Tendon Augmentation Research Articles

Subscapularis Tendon Augmentation in Patients With Anterior Shoulder Instability Associated With Capsule-Labral Deficit

Shoulder instability is a common problem in young adults. Without surgical treatment, the recurrence rate is unacceptably high. While arthroscopic capsulolabral repair is popular for anterior glenohumeral instability, it still faces limitations. Surgical failures may arise from technical errors, soft tissue insufficiency, bone loss, or rehabilitation challenges. In cases with less than 15% glenoid bone loss and no external rotation deficit, subscapular augmentation provides an option without necessitating bone grafts or additional surgery. An arthroscopic technique is presented that utilizes the subscapularis tendon for tenodesis at the anterior edge of the glenoid ring in patients with the absence of capsulolabral tissue to provide both protection of the anterior glenohumeral aspect and a safer return to functional activities.

Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery.

The aim is to determine the effect on healing and functionality of patients after 1 year of biceps augmentation of a rotator cuff repair (RCR) compared to RCR plus long head of the biceps (LHB) tenotomy. In addition, to analyse the main factors involved in the recovery after the surgery. A prospective, comparative, non-randomized study (Level of Evidence III) was conducted. Patients with repairable rotator cuff tears were allocated to either the control group, with a double row transosseous equivalent RCR with LHB tenotomy, or the RCR+augmentation with LHB group. Patients were evaluated for radiological (MRI), clinical (cuff size, Patte and Goutallier scales) and functional variables (Constant and American Shoulder and Elbow Surgeons [ASES] scales) before the intervention. At 1-year follow-up cuff healing was confirmed through MRI and functional evaluation with Constant, ASES, simple shoulder test [SST] and Disabilities of the Arm, Shoulder and Hand scales. Seventy-seven patients underwent control or RCR+augmentation with LHB, there were no preoperative differences between the groups. After 1 year of the surgery, re-rupture occurred in 38.5% and 16% of the patients in control and RCR+augmentation with LHB groups, respectively (p = .026). Total functionality was higher (p < .05) in RCR+augmentation with LHB than in the control group: Constant, SST and ASES scales. Among the explored factors involved in healing, re-rupture occurred in 100% of the cases with high fatty degeneration. Besides, higher initial functionality (Constant scale) and RCR+augmentation with LHB increased the odds of healing (odds ratio [OR] = 1.12 [1.04-1.21]; OR = 5 [1, 61], respectively), while higher cuff length had a detrimental effect (OR = 0.92 [0.85-0.99]). RCR+augmentation with LHB achieves a higher healing percentage and a better functional evolution than RCR+LHB tenotomy, 1 year after cuff repair. Fatty degeneration, cuff length and initial functionality are the main factors involved in cuff healing. Level III randomized controlled trial.

Using machine learning to identify risk factors for short-term complications following thumb carpometacarpal arthroplasty

BackgroundThumb carpometacarpal (CMC) joint osteoarthritis is among the most common degenerative hand diseases. Thumb CMC arthroplasty, or trapeziectomy with or without tendon augmentation, is the most frequently performed surgical treatment and has a strong safety profile. Though adverse outcomes are infrequent, the ability to predict risk for complications has substantial clinical benefits. In the present study, we evaluated a well-known surgical database with machine learning (ML) techniques to predict short-term complications and reoperations after thumb CMC arthroplasty. MethodsA retrospective study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) years 2005–2020. Outcomes were 30-day wound and medical complications and 30-day return to the operating room. We used three ML algorithms — a Random Forest (RF), Elastic-Net Regression (ENet), and Extreme Gradient Boosted Tree (XGBoost), and a deep learning Neural Network (NN). Feature importance analysis was performed in the highest performing model for each outcome to identify predictors with the greatest contributions. ResultsWe included a total of 7711 cases. The RF was the best performing algorithm for all outcomes, with an AUC score of 0.61±0.03 for reoperations, 0.55±0.04 for medical complications, and 0.59±0.03 for wound complications. On feature importance analysis, procedure duration was the highest weighted predictor for reoperations. In all outcomes, procedure duration, older age, and female sex were consistently among the top five predictors. ConclusionsWe successfully developed ML algorithms to predict reoperations, wound complications, and medical complications. RF models had the highest performance in all outcomes.

