Tendon Compartments Research Articles

Human Tendon-on-Chip: Unveiling the Effect of Core Compartment-T Cell Spatiotemporal Crosstalk at the Onset of Tendon Inflammation.

The lack of representative in vitro models recapitulating human tendon (patho)physiology is among the major factors hindering consistent progress in the knowledge-based development of adequate therapies for tendinopathy.Here, an organotypic 3D tendon-on-chip model is designed that allows studying the spatiotemporal dynamics of its cellular and molecular mechanisms.Combining the synergistic effects of a bioactive hydrogel matrix with the biophysical cues of magnetic microfibers directly aligned on the microfluidic chip, it is possible to recreate the anisotropic architecture, cell patterns, and phenotype of tendon intrinsic (core) compartment. When incorporated with vascular-like vessels emulating the interface between its intrinsic-extrinsic compartments, crosstalk with endothelial cells are found to drive stromal tenocytes toward a reparative profile. This platform is further used to study adaptive immune cell responses at the onset of tissue inflammation, focusing on interactions between tendon compartment tenocytes and circulating T cells.The proinflammatory signature resulting from this intra/inter-cellular communication induces the recruitment of T cells into the inflamed core compartment and confirms the involvement of this cellular crosstalk in positive feedback loops leading to the amplification of tendon inflammation.Overall, the developed 3D tendon-on-chip provides a powerful new tool enabling mechanistic studies on the pathogenesis of tendinopathy as well as for assessing new therapies.

Ultrasound-detected tenosynovitis in ankles with clinical arthritis and short-term outcome of patients with new-onset juvenile idiopathic arthritis.

To determine features and frequency of ultrasound (US)-detected tenosynovitis in ankles with clinically active disease and to investigate whether its detection may affect the achievement of inactive disease in patients with new-onset juvenile idiopathic arthritis (JIA). The study included children with new-onset JIA and clinically active disease of the ankle. Based on US, patients were stratified as having isolated arthritis or as having tenosynovitis irrespective of the presence of concomitant arthritis in the ankle. Estimation of patients who were able to achieve clinically inactive disease 6 months after starting treatment was assessed by the Kaplan-Meier method. Cox model was used to calculate hazard ratio (HR) and 95% confidence interval (CI). Reliability of US was tested using kappa statistic. Forty-five patients were recruited. On US, tenosynovitis of the ankle was detected in 28 patients (62.2%); isolated arthritis was found in 17 patients (37.8%). The medial and lateral tendon compartments were the tendon sites most frequently inflamed. Patients with tenosynovitis had similar likelihood of those without tenosynovitis to achieve clinically inactive disease (60.7% and 58.8%, respectively; HR 1.12, 95%CI:0.51-2.45). In the subanalysis excluding patients who were given biologics, the probability of experiencing inactive disease was slightly higher for patients with tenosynovitis compared to those without (64.7% and 54.5%, respectively; HR 1.56, 95%CI: 0.58-4.24). The rate of US reliability was high. US-detected tenosynovitis is frequent in ankles with clinical arthritis at JIA onset but does not impair the chance of achieving clinically inactive disease in the early disease phase.

De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success.

Anatomical variations of the first extensor compartment can affect de Quervain tendinopathy outcomes. Our study aimed to identify the anatomical prognostic indicators of symptom recurrence following a corticosteroid (CS) injection and to assess the efficacy of CS injections. Fifty consecutive patients received a single CS injection for de Quervain tendinopathy. Ultrasound imaging was used to assess anatomical factors of the first extensor tendon compartment of the wrist. The primary outcome was recurrence after six weeks and six months and the identification of the anatomical prognostic indicators of the recurrence. The Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Visual Analogue Scale (VAS) for pain were evaluated as secondary outcomes. Fifteen patients (30%) experienced symptom recurrence within six weeks. The intracompartmental septum and the number of tendon slips were associated with higher recurrence rates (adjusted odds ratio for the septum: 18.39, p = 0.045; adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). The mean DASH score improved from 74.1 ± 5 to 19.3 ± 25.3, and the mean VAS for pain from 8.5 ± 0.8 to 2 ± 2.7 (p < 0.01 for both scores). Five patients experienced minor adverse events with spontaneous improvement. CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options.

