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PubMed1993

Nine-year follow-up results of two methods of MacIntosh anterior cruciate ligament reconstructions.

Forty-seven MacIntosh anterior cruciate reconstructions using iliotibial band were performed in patients with chronic instability symptoms and positive pivot shift jerk. In 22 knees, a lateral substitution technique alone was used. In 25 knees, the technique was supplemented with an intraarticular component. After an average of follow-up of nine years, 62% of knees had an excellent or good Lysholm score; 83% of patients remained active in sports. Subjectively, there was no deterioration of stability with time, and no return of the jerk on pivot shift testing, although a slide persisted in one third of the patients. The addition of an intraarticular component did not alter the subjective result. Objectively, the trend was toward improvement in functioning. The lateral tenodesis was the major determinant in the improvement of subjective stability and control of pivot shift jerk.

Adult↗
PubMed1993

[The painful ulno-carpal joint. Diagnosis and therapy].

The ulnocarpal joint plays a critical role in hand and wrist function. It serves as part of forearm rotation as well as part of the carpal kinematics. The joint is comprised of the distal radio-ulnar articulation, triangular fibrocartilage complex, lunate, triquetrum, hamate, and pisiform, and the intra and extracapsular ligamentous and soft tissue constraints. Traumatic disruptions as well as chronic inflammatory conditions are commonplace. In addition to standard radiographs, arthrography, CT scanning, and MRI studies prove useful. Wrist arthroscopy is becoming of increasing importance in this region of the wrist. Ulnar impaction syndrome may occur associated with malunion of distal radius fracture, ulna positive variance, or chronic TFCC tears. Osteotomy of the distal radius or ulnar shortening osteotomy should be considered. Instability of the distal ulna can be treated with tenodesis procedures, hemi-resection arthroplasty, matched ulna resection or the Sauvé-Kapandji procedure.

Biomechanical Phenomena↗
PubMed1977

Flexible (silicone) implant arthroplasty of the metacarpophalangeal joint of the thumb.

Forty-four thumbs in thirty-four patients with rheumatoid arthritis were treated with a flexible implant arthroplasty of the metacarpophalangeal joint. After follow-ups ranging from two to six and a half years the results were rated good to excellent in forty-two thumbs since they were not painful, had an increased arc of motion of the metacarpophalangeal joint in a more functional range, and were more effective in the activities of daily living. The results in this series indicated that careful reconstruction of the extensor apparatus is essential, as well as stabilization of the interphalangeal joint either by arthrodesis or by tenodesis if there is a hyperextension deformity. Of the six patients who had a fusion of the metacarpophalangeal joint in one thumb and an arthroplasty in the other, five preferred the arthroplasty because the joint was stable and also had a useful arc of motion, while one noted no difference between the two thumbs.

Adolescent↗
PubMed1995

The surgical treatment of posterior shoulder instability.

Operative procedures for recurrent posterior instability range from glenoid osteotomy, posterior bone block procedures, posterior capsular plication with biceps tenodesis to arthroscopic stabilization with a biodegradable tac. The best results and the most commonly reported procedure(s) involve the reattachment of any labral detachment and a posterior capsular plication via a posterior approach.

Arm Injuries↗
PubMed1996

[Arthroscopic treatment of chronic anterior instability of the shoulder by staple capsulorrhaphy. Apropos of a series of 55 patients with a minimum of 18 months follow-up].