Patellar Tendon Debridement and Reconstruction With Hamstring Tendon Autografts in the Setting of Severe Patellar Tendinopathy

Background: Patellar tendinopathy is a multifactorial condition characterized by micro-degenerative changes in the patellar tendon. This results from repeated stress to the knee extensor mechanism from explosive movement, axial malalignment, and/or abnormal patellar height. Currently, there is no standard surgical procedure for the treatment of severe patellar tendinopathy. Indications: Patellar tendon reconstructions for patellar tendinopathy may be indicated when &gt;50% of the tendon attachment is degenerative and detached from the distal patella and non-operative treatment, like physical therapy, bracing, and injections, have not relieved symptoms. Debridement may not offer long-term viability against augmentation of the patellar tendon with autografts, with a risk of recurrent breakdown of the patellar tendon attachment with resumption of previous activities that initially lead to overload. Technique Description: An anterior incision was made from the superior pole of the patella to the tibial tubercle. Then, dissection was performed medially to harvest the gracilis and semitendinosus tendons. Open harvesters were used, and the hamstring tendons were released proximally, keeping the tibial insertions attached. A horizontal pin was drilled across the tibial tubercle and reamed with a 4.5 mm reamer. A passing stitch was fed through the tunnel. The proximal and distal margins of the patella were localized with spinal needles and a pin was drilled across its midportion, 5 mm deep to the dorsal cortical margin, and then rearmed. Degenerative tissue at the patellar tendon was excised. The gracilis tendon was passed medial to lateral through the tibial tubercle, and a Q-Fix anchor anchored the grafts medially and laterally. The semitendinosus graft was passed medial to lateral through the patella followed by the gracilis tendon lateral to medial. Appropriate reconstruction graft tension was confirmed and grafts were whipstitched together. Results: Clinical outcomes for the debridement of severe patellar tendinopathy report 77% symptomatic relief. With many unable to return to activity, patellar tendon reconstruction can be indicated. Outcomes for reconstructions for severe patellar tendinopathy are not reported. Discussion: Patellar tendon reconstruction with hamstring autografts for the treatment of severe patellar tendinopathy can provide a strong reconstruction graft to allow for the resumption of high-level activities. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.

Augmentation of Tendon and Ligament Repair with Fiber-Reinforced Hydrogel Composites.

This review highlights the promise of fiber-reinforced hydrogel composites (FRHCs) for augmenting tendon and ligamentrepair and regeneration. Composed of reinforcing fibers embedded in a hydrogel, these scaffolds provide both mechanical strength and a conducive microenvironment for biological processes required for connective tissue regeneration. Typical properties of FRHCs are discussed, highlighting their ability to simultaneously fulfill essential mechanical and biological design criteria for a regenerative scaffold. Furthermore, features of FRHCs are described that improve specific biological aspects of tendon healing including mesenchymal progenitor cell recruitment, early polarization to a pro-regenerative immune response, tenogenic differentiation of recruited progenitor cells, and subsequent production of a mature, aligned collagenous matrix. Finally, the review offers a perspective on clinical translation of tendon FRHCs and outlines key directions for future work.

A Surgical Technique for Tibial Tubercle Avulsion Fractures Using Transpatellar Suture Tape Tension Band and De-tensioning Suture Anchors

This article aims to present a comprehensive technical note detailing our preferred treatment approach for tibial tuberosity avulsion fractures in the adult and elderly populations, particularly in scenarios characterized by low tissue quality and limited bone stock. Existing literature on this fracture type is scarce, with many described techniques relying on optimal bone quality for effective screw fixation of the tibial tuberosity. Various methods for tibial tuberosity avulsion fixation include K-wires, cannulated screws, staples, tension bands, suture anchors, and in select cases, direct transosseous sutures. Our technique focuses on robustly supporting the extensor mechanism through a synergistic combination of de-tensioning suture anchors, tension band suture taping, and suture augmentation of the patellar tendon. This approach addresses the challenges posed by compromised tissue quality and limited bone stock, offering a valuable contribution to the management of these fractures.

Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments

Background: Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament. Purpose: To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device. Study Design: Descriptive laboratory study. Methods: A total of 22 LARS ligament grafts that were explanted from patients were sent for analysis. Five new, unused samples of the standard LARS ACL graft were also analyzed. Biomechanical testing was performed: ultimate tensile force, force versus displacement, and stress versus strain were recorded. Histopathological examination was performed looking for degree of fibrous tissue ingrowth as well as the presence of a foreign body reaction. Results: Of the 22 grafts retrieved, 14 were used for ACL grafts, 1 for a lateral collateral ligament graft, 2 for medial collateral ligament grafts, 4 for gluteal tendon augmentation, and 1 for a supraspinatus augmentation. A severe foreign body reaction was found in 86% of the grafts (18/22) and a mild foreign body reaction in the remaining 14% (4/22). Tissue ingrowth was minimal in the majority of ACL grafts; the other grafts showed moderate tissue ingrowth. Maximal tensile force was significantly higher for the new ACL grafts (mean ± SD, 1667 ± 845 N) compared with the retrieved grafts (897 ± 395 N; P < .05). Conclusion: This study demonstrated that the vast majority of retrieved LARS artificial ligaments had a florid foreign body reaction. There was minimal tissue ingrowth in ACL grafts and moderate ingrowth in other grafts. Retrieved grafts had a decreased ultimate tensile force, which increased their risk of rupture. Clinical Relevance: Surgeons should be cautious in choosing to use these grafts in reconstructive surgery for patients.

Assessing Bioprinted Functionalized Grafts for Biological Tendon Augmentation In Vitro.

Tendinopathy, characterized by inflammatory and degenerative changes, presents challenges in sports and medicine. In addressing the limitations of conservative management, this study focuses on developing tendon grafts using extrusion bioprinting with platelet-rich plasma (PRP)-infused hydrogels loaded with tendon cells. The objective is to understand paracrine interactions initiated by bioprinted tendon grafts in either inflamed or non-inflamed host tissues. PRP was utilized to functionalize methacrylate gelatin (GelMA), incorporating tendon cells for graft bioprinting. Bioinformatic analyses of overexpressed proteins, predictive of functional enrichment, revealed insights into PRP graft behavior in both non-inflamed and inflamed environments. PRP grafts activated inflammatory pathways, including Interleukin 17 (IL-17), neuroinflammation, Interleukin 33 (IL-33), and chemokine signaling. Interleukin 1 beta (IL-1b) in the graft environment triggered p38 mitogen-activated protein kinase (MAPK) signaling, nuclear factor kappa light chain enhancer of activated B cells (NF-kB) canonical pathway, and Vascular Endothelial Growth Factor (VEGF) signaling. Biological enrichment attributed to PRP grafts included cell chemotaxis, collagen turnover, cell migration, and angiogenesis. Acellular PRP grafts differed from nude grafts in promoting vessel length, vessel area, and junction density. Angiogenesis in cellular grafts was enhanced with newly synthesized Interleukin 8 (IL-8) in cooperation with IL-1b. In conclusion, paracrine signaling from PRP grafts, mediated by chemokine activities, influences cell migration, inflammation, and angiogenic status in host tissues. Under inflammatory conditions, newly synthesized IL-8 regulates vascularization in collaboration with PRP.

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved.

Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidityand is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. Level IV.

Trans-tendon Suture Bridge Rotator Cuff Repair With Biceps Tendon Augmentation for Retorn High-Grade Partial Articular Supraspinatus Tendon Avulsion (PASTA) Lesions

Revision repair of retorn partial articular supraspinatus tendon avulsion (PASTA) lesion is difficult for poor tendon quality without tear completion and repair. Trans-tendon suture bridge repair with biceps tendon augmentation can preserve the intact bursal side cuff attachment and has shown satisfactory clinical outcomes. Moreover, trans-tendon suture bridge rotator cuff repair technique, along with biceps tendon augmentation, reinforces high-grade PASTA lesions by moving the tenotomized biceps tendon into the torn articular side cuff defect with added advantage of blood supply through the tenotomized biceps tendon graft. Retear after trans-tendon repair of high-grade PASTA lesions was rare, and its poor tendon quality cause the revision repair to be too difficult. Without tear completion and rotator cuff repair, this arthroscopic trans-tendon suture bridge rotator cuff repair with biceps tendon augmentation is a reliable procedure that could be expected to produce improved short-term functional and radiologic outcomes, along with improved tendon quality of repaired tendon.

An Extracellular Vesicle-Cloaked Multifaceted Biocatalyst for Ultrasound-Augmented Tendon Matrix Reconstruction and Immune Microenvironment Regulation.