De Quervain's Tenosynovitis Release With Excision of the First Dorsal Compartment: Novel Surgical Technique and a Case Series.

Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment

De Quervain’s tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain’s syndrome after total trapeziometacarpal joint replacement. Level of evidenceNot applicable (laboratory study).

Engineering Tendon Assembloids to Probe Cellular Crosstalk in Disease and Repair.

Tendons enable locomotion by transferring muscle forces to bones. They rely on a tough tendon core comprising collagen fibers and stromal cell populations. This load-bearing core is encompassed, nourished, and repaired by a synovial-like tissue layer comprising the extrinsic tendon compartment. Despite this sophisticated design, tendon injuries are common, and clinical treatment still relies on physiotherapy and surgery. The limitations of available experimental model systems have slowed the development of novel disease-modifying treatments and relapse-preventing clinical regimes. In vivo human studies are limited to comparing healthy tendons to end-stage diseased or ruptured tissues sampled during repair surgery and do not allow the longitudinal study of the underlying tendon disease. In vivo animal models also present important limits regarding opaque physiological complexity, the ethical burden on the animals, and large economic costs associated with their use. Further, in vivo animal models are poorly suited to systematic probing of drugs and multicellular, multi-tissue interaction pathways. Simpler in vitro model systems have also fallen short. One major reason is a failure to adequately replicate the three-dimensional mechanical loading necessary to meaningfully study tendon cells and their function. The new 3D model system presented here alleviates some of these issues by exploiting murine tail tendon core explants. Importantly, these explants are easily accessible in large numbers from a single mouse, retain 3D in situ loading patterns at the cellular level, and feature an in vivo-like extracellular matrix. In this protocol, step-by-step instructions are given on how to augment tendon core explants with collagen hydrogels laden with muscle-derived endothelial cells, tendon-derived fibroblasts, and bone marrow-derived macrophages to substitute disease- and injury-activated cell populations within the extrinsic tendon compartment. It is demonstrated how the resulting tendon assembloids can be challenged mechanically or through defined microenvironmental stimuli to investigate emerging multicellular crosstalk during disease and injury.

Fascial Lengthening at the Time of Surgical Release for de Quervain's Tenosynovitis to Prevent Postsurgical Tendon Subluxation.

De Quervain's tenosynovitis is a relatively common, painful condition. Although commonly managed nonoperatively, some patients have recalcitrant disease, necessitating surgical release. Traditional surgical release for de Quervain's tenosynovitis with simple retinacular release can leave patients susceptible to first dorsal extensor compartment tendon subluxation. We present a stair-step flap technique that releases the first dorsal compartment while simultaneously preventing postoperative tendon subluxation via fascial lengthening. All patients over the past decade who underwent surgical release with this technique were collected. Preoperative characteristics, surgical details, and postoperative outcomes were reviewed and aggregated as summary statistics. A total of 101 patients were found. Of these, 35 patients had isolated first dorsal compartment release. Tourniquet time for the total group was 1 hour and that for the isolated first dorsal compartment release subgroup was 20 minutes. The average follow-up was 590 days for the total group and only 440 days for the isolated first dorsal compartment release subgroup. No patients who underwent our novel technique experienced subluxation of the tendons postoperatively. One patient required oral antibiotics for a superficial cellulitis, and 1 patient had recurrent symptoms due to excessive scarring that resolved with scar massage and steroid injection. No patient required repeat operations. Our study demonstrates that first dorsal compartment release with a stair-step incision allows for closure of the compartment with a very loose sheath without subluxation and simultaneously provides satisfactory decompression. This procedure is safe and efficacious and can be considered a useful modification to traditional retinacular release alone. Level III.

Examining the Forearm Intersection through Palpation and Ultrasonography.

Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister's) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle-tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography.

