit more reproducible.

Resultados clínicos y funcionales de la artroplastia total de rodilla Low Contact Stress (LCS®) con un mínimo de 5 años de seguimiento

IntroductionRotating-platform knee prosthesis were design to reduce contact stress of the implants and to increase the durability of implants. ObjectiveTo report the clinical outcomes of a consecutive series of patients who underwent primary rotating-platform knee arthroplasty, with a mean follow-up of 94 months. Material and methodFrom 2003 to 2010, 75 total knee replacements were performed with Low Contact Stress (LCS®) rotating-platform prosthesis. Painful knee osteoarthritis was the main diagnosis. Mean follow-up was 94 (60-118) months. Preoperatively, 64 knees had varus angulation (mean: 169°) and eleven knees had valgus angulation (mean: 187.8°). Patients were evaluated with the Hospital for Special Surgery (HSS) score at 1, 12, 36 and 60 months postoperatively. ResultsTwo intraoperative partial patella tendon avulsions (2.6%) were diagnosed. Six knees showed loosening of the tibial component (8%) and four (5.3%) required revision. Two chronic infections (2.6%) were successfully managed. No polyethylene dislocation (spin-out) was observed. The mean preoperative HSS score was 44.6 points, which improved to 86.9 points at the end of the follow-up (P<0.001). ConclusionOur study showed good survivorship and functional results of rotating-platform knee replacement at a mean follow-up of 94 months, similar to results of conventional fixed-bearing TKA. Level of evidenceIV.

Giant subungual glomus tumor: clinical, dermoscopy, imagiologic and surgery details

Glomus tumor is a rare benign vascular hamartoma derived from the modified smooth muscle cells of the glomus body. Paroxysmal pain is the leading symptom. A 78-year-old woman presented at our clinic with a 50-year history of a slow growing painful purple blue tender nodule under the right fourth finger nail. Dermoscopy and magnetic ressonance confirmed the presence of a large subungual tumor and total surgical excision was performed after partial nail plate avulsion. Histologic examination confirmed a glomus tumor. After 1 year of follow-up, the nail grew with normal shape and neither complications nor recurrence were observed.

Subungual Glomus Tumour Excision with Transungual Approach with Partial Proximal Nail Avulsion.

Subungual Glomus Tumour Excision with Transungual Approach with Partial Proximal Nail Avulsion.