PURPOSE OF THE STUDY: The authors studied the results of the arthroscopic staple capsulorrhaphy of 55 patients who had recurrent anterior shoulder instability. MATERIALS AND METHODS: There were 38 men and 17 women. The average age at operation was 30.3 years (17 to 68) and the dominant side was injured in 33 patients. 28 (51 per cent) patients had recurrent dislocations, 19 (38 per cent) patients had recurrent subluxations and 8 (14 per cent) complained of a painful shoulder with instability. Multidirectionnal hyperlaxity and glenoid rim fracture cases were excluded from this study. The average duration of symptoms was 43 months (i to 180). At operation, 46 patients had a Bankart lesion (Adolfsson A or C) and 9 had "non Bankart" lesion (Adolfsson B and intra ligamentous disruption). There were 6 (11 per cent) SLAP II lesions and 23 (42 per cent) other glenoid labral tears associated with main instability lesions. 58 staples were inserted. 53 inferior glenoid humeral ligament were fixed to the glenoid rim and in 2 cases we performed a subscapularis tendon tenodesis. RESULTS: The follow-up was continued for at least 18 months after treatment by an examiner different from the operating surgeon. (Average follow-up was 29.8 months). The results were assessed according to "Duplay" rating scale. Overall we have obtained 64 per cent excellent and good results. 71 per cent of shoulders were considered stable at revision whereas 7 per cent showed recurrent dislocation. 60 per cent of patients were able to return to their previous sport level. A limited range of motion was noted in only 11 per cent of cases. On the other hand 54 per cent of patients presented persistent pain. With regard to the shoulder stability, the factors possibly having a negative influence were the occurrence of an initial acute dislocation, the destruction of the inferior glenohumeral ligament (disruption or absence) and the sub-equatorial position of the staple on the anterior glenoid rim. Pain was more frequent in cases where there was associated subacromial impingement and where the staples had been badly positioned. DISCUSSION: We have compared our results with those of other authors who also performed stapling procedures, including different arthroscopic techniques and results of open stabilization surgery. Our results regarding shoulder instability were better than those obtained by arthroscopic sutures, equivalent to those obtained by the "Open Bankart" procedure, but less impressing than those obtained by the "Bone Block" procedure (Patte). However, pain was observed much more frequently than with all the other stabilization techniques, arthroscopic or not. CONCLUSION: Arthroscopic stapling therefore seemed to be less reliable than the "Patte Bone Block" procedure. At present, we reserve arthroscopic stabilization for patients with a good inferior glenohumeral ligament. Until an adapted biodegradable staple is perfected, we still use an anchorsuture technique to avoid pain due to metallic implant.

Adolescent↗
PubMed1998

[Current status of shoulder arthroscopy].

Arthroscopic and open shoulder surgery have to be combined for a successful surgical therapy of the shoulder joint. A surgeon performing open surgery only or just treating by arthroscopic measurements can not cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilisation of chronic anterior posttraumatic dislocations fail to compare with high success rates of open procedures. Better patient selection will probably be the key to improving results. In case of acute traumatic first time dislocation in young highly sportive athletes the arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy of shrunk capsule in frozen shoulder and tenodesis for lesions of the long head of the biceps. The arthroscopic subacromial decompression according to Ellman is the most often and successful performed procedure at the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon the arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with an mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In case of associated or isolated AC-joint arthritis an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Acromioclavicular Joint↗
PubMed1998

Tendon transfer for equinovarus deformed foot caused by cerebrovascular disease.

Surgical correction was performed on 125 patients who had equinovarus deformity caused by a cerebrovascular accident and who needed an ankle foot orthosis for walking. The operative procedures involved anterior transfer of the long toe flexors (flexor hallux longus and flexor digitorum longus; long toe flexor group) or lateral transfer of the anterior tibial tendon (anterior tibial tendon group), combined with lengthening of the Achilles tendon. On evaluation more than 2 years after surgery, 83 of 110 patients of the long toe flexor group and eight of 15 patients of the anterior tibial tendon group were able to walk without a brace. Five patients of the anterior tibial tendon group who had shown strong contraction of the anterior tibial muscle during the swing phase before surgery, needed a brace because of a drop foot after surgery. Thus, lateral transfer of the anterior tibial tendon was abandoned in 1984. Recurrence of varus deformity was seen in approximately 15% of the patients in both groups. Anterior transfer of the long toe flexors, using them as dorsiflexor tendons or for tenodesis, seemed to produce better results.

Adult↗
PubMedDate not supplied

[Biomechanical evaluation of biointegrable suture anchors composed of bovine compact bone in a pull-to-failure test in porcine tibial head specimens].