3D WRITING OF MULTICELLULAR TENDON-ON-CNC-CHIP MODELS

Relevant in vitro models emulating tendinopathies are highly needed to study these diseases and develop better treatments. We have recently proposed a new strategy that allows the automated 3D writing of microphysiological systems (MPS) embedded into its own biomimetic fibrillar support platform based on the self-assembling of cellulose nanocrystals (CNCs). Here, we explored this CNC platform for writing humanized in vitro tendon models using tendon decellularized extracellular matrix (dECM)-based bioinks to closely recapitulate the biophysical and biochemical cues of tendon cell niche and self-induce the tenogenic differentiation of stem cells. The proposed concept was further explored to study the crosstalk between the tendon core and vascular compartment.Porcine flexor tendons were decellularized to produce the dECM bioink hydrogel. hASCs were used as cell source and the bioink was directly printed within the CNC fluid gel. Tendon constructs were co-printed with compartmentalized microvascular structures to evaluate the cellular crosstalk with endothelial cells. The tendon-on-chip models showed high cell viability and proliferation during culture up to 21 days, and the synergy between dECM cues and printed patterns induced anisotropic cell organization similar to tendon tissues. Gene and protein analysis showed upregulation of the most important tendon related markers on tendon constructs, demonstrating that the biophysical and biochemical cues of dECM induced hASCs commitment toward tenogenic phenotype. In co-culture system, chemotaxis induced endothelial cells migration toward the tendon compartment, but without significant infiltration. Gene and protein expression results suggest that the cellular crosstalk established in this MPS with endothelial cells boosted hASCs tenogenesis, emulating tendon development stages.Overall, the proposed system might be promising for the automated fabrication of organotypic tendon-on-chip models that will be a valuable new tool to study tendon physiology, pathology, or the effect of drugs for the treatment of tendinopathy.Acknowledgments: EU H2020 for ERC-2017-CoG-772817; ERC-PoC-BioCHIPs-101069302; FCT/MCTES for 2022.05526.PTDC, 2020.03410.CEECIND, and PD/BD/129403/2017

Tibialis Anterior Tendon Rupture Surgical Treatments and Outcomes: A Systematic Review and Meta-Analysis

Tibialis anterior tendon ruptures are a rare condition with an often-delayed diagnosis due to transient pain and compensation of remaining anterior compartment tendons. Previous systematic reviews have limited their recommendations to surgical treatment over nonoperative cares given the relatively small sample size in the literature. This current systematic review and meta-analysis was performed to compare the outcomes amongst the various surgical techniques and define factors that may affect long term patients results. Twenty-six references (217 cases) were identified. Use of extensor tendon autograft (odds ratio [OR] 5.55; I2=46%), autograft repair through semitendinosus/gracilis/ plantaris/ Achilles tendon/ peroneus longus ([OR] 4.14; I2=71%), or direct repair ([OR] 3.59; I2=57%), provided the best postoperative outcomes, whereas allograft repair ([OR] .52; I2=77%),and ipsilateral split/ turn-down tibialis anterior tendon ([OR] .69; I2=71%), were associated with poorer outcomes. Ruptures fixed in the acute phase ([OR] 8.3; I2=26%), were associated with statistically significant better outcomes when compared to these ruptures fixed in the chronic phase ([OR] .52; I2=77%). Results of this systematic review and meta-analysis suggests that ruptures should be surgically repaired in the acute phase whenever possible and comparable outcomes can be achieved through extensor tendon autograft repair, autograft repair, and direct repair.

The ultrasound-guided percutaneous release technique for De Quervain's disease using an acupotomy.