The healing of tendon injury is often hindered by peritendinous adhesion and poor regeneration caused by the accumulation of reactive oxygen species (ROS), development of inflammatory responses, and the deposition of type-III collagen. Herein, an extracellular vesicles (EVs)-cloaked enzymatic nanohybrid (ENEV) was constructed to serve as a multifaceted biocatalyst for ultrasound (US)-augmented tendon matrix reconstruction and immune microenvironment regulation. The ENEV-based biocatalyst exhibits integrated merits for treating tendon injury, including the efficient catalase-mimetic scavenging of ROS in the injured tissue, sustainable release of Zn2+ ions, cellular uptake augmented by US, and immunoregulation induced by EVs. Our study suggests that ENEVs can promote tenocyte proliferation and type-I collagen synthesis at an early stage by protecting tenocytes from ROS attack. The ENEVs also prompted efficient immune regulation, as the polarization of macrophages (Mφ) was reversed from M1φ to M2φ. In a rat Achilles tendon defect model, the ENEVs combined with US treatment significantly promoted functional recovery and matrix reconstruction, restored tendon morphology, suppressed intratendinous scarring, and inhibited peritendinous adhesion. Overall, this study offers an efficient nanomedicine for US-augmented tendon regeneration with improved healing outcomes and provides an alternative strategy to design multifaceted artificial biocatalysts for synergetic tissue regenerative therapies.

Massive and irreparable rotator cuff tear treatment by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only

The aim of this study was to compare clinical and radiological outcomes of two treatment methods of massive and irreparable rotator cuff tears: partial repair (PR) and PR with long head of the biceps tendon augmentation (PRLHBTA). Biceps tendon augmentation is believed to promote better healing at the bone-tendon junction, leading clinical and radiological outcomes. This retrospective and comparative study included patients with chronic, massive and irreparable rotator cuff tears involving both the supraspinatus (SSP) and infraspinatus (ISP) muscles. Only patients who had previously failed non-operative treatment and had at least 1-year follow-up between 2013 and 2018 were analyzed. The patients were divided into 2 groups based on the chosen treatment method. Irreparability was defined intraoperatively as the inability to achieve sustainable repair of the SSP after complete release, typically corresponding to Goutallier classification of ≥ 3 and stage 3 in the Patte classification. The clinical assessment protocol involved measuring of range of motion (ROM), shoulder strength, Constant-Murley Score (CMS) and SST Scores. Radiological assessment comprised measurements of the Acromio-Humeral Index (AHI), the Hamada classification, the Sugaya's classification and Goutallier classification for both SSP and ISP. The study included data from 60 patients (30 in each group) with a mean age of 62.5 years and a mean follow-up of 34.5 months. The retear rate for PRLHBTA was 43.3% and 73.3% for PR alone (p=0.036). During the final examination statistically significant differences in favour of PRLHBTA were observed for: CMS 76.2±0.9 vs 70.9±11.5 (p=0.034), Sugaya's classification 3.5±1.1 vs 4.1±0.9 (p=0.035) and AHI 5.8±2mm vs 4.7±1.3 (p=0.021). There were no significant differences between the groups in patients' ROM, shoulder strength, the Hamada classification, Simple Shoulder Test (SST) and postoperative Goutallier scales. PR with LHBTA for patients with irreparable MRCT provides a lower retear rate and better humeral head centralization, and improved results measured by CMS compared to PR alone.

Poster 105: Rotator cuff healing using demineralised bone fibers in ovine infraspinatus tendon models