AIM: Suture anchors of various designs have gained wide acceptance for securing soft tissues to bone. The biointegrable Tutofix CB anchors derived from bovine compact bone are available with diameters of 3 mm (CB3 anchor), 4 mm (CB4 anchor) and 5 mm (CB5 anchor). The CB anchors are push-in anchors and, from the biomechanical standpoint, they are a combination of press-fit and angulation anchors. The purpose of this study was to evaluate the CB anchors for singular pull load-to-failure strength using porcine tibial head specimens as a test model. METHODS: In all specimens, the joint surface was removed by performing a subchondral osteotomy. Axial PQ-CT scans of 12 specimens were obtained to determine the trabecular BMD. The anchors were implanted posteromedially and centrolaterally in the porcine tibial head specimens. After threading the anchors with a steel suture and predrilling of the anchor holes perpendicular to the osteotomy surface they were inserted 4 mm below the osteotomy surface. A universal testing machine applied tensile loads parallel to the axis of insertion at rates of 10 mm/min and 500 mm/min until pull-out failure or anchor breakage and mean anchor fixation strengths were calculated. RESULTS: The fixation strength of the CB anchors was found to be much higher at the dorsomedial implantation site than at the centrolateral implantation site. The CB4 anchors and CB5 anchors provided nearly the same fixation strength at a level much higher than that of the CB3 anchors. Bone mineral density had a strong influence on axial pull-out force of the anchors, especially the CB4 anchors and CB5 anchors. The overall correlation coefficient for bone mineral density with ultimate load-to-failure was 0.869 for the CB4 anchors and 0.716 for the CB5 anchors. Differences in failure strengths were also seen between the low and high extraction rates. With the high extraction rate much higher failure strengths were obtained than with the low extraction rate. The sudden pull eccentrically on the anchors caused a better fixation due to angulation of the anchor within the drill holes. CONCLUSION: In spite of the double worst-case scenario in the testing conditions, the CB anchors provided a high fixation strength in the trabecular bone of porcine tibial head specimens with the CB4 anchors and CB5 anchors being nearly equal and both being superior to the CB3 anchors. Bone mineral density had a strong influence on the axial pull-out force. Our results show that the CB anchors seem to be a reasonable alternative to metal and bioabsorbable suture anchors.

Absorbable Implants↗
PubMedDate not supplied

[Operative treatment of ruptures of distal tendon of biceps muscle with a minimally invasive technique using suture anchors--clinical results].

AIM: Ruptures of the distal tendon of the biceps muscle should be treated operatively. A minimally invasive technique and the use of suture anchors may decrease the intraoperative risks. But can satisfactory clinical results be achieved? METHOD: We present the results of a clinical study. Between 1999 and 2005 nine patients were operated for distal biceps tendon avulsion. A minimally invasive operating technique using a suture anchor was established and the technique is described. Rantanen and Orava's score was used to compare clinical and radiological findings. RESULTS: Clinical follow-up was performed at 6 months after operation. In six patients excellent results according to Rantanen and Orava were achieved. No loss of strength was noticed in 6 of 9 cases. Range of motion was unlimited in six patients. In two cases we found heterotopic ossifications. CONCLUSION: On the basis of our results we suggest that minimally invasive surgery using a suture anchor should be performed more often. The technique described leads to results that are comparable to those found in the literature.

Accidents, Occupational↗
PubMed2006

The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study.

BACKGROUND: Rupture of the patellar tendon is a disabling injury that usually requires surgical treatment. The standard method of repair involves placing suture loops through transpatellar tunnels. The use of suture anchors in patellar tendon repair has not been previously described. HYPOTHESIS: No difference exists in the amount of gap formation during cyclic loading or in ultimate load-to-failure strength between repairs performed with anchors and those performed with 2 types of transpatellar sutures. STUDY DESIGN: Controlled laboratory study. METHODS: Six matched pairs of cadaveric knees were tested in a custom biomechanical apparatus based on an established model. Repairs were performed using either suture anchors with No. 2 FiberWire or transpatellar suture tunnels using 2 different types of suture-No. 5 Ethibond and No. 2 FiberWire. Gap formation across the repair site during 250 cycles of extension as well as ramp-up load to failure were measured for each repair. RESULTS: The mean total gap formation across the repair site at 250 cycles was 4.1 +/- 1.9 mm for the suture anchor group, 6.7 +/- 1.8 mm for the FiberWire tunnel group, and 8.5 +/- 2.7 mm for the Ethibond tunnel group. Mean load to failure was 779 +/- 183 N, 730 +/- 83 N, and 763 +/- 231 N, respectively. CONCLUSION: Significantly less gap formation throughout 250 cycles (P = .009) and no difference in load to failure occurred with patellar tendon repairs performed with suture anchors as compared with repairs performed with transpatellar tunnels. CLINICAL RELEVANCE: The newly described method, using suture anchors for repair of patellar tendon ruptures, may be clinically equal or superior to the established method of using transpatellar tunnels.

Aged↗
PubMed2006

Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels.

