Reinsertion Technique Research Articles

"The Chambat Sardine Can" technique for the treatment of chronic quadriceps tendon rupture.

Ruptures of the quadriceps tendon (QT) are rare but serious injuries accounting for less than 2% of all tendon injuries around the knee. These injuries, often occurring in individuals over 40, are leading to a loss of active extension and a significant impact on knee function. While the treatment of acute QT ruptures through various reinsertion techniques has shown excellent outcomes, managing chronic injuries and failed primary repairs remains challenging due to tendon retraction and difficulties in repositioning the tendon stump. This study introduces a novel approach associating direct tendon reinsertion with metal frame reinforcement, aiming to effectively lower the retracted tendon to the proximal pole of the patella. This technique offers a promising alternative that addresses the limitations of traditional methods and potentially improves patient outcomes by providing a safe primary fixation and protection of the repair, enabling early rehabilitation and reducing the need for subsequent interventions. LEVEL OF EVIDENCE: IV; case series study.

How To Avoid Suture Damage in Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Posterior Root Reinsertion With the Transtibial Pullout Technique: A Technical Note

Lateral meniscus posterior root tears (LMPRTs) are estimated to occur in 7% to 12% of anterior cruciate ligament (ACL)-injured knees. This topic is of great interest because of their biomechanical consequences in terms of interruption of hoop stress distribution. If left unrepaired, the corresponding compartment is exposed to unfavorable contact dynamics, similar to those resulting from a total meniscectomy. This Technical Note describes a transtibial LMPRT repair using a Knee Scorpion and an 18-gauge spinal needle. It is a reproducible arthroscopic LMPR reinsertion technique combined with concomitant standard ACL + anterolateral ligament reconstruction with hamstring tendons and it describes how to safely avoid damage to root traction sutures during the ACL independent tibial tunnel drilling.

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies.

Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears. A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair. A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair. These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique.

Replacement Versus Same-Site Salvage Using Hickman Catheter for Pediatric Stem Cell Transplantation Patients: A Comparative Study

Children undergoing bone marrow transplant need a double-lumen Hickman line. Therefore, changing Port-a-Cath ports to double-lumen Hickman catheter is mandatory. Several methods were described for changing Port-a-Cath ports either through the same-site or a new placement access site. The advantage of one method over the other is still debatable. We conducted this study to compare the safety and effectiveness of replacement versus salvage techniques to change ports to the Hickman lines before bone marrow transplants in pediatric patients. We included 85 pediatric patients who underwent stem cell transplants. Their age ranged from 0.2 to 15 years. According to the Hickman reinsertion technique, we classified the patients into 2 groups; the Replacement group (n = 47) and the Same-site salvage group (n = 38). We compared the data before and after Hickman insertion between both groups. Study outcomes were the catheter duration, its complications, and mortality. The mean age of all patients was 4.7 ± 3.9 years, and 65.9% were males. There was no difference in the baseline data between both groups. During Port-a- Cath first insertion; 16.5% of patients suffered complications, with 10.6% had conversion to cut down, 1.2% had a hematoma, and 4.7% had multiple site insertion. We did not report differences between groups in the complications of the first port insertion. The Hickman duration was longer in the replacement group (4 (Q1-Q2: 2-6) vs. 1 (0.5-3) months, P = 0.005). Increased age (odds ratio [OR]: 1.31, P = 0.001) and male gender (OR: 1.19, P = 0.046) were independent predictors of mortality. Endovascular same-site salvage technique could help preserve vascular access during the tunnel catheter exchange for noninfectious reasons. We recommend the use of the same-site salvage technique in pediatric transplant patients.

Mini-open surgical management of a type-2 jersey finger under WALANT with ultrasound assistance: A case report about a new technique

We describe an innovative mini-open technique for reinsertion of the flexor digitorum profundus tendon under Wide Awake Local Anesthesia No Tourniquet (WALANT) with ultrasound assistance. Ultrasound-aided detection at the surgeon’s practice is used to plan the surgical tendon repair procedure so that tendon reinsertion can be performed with the smallest incision possible. Passage of the tendon through the digital sheath was accomplished with the help of a compressive tendon guide to avoid a surgical approach. Reinsertion of the tendon under WALANT monitoring enables intraoperative validation of repair tension and physiological restitution of tendon glide within the digital sheath. Postoperative ultrasonographic examination at the surgeon's practice is an occasion to further patient education begun intraoperatively under WALANT.

