Proximal Rows Research Articles

Complex Axial Carpal Dislocation with Scapholunate Ligament Injury

Abstract Background Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively. Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury. Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability. Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.

Flow characterization of Maquet and Bio-Medicus multi-stage drainage cannulae during venoarterial extracorporeal membrane oxygenation

Background:Drainage cannulae extract blood from a patient during venoarterial extracorporeal membrane oxygenation (VA ECMO), a treatment that temporarily supports patients undergoing severe heart and/or lung dysfunction. Currently, the two most commonly used multi-stage drainage cannulae are manufactured by Maquet and Bio-Medicus, but their designs vary in many aspects which impacts the generated flow dynamics. Therefore, this study aimed to use computational fluid dynamics (CFD) to explore the flow characteristics of the aforementioned cannulae and their impact on complications such as thrombosis. Methods:The Maquet and Bio-Medicus cannulae were 3D modelled within a patient-specific geometry of the venous vasculature taken from a computed tomography scan of a patient undergoing VA ECMO. A drainage flow rate of 4 L/min was assigned to each cannula. Lastly, a stress blended eddy simulation turbulence model was employed to resolve bulk flow turbulence. Results:The proximal row of side holes in both cannulae generated high intensity counter-rotating vortices, thus generating supraphysiological shear. These proximal rows were also responsible for the majority of flow extraction in both cannulae (>1.6 L/min). Despite identical simulation settings, each cannulae had differing impacts on global flow dynamics. For instance, the Bio-Medicus model produced a total stagnant blood volume of 25.6 ml, compared to 17.8 ml the Maquet cannula, thereby increasing the risk of thrombosis. Conclusions:Overall, our results demonstrate that differences in design clearly impact flow dynamics and risk of complications. Therefore, further work in optimizing cannula design may be beneficial to prevent harmful flow characteristics.

Scaphoid fracture and nonunion: new directions.

The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.

Early outcomes of the Conformable endograft in severe neck angulation from the Triveneto Conformable Registry

ObjectiveThe study reports retrospective evaluation of early outcomes from a multicentric experience with the Excluder conformable endograft with active control system (CEXC Device) in the treatment of abdominal aortic aneurysms. Its design allows more flexibility, given by proximal unconnected stent rows and a bending wire within the delivery catheter enables control of proximal angulation. This study specifically focuses on the severe neck angulation (SNA) subgroup (≥60°). MethodsAll patients treated with CEXC Device in nine vascular surgery centers of Triveneto area (Northeast Italy) between January 2019 and July 2022 were enrolled prospectively and analyzed retrospectively. Demographic and aortic anatomical characteristics were evaluated. Endovascular aneurysm repair in SNA were selected for analysis. Major investigated outcomes were technical success, endoleaks, morbidity, mortality, and reinterventions at 30 days and during follow-up. Endograft migration and postoperative aortic neck angulation changes were also analyzed. ResultsA total of 129 patients were enrolled. An infrarenal angle of ≥60° was observed in 56 patients (43%) (SNA group) and their data analyzed. The mean patient age was 78.9 ± 5.9 years and median abdominal aortic aneurysm diameter 59 mm (range, 45-94 mm). Median aortic infrarenal neck length, angulation and diameter were 22 mm (range, 13-58 mm), 77° (range, 60°-150°), and 22.0 ± 3.5 mm respectively. Analysis revealed a technical success rate of 100% and perioperative major complication rate of 1.7%. Intraoperative and perioperative morbidity and mortality rates were 3.5% (one buttock claudication and one inguinal surgical cutdown) and 0%, respectively. No perioperative type I endoleaks were observed. The median follow-up was 13 months (range, 1-40 months). Five patients died during follow-up from aneurysm-unrelated causes. Two reinterventions occurred (3.5%): one conversion for a type IA endoleak and one sac embolization for a type II endoleak. Aneurysm sac shrinkage was observed in 15 patients (26%) and aneurysm stability in 35 patients (62%), respectively. Estimated freedom from reinterventions at 24 months was 92%. Aortic neck median postoperative angulation was 75° (range, 45°-139°). ConclusionsThe Triveneto Conformable Registry shows good early results of the CEXC device in severely angulated aortic infrarenal necks. These data need confirmation on longer follow-up and a wider cohort of patients to further increase endovascular aneurysm repair eligibility in SNA.