Objectives: Rotator cuff tears are a common cause of shoulder pain and functional deficits. Although surgical repair is often able to restore function and resolve pain, high rates of postoperative structural failures have been reported. To improve the outcomes and reduce re-tear rates biologic tissue scaffolds have been used to augment and reinforce the primary tendon repair by providing mechanical support of the initial repair and ideally improving the rate and/or quality of biological healing at the tendon-bone interface. Demineralised bone fibers (DBF) are bone collagen and can be formed into a patch providing a scaffold and inductive bone morphogenetic proteins known to facilitate healing. This study evaluated the in vivo response of human DBF Patches (hDBF-P) as an onlay over the infraspinatus tendon (IST) and at the tendon-bone interface in an ovine model. Methods: The hDBF-P was characterised using stereozoom (Figure 1A) and environment electron microscopy (Figure 1B). The osteoinductivity (OI) was evaluated in the standard nude rat intramuscular implantation (IM) model at 28 days using mCT and paraffin histology. A bilateral model of an onlay or an enthesis repair was performed in 12 adult wethers following ethical approval. Four groups were evaluated at 6 and 12 weeks (n=3 per time point): Onlay control and hDBF treated; Enthesis repair control and hDBF treated. The onlay model simulated a tendon injury by 4 longitudinal slits along the IST and lateral drill holes in the proximal humerus in the onlay control group [1]. In the onlay treated group the hDBF-P was hydrated in saline and secured to the IST with interrupted 2-0 non-resorbable sutures (Figure 2A). On contralateral side, the central third of the IST was sharply dissected, the footprint burred, and 2 medial row anchors inserted. The sutures were passed through the IST in the enthesis repair control group. In the enthesis repair treatment group, the sutures were passed through the hDBF-P which was placed at the tendon bone interface followed by sutures through the IST. Two lateral push lock anchors were used for a suture bridge (Figure 2B) in the control and treated groups. Endpoints included clinical recovery, macroscopic dissection, 3T MRI, radiographs, mCT and paraffin histology processing, H&amp;E staining, and light microscopic evaluations to assess local cell and tissue responses and healing. Results: OI was confirmed on IM implantation in nude rats. The sheep recovered uneventfully with no adverse events macroscopically or radiographically. MRI in the onlay control group revealed little response and no increase in tendon thickness which was confirmed histologically. In contrast the onlay hDBF-P treated demonstrated increased tendon thickness and hDBF resorption with time. Histology showed some initial inflammatory cells that decrease with time in the onlay group. MRI in the hDBF-P treated enthesis group supported increased activity at the bone interface at 6 and 12 weeks compared to controls. Histology at the interface with hDBF-P showed evidence of new bone formation at 6 weeks that matured with time support enthesis reformation. Conclusions: hDBF-P is a collagen graft composed of demineralized bone fibers that have osteoconductive and osteoinductive potential. When formed into a patch, this implant provides a scaffold that can participate with the local biology. hDBF-P used as on-lay in a tendon injury model increased tendon thickness. hDBF-P when used at the interface between the tendon and bone facilitated enthesis reformation through its conductive and inductive potential as well as scaffold architecture. DBF patches represent an exciting allograft implant with the potential to address the clinical problems in rotator cuff surgery. Literature cited Van Kampen, C., et al. (2013). Tissue-engineered augmentation of a rotator cuff tendon using a reconstituted collagen scaffold: a histological evaluation in sheep. Muscles, ligaments and tendons journal, 3(3), p.229.

Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review.

The spring ligament is one of the main stabilizers of the medial arch of the foot and the primary static supporter of the talonavicular joint. Attenuation or rupture of this ligament is thought to play a central role in the pathophysiology of progressive collapsing foot deformity. Traditional correction of flexible flatfoot consists of posterior tibial tendon augmentation along with various osteotomies or hindfoot fusions. Repair or reconstruction of the spring ligament has not been as widely pursued. In recent years, newer techniques have been explored and may improve outcomes of traditional procedures, or possibly entirely replace some osteotomies. Combined spring-deltoid ligament reconstruction is also gaining traction as a viable technique, particularly as the ankle begins to deform into valgus. This review summarizes the variety of nonanatomic and anatomic reconstruction techniques that have been described, including autologous tendon transfers, allografts, and synthetic augmentation. Although many have only been characterized in biomechanical cadaver studies, this article reviews preliminary clinical studies that have shown promising results. There is a need for more high-quality studies evaluating the clinical, radiographic, and patient-reported outcomes following spring ligament reconstruction.

Bankart repair with subscapularis augmentation: A case control study.

To examine the effect on functional shoulder scores of Bankart repair with arthroscopic subscapularis tendon augmentation applied to cases of anterior shoulder instability with < 25% glenoid defect and ligament-labral failure. A total of 83 patients underwent Bankart repair with subscapularis tendon augmentation between 2015 and 2021. The range of movement of the patients was measured by 2 doctors using a goniometer. The Constant Murley score, American Shoulder and Elbow Surgeons score, Rowe score, and the University of California at Los Angeles scores were recorded preoperatively and postoperatively. Statistically significant increases were determined in the postoperative functional scores compared to the preoperative values as mean 41.4 ± 2.08 unit increase in the Constant Murley score, mean 41.4 ± 1.8 unit increase in the American Shoulder and Elbow Surgeons score, mean 13.8 ± 1.45 unit increase in the University of California at Los Angeles and mean 49.3 ± 7.45 unit increase in the Rowe score (P = .001; P < .01). Compared with the preoperative evaluation, there was found to be a postoperative statistically significant unit decrease of 10.2 ± 1.47 in the external rotation measurement (P = .001; P < .01). The number of dislocations was determined to have a negative correlation with the internal rotation measurements (r = -0.305; P = .005; P < .01), and a weak negative statistically significant relationship with external rotation measurements (r = -0.329; P = .002; P < .01). Unlike other techniques, as this repair technique includes both the tendon and the capsule as a single piece, it was seen to be a sufficient and reliable technique that is easy-to apply.