A prospective comparative study of arthroscopic Brostrom procedure alone vs. Brostrom-Gould procedure in the repair of isolated ATFL injury at follow-up in one year

Objectives:Arthroscopic Brostrom-Gould procedure is the reference technique in the treatment of isolated anterior talofibular ligament injury. Extensor retinaculum reinforcement uses the proximal part, without any mechanical function. The objective is to compare the isolated ATFL reinsertion technique with reinsertion + biological augmentation.Methods:This is a prospective study that compares the isolated ATFL reinsertion technique (Brostrom) vs. reinsertion + retinaculum reinforcement (Brostrom-Gould) at one year follow-up. 2 groups of 25 patients were selected. The two groups matched in terms of age, weight, and gender. All patients presented with isolated ATFL with stage 1 or 2 lesions according to the French arthroscopy society (SFA) classification. Patients were clinically evaluated preoperative and in one year with the FAAM and FAOS scores and the recurrence rate was assessed as well as passive joint amplitudes pre- and postoperatively. There was a single operator for the series and the surgical technique was chosen before surgery. Patients had the same postoperative rehabilitation protocol (ankle splint to be worn for 30 days with weight-bearing, no work in varus before 30 days, rehabilitation at D2).Results:Regarding clinical scores, in both groups there was a significant improvement in the sports FAAM and FAOS scores in the postoperative period. In the isolated Brostrom group, the FAAM score increased from 20 to 29 and the FAOS score from 75% to 95%. In the Brostrom-Gould group, the FAAM score increased from 19 to 30 and the FAOS score from 77% to 96%. There was no significant difference between the 2 groups. We identified no postoperative complications in either group. A sprain recurred in 2 patients in the Brostrom-Gould group and in 3 patients in the isolated Brostrom group. The sprain was mild in all cases and was controlled by ultrasound. The joint amplitudes in active plantar flexion were 36° in the isolated Brostrom group and 34° in the Brostrom-Gould group. There was no significant difference between the 2 groups.Conclusion:Our study shows that there is no difference between the isolated arthroscopic Brostrom technique and the Brostrom-Gould technique in the management of isolated ATFL grade 1 and 2 lesions in terms of recurrence and clinical scores and that the isolated Brostrom technique can be used to treat these lesions.

New online reinsertion approaches for a dynamic Dial-a-Ride Problem

This study is inspired by a challenging dynamic Dial-a-Ride Problem (DARP) encountered in a mobility service operated by the company Padam.11www.padam.io . Customers ask for a transportation service either in advance or in real-time and get an immediate answer about whether their requests are accepted or rejected. The main goal is to maximize the number of accepted requests during the service while respecting maximum capacity of limited number of vehicles. In this study, we propose novel methods based on reinsertion techniques to improve Padam's online system. The proposed reinsertion techniques aim to exploit the neighborhood of a solution and must be run in real-time whenever a request is rejected by an online system. Three main online reinsertion heuristics based on different neighborhoods are proposed. The first heuristic called HDR uses destruction and repair operators, the second heuristic called GH (graph heuristic) uses the ejection chain concept, and allow modeling the reinsertion problem as a constrained shortest path problem on directed graph built from a current solution, and the third heuristic called IGH (improved graph heuristic) based on GH with intensive exploration of the neighborhood. Our proposed approaches were extensively tested on real and hard instances provided by Padam. These instances contain up to 1011 requests and 14 vehicles and with very tight time windows. The obtained results revealed the performance of the proposed reinsertion methods compared to the online heuristic, where the number of served requests is increased and the number of vehicles is reduced while maintaining operating costs close to those of the online system. The results confirm the interest of using reinsertion techniques in the dynamic DARP service.

Revisiting the power of reinsertion for optimal targets of network attack

Understanding and improving the robustness of networks has significant applications in various areas, such as bioinformatics, transportation, critical infrastructures, and social networks. Recently, there has been a large amount of work on network dismantling, which focuses on removing an optimal set of nodes to break the network into small components with sub-extensive sizes. However, in our experiments, we found these state-of-the-art methods, although seemingly different, utilize the same refinement technique, namely reinsertion, to improve the performance. Despite being mentioned with understatement, the technique essentially plays the key role in the final performance. Without reinsertion, the current best method would deteriorate worse than the simplest heuristic ones; while with reinsertion, even the random removal strategy achieves on par with the best results. As a consequence, we, for the first time, systematically revisit the power of reinsertion in network dismantling problems. We re-implemented and compared 10 heuristic and approximate competing methods on both synthetic networks generated by four classical network models, and 18 real-world networks which cover seven different domains with varying scales. The comprehensive ablation results show that: i) HBA (High Betweenness Adaption, no reinsertion) is the most effective network dismantling strategy, however, it can only be applicable in small scale networks; ii) HDA (High Degree Adaption, with reinsertion) achieves the best balance between effectiveness and efficiency; iii) The reinsertion techniques help improve the performance for most current methods; iv) The one, which adds back the node based on that it joins the clusters minimizing the multiply of both numbers and sizes, is the most effective reinsertion strategy for most methods. Our results can be a survey reference to help further understand the current methods and thereafter design the better ones.

A Novel Hump Reinsertion Technique to Reconstruct the Nasal Dorsum.

Nasal hump removal and modification is a commonly performed procedure in rhinoplasty. The spreader flap is most commonly used in the reconstruction technique and involves suturing the medial end of the upper lateral cartilage (ULC) onto the septum. In this study, author presents a new hump removal technique that includes a novel procedure for hump reinsertion and suturing that is easy and comfortable to apply in hump removal operations. The records of the patients were assessed retrospectively from private practice. Patients who had undergone hump removal operations using a hump reinsertion graft were included. In total, 54 patients met the inclusion and exclusion criteria, and their records were assessed. The hump was divided into 3 parts longitudinally. The septum, which is a part of the nasal hump, was prepared as a strut graft, and the ULCs were prepared as spreader grafts. A novel suturing technique was used while the spreader grafts were fixed. This technique was used if the ULC was larger than 3 mm. The patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) 12 months after surgery. The initial median ROE score was 40.5; after surgery, it increased to 88.5. The ROE score changed significantly (P < .001). The postoperative results were satisfactory. After assessments, no asymmetry or functional problems were found in all participants. This technique allows for closed rhinoplasty without the need for an additional graft from the septum, enhancing the prevention of displacement and improving functionality.

Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable

BackgroundPurpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel.MethodsTwenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test.ResultsThere is no significant difference in protection of the ligament suture between the “terylene” and “steel” groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004).ConclusionSuture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of the chain extenders with no contraction/muscle shortening and partial dehydration of tendons and ligaments and the mean age of 69.3 years.Level 5.

Speed-Bridge arthroscopic reinsertion of tibial eminence fracture (complementary to the adjustable button fixation technique)

In comminuted fractures of the intercondyloid eminence of the tibial spine, the quality of the reduction and the arthroscopic fixation, notably adjustable suture button fixation, is sometimes disappointing with reduction defects of the anterior bone block. In the Speed-Bridge technique, the two traction sutures of the adjustable button fixation are replaced with two braided sutures of different colors. After the button is placed above the eminence, reduction is obtained by tightening the loop of the button. The accessory communitive fragments are then packed in the depression around the main fragment. A second row provides bone suturing for these accessory fragments; traction sutures of the button are attached anteromedially and laterally with knotless anchors to obtain a Speed-Bridge-type inverted-V bone suture. The Speed-Bridge arthroscopic reinsertion technique of the tibial eminence effectively completes the adjustable button bone suture technique for communitive fractures to obtain better reduction and good stability.

Surgical Correction of Blepharoptosis Using a Modified Levator Aponeurosis–Müller Muscle Complex Reinsertion Technique

The purpose of this study was to evaluate the outcomes after ptosis correction surgery using a modified levator aponeurosis-Müller muscle complex reinsertion technique. In this clinical study, 75 eyelids of 49 patients with congenital blepharoptosis were treated with the modified technique. The results, including complications, were followed up and evaluated. Operation was performed via anterior transcutaneous incision. After separating the preseptal orbicularis oculi muscle, the levator complex, including Müller muscle and the levator aponeurosis, was visualized. The levator complex was cut into 2 parts at the top of the conjunctival fornix to create an upper portion and a lower portion. The detached lower portion of the complex flap combined with the tarsal plate was advanced superiorly and reinserted into the posterior aspect of the upper portion of the complex flap by using 3 horizontal mattress sutures. Preoperative ptosis severity was compared with the degree of ptosis correction using the Cochran-Mantel-Haenszel test. Preoperative levator function was compared with the degree of ptosis correction and the postoperative levator function using Fisher exact test for paired data. Sufficient postoperative correction of ptosis was achieved in 78.7% of eyelids. Postoperative levator function of more than 4 mm was achieved in 82.7% of all eyelids that underwent surgery. We conclude that the modified levator aponeurosis-Müller muscle complex reinsertion technique is effective for correcting congenital blepharoptosis, especially in patients with fair to good (>4 mm) preoperative levator function.