Midcarpal Instability.

Midcarpal instability (MCI) of the wrist represents multiple distinct clinical entities that all have in common abnormal force transmission across the midcarpal joint. This can be asymptomatic but can also result in painful wrist motion, a characteristic catch-up clunk, and symptoms of instability. The carpus is stabilized by numerous extrinsic and intrinsic ligaments. Dynamic joint reactive forces between the proximal and distal carpal rows help create reciprocal motion, which results in smooth, physiologic wrist mechanics. Diagnosis of MCI requires a thorough history, physical examination, and adequate imaging. MCI can be managed nonsurgically with activity modification, physical therapy, specialized orthotics, medications, and corticosteroid injections. A variety of surgical treatment options exists to treat symptomatic MCI. These include arthroscopic thermal capsulorrhaphy, ligament repair or reconstruction, radial osteotomies, and limited radiocarpal or intercarpal fusions. Capsulorrhaphy or ligament repair is favored for mild to moderate cases; osteotomies can be used for the correction of bony deformities contributing to instability, whereas partial wrist arthrodesis is indicated for severe or recurrent instability and fixed deformities.

Effects of Laptop use on Wrist in Students and Teachers of Different Universities during Covid-19

The wrist is an ellipsoidal type (condyloid) of articulation synovial is permitting movements at two axes. The anatomical name of the joint is the radio-carpal joint [1-5].It presents a sinuous opposing. The concave proximal articular surface is formed by the lower end of the radius and the articular disc of the inferior radio-ulnar joint. The reciprocally convex distal articular surface is formed by the scaphoid, lunate and triquetral bones from lateral to the medial side. The joint capsule surrounds the wrist and is attached to the distal ends of the radius and ulna and proximal rows of carpals excluding the pisiform. Strong ligaments strengthen and stabilize the joint from the sides, and on the ventral and dorsal surfaces. Repeated episodes of mechanical stress can cause the event of repetitive motion injuries or overuse injuries, which when including poor posture and biomechanics put much strain on the joints. They usually develop slowly over an extended period of your time. Wrists are one of the foremost common sites of repetitive motion injury. Therefore this research was designed to study the effect of laptop usage among physiotherapists(students and teachers). This study may give awareness to the individual to avoid or minimize the overuse of laptops and therefore the complications by breaking bad habits, practicing recommended/approved posture while using the laptop, and modulating the planning of the keyboards. Due to covid 19 era, the use of laptops and computer has significantly increased among students and teachers of different universities for teaching purposes. Therefore the study was designed to study the impact of laptop use on the wrist in students and Teachers duringcovid 19.Objective: To find the impact of laptop use on the wrist in Physiotherapist during covid 19

Comprehension of Midcarpal Instability

The midcarpal instability is the state with instability between the proximal and distal carpal rows, without dissociation between carpal bones. It can be divided into the intrinsic one that is caused by ligament hyperlaxity, and extrinsic one that is caused secondarily by the malunion of distal radius. The pathophysiology of the intrinsic one is still unknown, and the treatment is also controversial. On the other hand, the extrinsic one can be treated by corrective osteotomy of the radial malunion. This review investigated the comprehension, definition, classification, symptoms, diagnosis, and treatment of the midcarpal instability.

Investigation of Localized Skin Temperature Distribution Across the Transtibial Residual Limb.