This study aimed to compare the effectiveness and safety of the percutaneous first extensor compartment performed by acupotomy procedure with or without ultrasonic (US) guidance. The percutaneous release was performed with an acupotomy on 40 wrists of cadavers, which was divided into US guidance operation and blind operation. Each arm was dissected and assessed regarding the amount of release and the extent of neurovascular and tendon injury. An analysis of finite biomechanical elements based on wrists specimen data is analyzed to observe the stress of the first extensor tendon compartment. A prospective study observed the pain visual analogue score(VAS) and Patient-Rated Wrist Evaluation (PRWEB) changes after the ultrasound guidance or blind acupotomy treatment in 30 dQD patients. The success rate in the ultrasound-guided technique was 85%, and the blind technique was 70% in the cadaver study, both techniques without neurovascular injury. There was no statistically significant difference between the two groups in measuring the distance from the incision marks to the blood vessels and nerves (P > 0.05). According to the biomechanical analysis, the tendon friction rubs when the wrist is upright. When the wrist is flexed, the tendon and tendon sheath is stressed in the bone ridges. In this prospective study, both ultrasound guidance and blind acupotomy treatment achieved well improvements in pain and function (P < 0.05), but the results with no statistically significant between groups (P > 0.05). Both blind and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can get a good result. US-guided techniques can improve the success rate during acupotomy operations, especially for beginners and followers.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF TRAUMATIC INJURIES OF ANKLE JOINT

Background: Because of its wide array of advantages, MRI has gained popularity in evaluation of the musculoskeletal system. The advantages include non-invasiveness, lack of ionizing radiations, superior soft-tissue imaging and direct multiplanar imaging. Excellent visualization of cartilage, ligaments, tendons and bones can be achieved by the high resolution images of MRI. MRI can provide a comprehensive evaluation of ankle, including soft tissue and bone pathology. The soft tissue contrast resolution of MRI is superior to that of CT, and MRI is as good as or better than CT for most bone pathology. MRI is more sensitive than CT in the detection of stress fractures and trabecular bone injury.[4] Aim &amp; Objective: 1.To study the normal anatomy of ankle joint on MRI.2 To assess acute traumatic injury patterns of ankle joint.3.To study the role of MRI in the evaluation of traumatic injuries of ankle joint..4 To study the chronic sequelae of ankle injuries. Methods: Study setting: Cross sectional study Tertiary care center. Study duration: 2 years ( from October 2019 to March 2021). Study population: The study population included all the cases with traumatic ankle injury referred to the Dept. of Radiodiagnosis our institute for MRI scan with or without X-ray ndings admitted at a tertiary care center such cases were included in the study. 50 Majority of cases found in 20-30 years age group 18( 36% Sample size: Results: ) followed by 40-50 group 12 cases (24%), 9 cases in 30-40, 7 cases in &gt;50 and 4 cases in 10-20. Males contributing 34 (68%) and females 16 (32%). Deltoid ligament injuries are observed in 12 patients. However, isolated injuries are not seen. Deltoid ligament injuries are associated with bone, other ligamentous and tendon injuries. Anterior compartment tendon injuries were not observed in this study. 16 patients had a history of acute inversion injury. MRI plays an important role Conclusions: for planning further management and to decide whether the patient will require conservative or surgical management. Even though anatomical variants and technical artefacts can mimic a tear on MRI, it is still considered the primary imaging modality for optimal depiction of internal derangement in ankle injury. Common injuries observed in our study are - anterior talo- bular ligament injury, deltoid ligament injury, tenosynovitis, bone contusions and joint effusion.

Percutaneous Release of the First Extensor Tendon Compartment in De Quervain's Disease by Acupotomy with US-Guidance: A Cadaveric Study.

De Quervain's disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance. Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study. Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment. Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

The value of ultrasound-defined tenosynovitis and synovitis in the prediction of persistent arthritis.

The value of US-defined tenosynovitis in predicting the persistence of inflammatory arthritis is not well described. In particular, the predictive utility of US-defined tenosynovitis of larger tendons is yet to be reported. We assessed the value of US-defined tenosynovitis alongside US-defined synovitis and clinical and serological variables in predicting persistent arthritis in an inception cohort of DMARD-naïve patients with early arthritis. One hundred and fifty DMARD-naïve patients with clinically apparent synovitis of one or more joints and a symptom duration of ≤3 months underwent baseline clinical, laboratory and US (of 19 bilateral joints and 16 bilateral tendon compartments) assessments. Outcomes were classified as persistent or resolving arthritis after 18 months' follow-up. The predictive value of US-defined tenosynovitis for persistent arthritis was compared with those of US-defined synovitis, and clinical and serological variables. At 18 months, 99 patients (66%) had developed persistent arthritis and 51 patients (34%) had resolving disease. Multivariate logistic regression analysis showed that US-detected digit flexor tenosynovitis [odds ratio (OR): 6.6, 95% CI: 2.0 , 22.1, P = 0.002] provided independent predictive data for persistence over and above the presence of US-detected joint synovitis and RF antibodies. In the RF/ACPA-negative subcohort, US-defined digit flexor tenosynovitis remained a significant predictive variable (OR: 4.7, 95% CI: 1.4, 15.8, P = 0.012), even after adjusting for US-defined joint synovitis. US-defined tenosynovitis provided independent predictive data for the development of persistent arthritis. The predictive role of US-defined digit flexor tenosynovitis should be further assessed; investigators should consider including this tendon site as a candidate variable when designing imaging-based predictive algorithms for persistent inflammatory arthritis development.

Wrist Arthroscopy Using the 2R Portal: Is It Safer Than the 1,2 Portal?

The purpose of this study was to compare the 1,2 with a novel 2R portal in terms of proximity to critical structures. Wrist arthroscopy was performed on 8 fresh frozen cadavers via the 1,2 and 2R portals. External anatomy was then dissected under loupe magnification. The closest distance between the portals and surrounding anatomical structures was measured in millimeters using digital calipers. The 1,2 portal was significantly closer to radial artery and first extensor compartment tendons than the 2R portal. The radial artery was on average 1.32 mm from the 1-2 portal and 14.25 mm from the 2R portal. The 2R portal was significantly closer to the second and third extensor compartment tendons. The closest branch of the superficial branch of the radial nerve (SBRN) was on average 2.04 mm from the 1-2 portal and 7.59 mm from the 2R portal, but this was not statistically significant. We advocate using the 2R portal preferentially to the 1,2 portal when treating radial sided wrist pathology to decrease the risk of iatrogenic radial artery and SBRN injury.

Surgical treatment of the ulnar styloid process using an angle-stable hook plate in fractures and symptomatic nonunions

Anatomical reduction of dislocated fractures using an angle-stable hook plate. Surgical revision of symptomatic nonunions with the aim of bone regeneration. Dislocated fractures of the ulnar styloid process with involvement of the ulnar fovea. Combined fractures with instability of the distal radioulnar joint and symptomatic nonunions. Undisplaced fractures of the ulnar styloid process and asymptomatic nonunions. Dorsoradial access to the distal ulna between the 6th extensor tendon compartment and the tendon of the flexor carpi ulnaris muscle. Exposition of the fracture/nonunion. In case of nonunions, excision and freshening of the fracture ends. Reduction is carried out using the hooks of the plate, if necessary additional attachment of autologous cancellous bone in case of nonunions. Fixation of the plate over the gliding hole and subsequent filling of the angular stable screw holes. Depending on the accompanying injury, immobilization in aforearm plaster splint for 1-2weeks. Active movement exercises of the fingers from postoperative day1, if necessary lymph drainage. After bone development, load build-up under ergotherapy guidance. Bony healing was achieved in 100% of our cases. The surgical treatment of symptomatic nonunions as well as dislocated fractures of the ulnar styloid process using anangle-stable hook plate has proven to be successful.

Closed reduction in the treatment of tibial tubercle fractures.

Open reduction and internal fixation (ORIF) is considered the standard care for displaced tibial tubercle fractures, but closed reduction and internal fixation (CRIF) can also be successful. Our aim was to compare outcomes between ORIF and CRIF for tibial tubercle fractures. Children younger than 18 years presenting for a tibial tubercle fracture at a single institution. The main outcomes were operative details (blood loss, tourniquet time, operative time) and complications. Follow-up of at least one month was required. 98 fractures from 95 patients were included. Follow-up averaged 8.7 months. 49% of the fractures had intraarticular involvement (type III). The most common associated injuries were patellar tendon tears and compartment syndrome, occurring in 10.2% and 3.1% of patients, respectively. No meniscal or ligamentous injuries were encountered. ORIF was performed for 81 fractures and CRIF for 17. Both groups were similar regarding sex, age, weight, and follow-up duration (P>0.4). No tourniquet was used for CRIF, while the majority of ORIF cases utilized a tourniquet for an average of 50.6 minutes. Operative blood loss was 31mL less in CRIF (P<0.0001), and the procedure of CRIF was 23.3 minutes shorter than ORIF (P=0.0003). All cases, except 1 fracture treated with ORIF, achieved union. The complication rate was similar in both groups (P=0.79). At final follow-up, patients from both groups had favorable outcomes, with normal knee range of motion and angulation, gait, and quadriceps strength on exam. CRIF is often overlooked in the surgical treatment of displaced tibial tubercle fractures. It is a less invasive treatment option for such fractures and has advantages such as less bleeding, avoiding a tourniquet, and shorter operative duration. Patients treated with either ORIF and CRIF healed with similar rates of complications and had a satisfactory outcome. Given the rarity of associated meniscal or ligamentous injuries, open reduction to visualize the joint surface might not be needed for most patients. The two most common associated injuries, patellar tendon tears and compartment syndrome, can be preliminarily diagnosed pre-operatively. Closed reduction could be initially attempted for tibial tubercle fractures, even ones with intraarticular extension.

Ultrasound Imaging in Psoriatic Arthritis: What Have We Learnt in the Last Five Years?

Psoriatic arthritis (PsA) is a complex heterogeneous disease with multiple inter-related pathologies such as synovitis, enthesitis, tendinopathy, and dactylitis. Clinical assessment is limited in its detail to assess pathology, thus in recent years, ultrasound (US) has become more popular, given its high sensitivity to detect inflammatory arthritis and ability to inform clinical decisions. Although a qualitative technique, US findings can be graded semi-quantitatively for grayscale (GS) and power Doppler (PD). Synovitis is frequently present in inflammatory arthritis pathologies, and in PsA, recent evidence shows a propensity for tendon and entheseal lesions. The presence of flexor tenosynovitis and flexor tendon insertional enthesopathy at accessory pulleys is supportive of the “Deep Koebner” concept. Peri-tendinous inflammation—mutual to PsA or rheumatoid arthritis (RA), is associated with soft tissue oedema with PD signal frequently at the flexor tendon compartments in PsA. Research on enthesitis in PsA/PsO has improved understanding in subclinical and clinical PsA, explored associations with progression to PsA, and investigated links to prognosis assessment. Dactylitis is a pathognomonic PsA lesion where US has enhanced knowledge of the disease course and pathology of lesions such as: flexor tenosynovitis; synovitis; and soft tissue oedema. Increased US sensitivity has also brought innovation including promising automated ultrasound scanning techniques. So, what have we learnt in recent years and what are the unmet needs to focus future research initiatives in this disabling disease? This narrative review article assesses the neoteric evidence, bringing into context the knowledge gained and highlighting potential areas of research.

Volar Approach to the First Extensor Compartment for Surgical Treatment of DeQuervain Tenosynovitis.

Many surgical techniques have been published in regards to the operative management of DeQuervain tenosynovitis. As it has been classically described, stenosing tenosynovitis of the first extensor tendon compartment is a common tendinopathy along the radial side of the wrist causing pain and swelling in the affected area. When surgery is necessary, decompression of the abductor pollicis longus and extensor pollicis brevis tendons decreases first extensor compartment friction and has been shown to successfully alleviate symptoms. A number of varying techniques have been reported in the literature to achieve adequate decompression and minimize postoperative complications such as sensory nerve injury, incomplete decompression, and tendon subluxation. We describe a novel volar approach to the first extensor compartment, which allows direct visualization of the retinaculum and a midline retinacular release. In addition, the volar approach has an associated decreased risk of iatrogenic nerve injury by passing volar and deep to the more superficial sensory nerves that overly the retinaculum. On the basis of our experience, patients do not experience an increased risk of volar tendon subluxation with this approach.