Avulsão das origens lateral e medial do músculo gastrocnêmio em gata: relato de caso

Poucos relatos têm descrito avulsões das cabeças lateral ou medial e avulsão bilateral das origens do músculo gastrocnêmio em cães e gatos. Este trabalho descreveu o primeiro relato de avulsão das origens lateral e medial do músculo gastrocnêmio em gata, bem como a técnica de reinserção cirúrgica. Uma gata, sem raça definida, com 10 anos, apresentou claudicação do membro posterior direito com postura plantígrada. Avulsão bilateral das cabeças do músculo gastrocnêmio foi diagnosticada com base nos achados do exame clínico. A técnica de reinserção foi realizada com fio mononáilon, numa sutura de Kessler modificada, ancorada em um orifício criado na porção metafisária distal do fêmur. Após período de imobilização externa complementar seguida de fisioterapia, houve recuperação satisfatória.

The Simple Transverse Intraosseous Phalangeal Suture for Zone 1 Flexor Digitorum Profundus Injuries

Zone 1 flexor digitorum profundus injury often precludes the use of a simple core suture as a result of a distal remnant that is too short. The aim of this study was to assess the senior author's (S.I.) simple technique for reinsertion of the flexor digitorum profundus tendon. The case series consisted of 12 patients who required a primary flexor digitorum profundus repair in zone 1, with all repairs performed by the senior author. A Bruner incision was extended to the pulp to expose the base of the distal phalanx. A two-strand repair was anchored to the distal phalanx using the author's technique, which involved passing a 3-0 polypropylene suture on a straight needle through a hypodermic needle that had been drilled through the base of the distal phalanx. This provided a stable, intraosseous, internal repair, allowing a standard early active mobilization regimen. Two patients had excellent results and 10 had good results in terms of distal interphalangeal joint range of movement (mean, 57 degrees; range, 51 to 80 degrees) and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores (mean, 12; range, 0 to 31.8). There were no reported tendon ruptures at the time of writing this article (range, 6 to 37 months after surgery). The authors present a technique for the repair of zone 1 flexor digitorum profundus injuries that is simple, can be performed quickly, is easily learned, and has results that compare favorably with other techniques in the literature. Furthermore, there is limited morbidity to surrounding fingertip structures. Therapeutic, IV.

Safe and simple reinsertion technique for occluded central venous catheter in premature infants

Reoperation for a malfunctioning central venous catheter (CVC) is technically demanding as a bedside procedure in premature infants, and general anesthesia and paralysis is usually required for such an operation. Herein, we describe a safe and simple reinsertion technique to treat CVC occlusion using the original tract. Using a previous incision, the subcutaneous tract was identified, and the anterior half circle of the tract was opened. The catheter was transected through the opening, and the distal part was removed. A new catheter was introduced through an empty subcutaneous tunneling pathway and skin exit site, where the old distal part had been recently removed. Using fine 6–0 monofilament suture, traction sutures were placed along the cut edge of the proximal tract. The proximal part was then removed, and a newly placed catheter tip was inserted into the tract opening. When CVC reinsertion is required in premature infants, reinsertion can be accomplished easily and safely using this technique as a bedside procedure without general anesthesia.

Interventions for treating chronic ankle instability

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. Initial treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered. To compare different treatments, conservative or surgical, for chronic lateral ankle instability. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and reference lists of articles, all to February 2010. All identified randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included. Two review authors independently assessed risk of bias and extracted data from each study. Where appropriate, results of comparable studies were pooled. Ten randomised controlled trials were included. Limitations in the design, conduct and reporting of these trials resulted in unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting. Only limited pooling of the data was possible.Neuromuscular training was the basis of conservative treatment evaluated in four trials. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool (AJFAT): mean difference (MD) 3.00, 95% CI 0.3 to 5.70; 1 trial, 19 participants; Foot and Ankle Disability Index (FADI) data: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, 56 participants). The fourth trial (19 participants) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.Four studies compared surgical procedures for chronic ankle instability. One trial (40 participants) found more nerve injuries after tenodesis than anatomical reconstruction (risk ratio (RR) 5.50, 95% CI 1.39 to 21.71). One trial (99 participants) comparing dynamic versus static tenodesis excluded 17 patients allocated dynamic tenodesis because their tendons were too thin. The same trial found that dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77, 82 participants). One trial comparing techniques of lateral ankle ligament reconstruction (60 participants) found that operating time was shorter using the reinsertion technique than the imbrication method (MD -9.00 minutes, 95% CI -13.48 to -4.52). Two trials (70 participants) compared functional mobilisation with immobilisation after surgery. These found early mobilisation led to earlier return to work (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial). Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.

Suture anchor reinsertion of distal biceps rupture: Clinical results and radiological assessment of tendon healing

The present study consisted in a clinical follow-up of patients with distal rupture of the biceps brachii tendon managed by suture anchor reinsertion to the radial tuberosity. Tendon apposition on the cortical bone is the least resistant reinsertion technique according to biomechanical studies. A parallel radiological (X-ray and MRI) study was therefore performed to assess the exact quality of tendon healing and its correlation to clinical results. Twenty-eight patients were followed up retrospectively at a mean 22 months (minimum FU: six months) with clinical examination (mobility, force, satisfaction, residual pain, and return to work) and radiological assessment (standard X-ray exploration for heterotopic ossification, and MRI for quality of healing of the tendon apposed to the cortical bone). Forty percent of cases showed complications (mainly neurological) which resolved without sequelae under medical treatment. Mobility was normal in all but eight patients who showed -5° to -20° supination loss. Force in flexion-supination was 91% of that on the contralateral side. On X-ray, only 46% of patients were free of ossification. On MRI, reinsertion was judged anatomic in 19 patients (70%), moderate in six and poor in two, with one iterative rupture. Statistical analysis revealed that the greater the number of suture tacks through the tendon, the greater the force in patients with less than two weeks' interval to surgery and satisfactory reinsertion on MRI. Many reinsertion techniques have been reported, giving clinical results similar to one another and to the present findings. The complications rate, in contrast, varies according to technique and surgical approach. Radiologically, 70% of reinsertions were satisfactory: healing with the tendon apposed on the cortical bone is thus a reliable technique. Heterotopic ossification is considered benign in the literature. The present radiological study refined this notion by identifying three types of ossification: pure asymptomatic intratendon ossification; pure asymptomatic tuberosity ossification without impact on healing on the radial tuberosity; and tuberosity ossification with associated boney metaplasia of the terminal part of the reinserted tendon, impairing healing and leading to less satisfactory clinical results. To ensure anatomic healing of the distal biceps tendon, we recommend less than two weeks' interval to surgery and at least two suture tacks to obtain good apposition on the radial tuberosity.

Revision cochlear implantation in children

The cochlear implant intervention is the standard of care for the rehabilitation of severe to profound hearing loss in children. Growing case numbers are associated with increasing prevalence of conditions that may require surgical revision to maintain electrical hearing and language acquisition. Scalp complications can be avoided by observing core surgical principles, which also reduces the risk of wound infections. Providers of cochlear implant care should also become familiar with the indications for revision surgery, including the work-up and appropriate technique for electrode re-insertion. A summary of the literature reveals varied outcomes depending on indication, ranging from diminished speech performance to significant gains after revision surgery. Patient selection must be carefully considered to minimize additional delays in language development. The decision for revision surgery is straightforward in cases of documented speech perception decline, device failure and infection. In cases of failure to progress, however, the outcome may be reduced or unchanged.

Traumatische Ruptur des Musculus pectoralis major – ein Fallbericht

A 49-year-old male athlete sustained a complete rupture of the pectoralis major muscle while bench pressing. The inferior and the superior border of the clavicular lamina and the sternal lamina were fixed with mattress sutures. After that transosseous reinsertion via drill holes (no suture anchors). The lateral rim of both tendons was fixed with Mason-Allen sutures. Final adaption of the distal tendon stump above the reinserted tendon (doubling). Postoperative immobilisation for 3 weeks in Gilchrists sling was followed by active-assistive step-by-step mobilisation. A speedy rehabilitation was planned after 6 weeks, but at this time the patient was doing strength training, swimming, pull-ups and press-ups at his own responsibility. Normal mobility and previous sports activity were achieved in spite of the early and extremely high stress. We assume that the very strong and secure reinsertion technique with 4 mattress sutures, Mason-Allen sutures and doubling of the tendon close to the foot print region may be the reason for the good result in spite of the massive and early loading.

A Novel Surgical Approach to Lipomatous Tumours of the Deltoid Region

Resection of large lipomatous tumours in the subdeltoid region remains technically challenging due to the risk of injury to the axillary neurovascular bundle. We describe a novel deltoid release and reinsertion technique for resection of large lipomatous tumours of the sub-deltoid region and report the functional and oncologic outcomes of six patients who underwent this procedure. Three cases were diagnosed histologically as atypical lipoma and three cases were diagnosed as lipoma. There was one local recurrence in a case of an atypical lipoma. Rotator cuff function was comparable to that of the contralateral side in all cases and the average Constant Score adopted by the European Shoulder and Elbow Society was 84 (range 81 to 92) out of 100. We conclude that patients with large sub-deltoid lipomatous tumours who undergo resection through a previously undescribed deltoid release and reinsertion technique have excellent functional outcome with a low risk for recurrence.