Interventions to resolve thermal discomfort as a common complaint in amputees are usually chosen based on the residual limb skin temperature while wearing prosthesis; whereas, less attention has been paid to residual limb skin temperature while outside of the prosthesis. The objective of this study was to explore the localized and regional skin temperature over the transtibial residual limb (TRL) while outside of the prosthesis. Eight unilateral transtibial adults with traumatic amputation were enrolled in this cross-sectional study. Participants sat to remove their prostheses and rested for 30 minutes. Twelve sites were marked circumferentially in four columns (anterolateral, anteromedial, posteromedial, and posterolateral) and longitudinally in three rows (proximal, middle, and distal) over the residual limb and used for attachment of analog thermistors. Skin temperature was recorded and compared for 11 minutes. Furthermore, the relationship of skin temperature with participants' demographic and clinical characteristics was explored. The whole temperature of the TRL was 27.73 (SD=0.83)°C. There was a significant difference in skin temperature between anterior and posterior columns. Likewise, the distal row was significantly different from the proximal and middle rows. The mean temperature at the middle and distal zones of the anteromedial column had the highest and lowest skin temperatures (29.8 and 26.3°C, p<0.05), respectively. The mean temperature of the whole TRL had no significant relationships (p>0.05) with participants' demographic and clinical characteristics. An unequal distribution of temperature over the TRL was found with significantly higher and lower temperatures at its anterior column and distal row, respectively. This temperature pattern should be considered for thermoregulation strategies. Further investigation of the residual limb temperature with and without prosthesis, while considering muscles thickness and blood perfusion rate is warranted.

Novel Technical Factors Affecting Proximal Humerus Fixation Stability.

Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation. A retrospective radiological study. Level 1 trauma center. Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed. Open reduction and internal fixation with the Synthes Philos locking plate. Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications. Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3). The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Trapeziectomy on Carpal Stability.

Background: The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. Methods: A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. Results: A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: -2.2° ± 11.8° to -10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Conclusions: Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.

Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis.

Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.

†Bittacopsocus-a new bizarre genus of †Permopsocida (Insecta) from Burmese Cretaceous amber.

A new insect species (†Bittacopsocus megacephalus Beutel, Prokop, Müller et Pohl gen. et sp. nov.) is described, based on a single small male (ca. 2.5 mm) embedded in mid Cretaceous Burmese amber. The species shows some resemblance with the mecopteran family Bittacidae, mainly due to strongly elongated and thin legs. However, the structural affinities are apparently due to convergency. Different features, but especially the mouthparts and the pattern of wing venation, indicate that the species belongs to the extinct order †Permopsocida (?Archipsyllidae). However, it differs markedly from all species previously described in this extinct group. The very thin and strongly elongated legs are probably autapomorphic. A very unusual feature is the antenna with only seven segments and extremely elongated flagellomeres. The two pairs of wings are unusually narrow. M and CuA are basally fused. Proximal rows of spines, two series of closed cells, and a distinctly increased number of terminal branches of M are present in the forewings, in contrast to other archipsyllid genera. It is conceivable that Bittacopsocus megacephalus used its long legs to rest suspended in the vegetation like Bittacus. The head structures tentatively suggest predatory behavior but the feeding habits are unclarified yet.

Investigating the Echocardiography and Heart Anatomy of Immature Beluga (Huso huso)

Objective: The purpose of present study was to obtain a complete understanding about anatomical features and echocardiography of Beluga (Huso huso) species in order to provide standard approaches for performing echocardiography on this sturgeon species.Design - Experimental studyAnimals -10 immature (2.5 years old) Beluga (Huso huso)Procedures- To perform echocardiography, Sonosite-MicroMaxx ultrasonography Machin and Linear Probe with a frequency of 6-12 MHz of ventral approach between two pectoral fins were used.Results-Four main parts of the heart were identified in investigations and the way of locating and connections of these parts were examined. Sinus venosus had a thin wall and leaned toward left. The atrium wall was characterized by connective tissue and muscle. There was a valve structure between Sinus venosus and atrium. The ventricle had a thick muscular wall with a two-layer appearance. Conus arteriosus leaned toward right. This part had three rows of valves including one distal row and two proximal rows with a certain distance between the distal row and the two proximal rows.Conclusion and Clinical Relevance- Since there has not yet been a complete study on the heart of Beluga species in the terms of ultrasonography and anatomy, the present study can be utilized as a basis for investigating other sturgeon species. In the present study, a standard approach has been provided to perform echocardiography on Beluga species.

A new species of Rhagovelia Mayr, 1865 (Hemiptera: Heteroptera: Veliidae) from Pará State, with an updated key to Brazilian species of the robusta group.

Rhagovelia brunae Magalhães & Moreira sp. nov., collected in the State of Pará, Brazil, is described, illustrated, and compared with congeners. The new species belongs to the robusta group and can be differentiated from others by the general color black, abdominal sternum VII with black denticles laterally, male hind trochanter with 1-4 subequal spines plus a longer spine, and male hind femur lacking a medium spine between the proximal and distal rows of spines. Additionally, an updated identification key to species of the robusta group occurring in Brazil is presented.

Triquetrohamate Coalition with Lunotriquetral and Lunohamate Osteoarthritis

In this article a case of triquetrohamate synostosis with accompanying lunotriquetral and lunohamate osteoarthritis is presented. Triquetrohamate synostosis is a very unusual type of carpal coalition. Generally speaking, carpal coalition is a condition in which two or more carpal bones fail to segment during development, resulting in congenital fusion. The incidence in general population is around 0.13%, however this can be almost ten times higher among black people [1]. The most common coalition is lunotriquetral, representing nearly 90% of all carpal synostosis, followed by capito-hamate coalition with 5.6% of all cases [1]. In the English medical literature triquetrohamate coalition has been described associated to calcaneus-cuboid coalition [2] or to hereditary symphalangism [3, 4]. None of those authors reported concomitant lunotriquetral and lunohamate osteoarthritis. What makes this case also different is the absence of associated conditions particularly since coalition between the proximal and distal carpal rows is usually syndromic [5] Moreover, lunotriquetral osteoarthritis is relatively uncommon and mainly secondary to congenitally incomplete separation of both bones [6]

Joint Ultrasonography of Goats Infected by the Caprine Arthritis Encephalitis Virus

Background: The most important form of caprine arthritis encephalitis virus in the goat is the arthritic, generally observed in animals over eight months of age. Differently in sheep, there is less arthritis incidence, affecting 2-3-year-old animals. The clinical alterations frequently affect goat joints, and an increase in the joint consistency and size is observed. The objective of the present study was to standardize the ultrasound technique to access joints in animals infected with the caprine arthritis encephalitis virus (CAEV), so that it can be a complimentary support tool for diagnosis and animal management.Materials, Methods &amp; Results: Animals were examined from farms located in the municipality of Teresina, state of Piauí, Brazil. For this, the M-Turbo, Sonosite Fujifilm ultrasonography apparatus was used, attached to a linear transducer with 10-13 MHz frequency. The ultrasound examination analyzed three regions: patella-humerus joint, carpal and tarsal joints. The patella-humerus joint was characterized by its concave convex surface. The surface of the head humerus was a fine hyperechoic line composed by the junction between the joint cartilage and the subcontinent bone. The sub patella muscle was visible and its fibers present a parallel and hypoechogenic pattern compared to bone tissue. A discreet muscle edge with echogenicity was observed separating the sub patella and supraspinatus muscles. The surface of the proximal and distal rows of the carpal bones was characterized by fine hyperechogenic lines that formed acoustic shadow. Regarding the bones of the tarsal joint, the surface of the central tarsal joint bone was observed centrally as a fine, hyperechogenic line. The third tarsal joint bone was visualized on the left side and was represented by a thick hyperechoic line, while the fourth tarsal joint bone was observed to the right with a hypoechogenic surface and both formed acoustic shadow.Discussion: Joint inflammation caused by other diseases, such as derived from bacteria of the Micoplasma genus can suggest similar semiological aspects and can present positive results for the joint clinical index. Studies carried out have established measurements of the joints of animals affected by various degrees of arthritis, where absolute values equal or less than 5.5 cm would be indicative of negative arthritis diagnosis, variations between 6.0 and 6.5 cm would be considered suspicious and when equal or greater than 7.0 cm they would be positive. From the anatomical point of view, ultrasound assessment of the joints of the normal animals showed a morphological pattern as observed in dogs, horses and humans. The loss of echogenicity, surface erosions and exposure of subchondral bone observed in goats infected with CAEV were also reported in dogs with patella-humerus osteochondrosis, by the presence of a cartilage flap seen radiographically, or even as cracks, characterized by a hyperechoic line parallel to the subchondral defect, in the ultrasonography examination. The lesions observed in the ultrasound examination showed various degrees of osteoarthritis, with the presence of sound hyperreflection, hyperechogenic areas, cartilage lesions with erosion of the subchondral bone and loss of anatomic limits, and these characteristics were described for the metacarpal phalangeal and metatarsal phalangeal joints of dogs submitted to routine radiographic examination. The ultrasound examination of the joints of normal goats and goats infected with caprine arthritis encephalitis virus allowed the comparative description of normal anatomy, evolution of joint and adjacent soft tissue lesions, generating valuable clinical and surgical information.

Midcarpal instability.

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

Osseous Scaphotrapezial Coalition.

Osseous scaphotrapezial coalition is one of the rarest forms of carpal coalition of the hand. Often discovered incidentally, pain and functional limitation have not been reported. Carpal coalitions occurring across the carpal rows are thought to occur as a result of some insult or congenital anomaly. Isolated scaphotrapezial coalition calls into question the traditional thinking that fusion between the proximal and distal carpal rows must be acquired or associated with congenital syndromes.

Biomechanical Properties of Double- and Single-Row Suture Anchor Repair for Surgical Treatment of Insertional Achilles Tendinopathy

Background: Because of intratendinous ossifications, retrocalcaneal bursitis, or intratendinous necrosis commonly found in insertional tendinosis, it is often necessary to detach the tendon partially or entirely from its tendon-to-bone junction. Hypothesis: Double-row repair for insertional Achilles tendinopathy will generate an increased contact area and demonstrate higher biomechanical stability. Study Design: Controlled laboratory study. Methods: Eighteen cadaver Achilles tendons were split longitudinally and detached, exposing the calcaneus; an ostectomy was performed and the tendon was reattached to the calcaneus in 1 of 2 ways: 2 suture anchors (single row) or a 4-anchor (double row) construct. Footprint area measurements over time, displacement after cyclic loading (2000 cycles), and final load to failure were measured. Results: The double-row refixation technique was statistically superior to the single-row technique in footprint area measurement initially and 5 minutes after repair (P = .009 and P = .01, respectively) but not after 24 hours (P = .713). The double-row construct demonstrated significantly improved measures for peak load (433.9 ± 84.3 N vs 212.0 ± 49.7 N; P = .042), load at yield (354.7 ± 106.2 N vs 198.7 ± 39.5 N; P = .01), and slope (51.8 ± 9.9 N/mm vs 66.7 ± 16.2 N/mm; P = .021). Cyclic loading did not demonstrate significant differences between the 2 constructs. Conclusion: Double-row construct for reinsertion of a completely detached Achilles tendon using proximal and distal rows resulted in significantly larger contact area initially and 5 minutes after repair and led to significantly higher peak load to failure on destructive testing. Clinical Relevance: In treatment for insertional Achilles tendinosis, the tendon often has to be detached and anatomically reattached to its insertion at the calcaneus. To our knowledge there is a lack of biomechanical studies supporting either a number or a pattern of suture anchor fixation. Because the stresses going across the insertion site of the Achilles tendon are significant during rehabilitation and weightbearing activities, it is imperative to have a strong construct that allows satisfactory healing during the early postoperative process.

Understanding Wrist Mechanics: A Long and Winding Road

Understanding Wrist Mechanics: A Long and Winding Road