BACKGROUND: This research was undertaken to determine whether there is a need for a second tibial tunnel in anatomic anterior cruciate ligament reconstruction. HYPOTHESIS: Anatomic two-bundle reconstruction with two tibial tunnels restores knee anterior tibial translation in response to 134 N and to 5-N.m internal tibial torque combined with 10-N.m valgus torque more closely to normal than does double-bundle reconstruction with one tibial tunnel. STUDY DESIGN: Controlled laboratory study. METHODS: Ten cadaveric knees were subjected to a 134-N anterior tibial load at 0 degrees, 30 degrees, 60 degrees, and 90 degrees and to 5-N.m internal tibial torque and 10-N.m valgus torque at 15 degrees and 30 degrees. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament-deficient, (3) double-bundle/one tibial tunnel, and (4) double-bundle/two tibial tunnels. RESULTS: Anterior tibial translation for the reconstruction with two tibial tunnels was significantly closer to that of the intact knee than was the reconstruction with one tibial tunnel at 0 degrees and 30 degrees of flexion (0 degrees = 3.82 vs 6.0 mm, P < .05; 30 degrees = 7.99 vs 11 mm, P < .05). The in situ force normalized to the intact anterior cruciate ligament for the reconstruction with two tibial tunnels was significantly higher than the in situ force of the reconstruction with one tibial tunnel (30 degrees = 89 vs 82 N, P < .05). With a combined rotatory load, the anterior tibial translation of specimens with a tibial two-tunnel technique was significantly lower than that of specimens with one tunnel (0 degrees = 5.7 vs 8.4 mm, P < .05; 30 degrees = 7.5 vs 9.5 mm, P < .05). CONCLUSIONS: Anatomic reconstruction with two tibial tunnels may produce a better biomechanical outcome, especially close to extension. CLINICAL RELEVANCE: At the time of initial fixation, there appears to be a small biomechanical advantage to the second tibial tunnel in the setting of two-bundle anterior cruciate ligament reconstruction.

Aged↗
PubMed2006

Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair.

BACKGROUND: Recent technical improvements have led the way to a resurgence of the single-incision approach for repair of distal biceps tendon injuries. There has been no biomechanical evaluation of all these techniques with comparison to the standard 2-incision bone tunnel technique. HYPOTHESIS: There will be no difference under cyclic loading and ultimate failure between the 2-incision bone tunnel technique, suture anchor repair, interference screw, and EndoButton techniques for the repair of distal biceps tendon ruptures. STUDY DESIGN: Controlled laboratory study. METHODS: Sixty-three fresh-frozen cadaveric elbows were randomly assigned to 4 treatment groups (bone tunnel, EndoButton, suture anchor, interference screw). Cyclic loading was then performed from 0 degrees to 90 degrees at 0.5 Hz for 3600 cycles with a 50-N load. A differential variable reductance transducer was placed between the radius and distal tendon to determine displacement. The construct was then pulled to failure at 120 mm/min. RESULTS: A multiple analysis of variance revealed no statistically significant difference for displacement among the 4 repair techniques. Displacement using the bone tunnel was 3.55 mm, EndoButton was 3.42 mm, suture anchor was 2.33 mm, and interference screw was 2.15 mm. There was a statistically significant greater load to failure with EndoButton (440 N) than suture anchor (381 N), bone tunnel (310 N), or interference screw (232 N) (P < .001). CONCLUSION: The EndoButton technique had the highest load to failure. CLINICAL RELEVANCE: These data demonstrate the EndoButton to be the strongest repair technique, with no failures during cycling at physiologic loads and with the largest load to failure. These findings are important in maximizing surgical results and stability and suggest that the construct can tolerate early postoperative active range of motion.

Arm↗
PubMed2005

[Functional reconstruction of irreversible partial injury of brachial plexus].

OBJECTIVE: To assess treating results of functional reconstruction of irreversible partial injury of brachial plexus and to improve the function of injured upper extremity. METHODS: Seventy-nine cases with irreversible partial injury of brachial plexus were treated in transfer of muscle (tendon) or by functional arthrodesis (fixation of tendon) from January 1984 to June 2003. According to the evaluation criterion by American Shoulder and Elbow, Hand Association, all patients were followed up in motion of reconstructive joint and daily activities after operation for 1 year to 19 years. The effect of the operation was comprehensively scored and evaluated. RESULTS: Final results in 54 cases were as follows: 30 patients with good results, 19 patients with fair results, and 5 with poor results. The results demonstrated some points as follow: (1) if the shoulder was instable, arthrodesis of shoulder would be a better choice; (2) the flexion of the elbow joint should be only reconstructed with the dynamic reconstructive methods. The reconstruction of flexion of elbow by transfer of pectoral major muscle was more effective than that by transfer of flexor carpi ulnaris muscle; (3) the dynamic reconstruction of extension of digital and carpi was better than that of flexion of digital and opposition function of the thumb; (4) the supination of the forearm was effectively reconstructed by transfer of flexor carpi ulnaris muscle. Pronation teres muscle should be studied more in reconstruction of supination function of the forearm. CONCLUSION: The functional reconstruction is effective in treating irreversible partial injury of brachial plexus.

Adolescent↗