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity.

Spring ligament reconstruction (SLR) has been suggested as an adjunct to other reconstructive procedures to potentially avoid talonavicular joint fusion in progressive collapsing foot deformity (PCFD) with severe abduction deformity. Most clinical reports present short-term follow-up data and a small number of patients. The purpose of this study was to examine the medium- to long-term outcomes of an SLR using allograft tendon augmentation as part of PCFD surgical reconstruction. This study to our knowledge represents the largest number of patients and the longest follow-up to date. This study retrospectively reviewed 26 patients (27 feet, mean age of 61.4 years) who underwent SLR with allograft tendon as part of PCFD reconstruction. The mean follow-up of the cohort was 8 years (range, 5-13.4). Radiographic evaluation consisted of 5 parameters including talonavicular coverage angle (TNC), with the maintenance of correction being evaluated by comparing parameters from the early postoperative period (mean: 11.6 months, range, 8-17) to final follow-up. Foot and Ankle Outcome Score (FAOS) and patient satisfaction questionnaires were collected at final follow-up. Conversion to talonavicular or subtalar fusion was considered as a failure. Final radiographs demonstrated successful abduction correction, with the mean TNC improving from 43.7 degrees preoperatively to 14.1 degrees postoperatively (P < .0001). All other radiographic parameters improved significantly and exhibited maintenance of the correction. All FAOS subscales showed significant improvement. Responses to the satisfaction questionnaire were received from all except 1 patient, of whom 88.5% (23/26) were satisfied with the results, 96.2% (25/26) would undergo the surgery again, and 88.5% (23/26) would recommend the surgery. Eight feet (29.6%) required painful hardware removal and 1 (3.7%) developed nonunion of the lateral column lengthening osteotomy. No patient required conversion to talonavicular or subtalar fusion. This study demonstrates favorable medium- to long-term outcomes following PCFD reconstruction including an SLR with allograft tendon augmentation. Level IV, case series.

Management of Shoulder Instability in Patients with Underlying Hyperlaxity.

Shoulder instability in patients with underlying joint hyperlaxity can be challenging to treat. Poorly defined terminology, heterogeneous treatments, and sparse reports on clinical outcomes impair the development of best practices in this patient population. This article provides a review of the current literature regarding optimal management of patients suffering from shoulder instability with concomitant hyperlaxity of the shoulder, from isolated shoulder joint hyperlaxity to congenital hypermobility spectrum disorders (HSD). Current research shows specialized physiotherapy protocols focused on strengthening of periscapular muscles and improvement of sensorimotor control are a promising non-surgical therapeutic avenue in certain patients, which can be augmented by device-based intervention in select cases. If surgical treatment is warranted, arthroscopic techniques such as pancapsular shift or plication continue to demonstrate favorable outcomes and are currently considered the benchmark for success. The long-term success of more recent innovations such as coracoid process transfers, conjoint tendon transfers, subscapularis tendon augmentation, and capsular reconstruction remains unproven. For patients affected by connective tissue disorders, treatment success is generally less predictable, and the entire array of non-operative and operative interventions needs to be considered to achieve the best patient-specific treatment results. In the treatment of shoulder instability and concomitant hyperlaxity, specialized physiotherapy protocols augmented by device-based interventions have emerged as powerful, non-operative treatment options for select patients. Successful surgical approaches have been demonstrated to comprehensively address capsular redundancy, labral lesions, and incompetence of additional passive stabilizers in a patient-specific fashion, respective of the underlying connective tissue constitution.

Superior Capsule Reconstruction Using an Acellular Dermal Matrix Allograft Combined With Remnant Tendon Augmentation for Irreparable Rotator Cuff Tear

Graft fixation sites on the greater tuberosity and the superior glenoid for superior capsule reconstruction (SCR) are prone to graft failure. The graft fixation procedure on the superior glenoid is challenging due to the limited working space, narrow graft attachment site, and difficulties in suture management. This technical note introduces the surgical technique of SCR using an acellular dermal matrix allograft combined with remnant tendon augmentation to enhance graft healing and the suture management technique to prevent suture tangling for the treatment of irreparable rotator cuff tear.

Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities.

Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities. This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place. All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002). Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex.