Pub Date : 2024-08-30DOI: 10.1016/j.xrrt.2024.08.003
Javier Ardebol MD, MBA , Kassem Ghayyad MD , Theresa Pak DO , Lisa Galasso MD , Matthew Noble DO , Ali Īhsan Kiliç MD, PhD , Diego Gonzalez-Morgado MD , Mariano E. Menendez MD , Patrick J. Denard MD
Pathology of the long head of the biceps tendon is commonly associated with massive rotator cuff tears (MRCTs), which account for roughly one third of all rotator cuff tears. Treatment options for this condition include tenotomy, tenodesis, augmentation, and the use of the tendon as a graft for partial superior capsule reconstruction. Augmentation and superior capsular reconstruction are evolving techniques in the management of MRCTs. However, similar to the lack of consensus on the treatment of MRCTs, there are no clear guidelines for the management of concurrent biceps tendon pathology.
{"title":"Long head of biceps tendon management in the setting of massive rotator cuff tears","authors":"Javier Ardebol MD, MBA , Kassem Ghayyad MD , Theresa Pak DO , Lisa Galasso MD , Matthew Noble DO , Ali Īhsan Kiliç MD, PhD , Diego Gonzalez-Morgado MD , Mariano E. Menendez MD , Patrick J. Denard MD","doi":"10.1016/j.xrrt.2024.08.003","DOIUrl":"10.1016/j.xrrt.2024.08.003","url":null,"abstract":"<div><div>Pathology of the long head of the biceps tendon is commonly associated with massive rotator cuff tears (MRCTs), which account for roughly one third of all rotator cuff tears. Treatment options for this condition include tenotomy, tenodesis, augmentation, and the use of the tendon as a graft for partial superior capsule reconstruction. Augmentation and superior capsular reconstruction are evolving techniques in the management of MRCTs. However, similar to the lack of consensus on the treatment of MRCTs, there are no clear guidelines for the management of concurrent biceps tendon pathology.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 662-667"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.xrrt.2024.08.004
Robert T. Tisherman MD , Emily Luo BS , Damon Briggs BS , Clark Bulleit BS , Gabrielle Fatora MD , Brian Lau MD
Background
Glenohumeral instability is a complex clinical problem with underlying pathology in the bony, labral, and capsular tissues. The rate of specific capsular injuries varies widely in the literature and the clinical importance of these specific injury patterns remains unclear.
Methods
Following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic review was performed of multiple databases for all primary research articles between 2008 and 2023 which included advanced imaging and included rates of capsular injury in patients with glenohumeral instability.
Results
Twelve studies met inclusion criteria. The most prevalent capsular injury seen was in the inferior glenohumeral ligament (34.1%) across all studies, followed by anterior labroligamentous periosteal sleeve avulsions with 24.9% prevalence. Humeral avulsions of the glenohumeral ligaments lesions were the least common (6.2%) of subjects, followed closely by capsular tears (8.3%) of subjects.
Conclusion
Capsular injury is commonly seen in magnetic resonance imaging of patients with anterior shoulder instability. Significant heterogeneity in language and imaging techniques was found in the existing literature. Further research is needed to explore these specific capsular lesions’ clinical implications and rehabilitation strategies.
背景肱骨不稳定性是一个复杂的临床问题，其根本病理在于骨、唇和关节囊组织。方法根据《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analysis）指南，在多个数据库中对 2008 年至 2023 年期间的所有主要研究文章进行了系统综述，这些文章包括先进的成像技术，并纳入了盂肱关节不稳患者的关节囊损伤率。在所有研究中，最常见的关节囊损伤发生在盂肱下韧带（34.1%），其次是前唇韧带骨膜套撕脱，发生率为24.9%。肱骨盂肱韧带撕脱病变在受试者中最少见（6.2%），紧随其后的是肩关节囊撕裂（8.3%）。结论肩关节前部不稳定患者的磁共振成像中经常出现肩关节囊损伤，在现有文献中发现语言和成像技术存在明显的异质性。需要进一步研究探讨这些特殊的肩关节囊损伤的临床意义和康复策略。
{"title":"Glenohumeral capsular injury rate in patients with glenohumeral instability: a systematic review and meta-analysis","authors":"Robert T. Tisherman MD , Emily Luo BS , Damon Briggs BS , Clark Bulleit BS , Gabrielle Fatora MD , Brian Lau MD","doi":"10.1016/j.xrrt.2024.08.004","DOIUrl":"10.1016/j.xrrt.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Glenohumeral instability is a complex clinical problem with underlying pathology in the bony, labral, and capsular tissues. The rate of specific capsular injuries varies widely in the literature and the clinical importance of these specific injury patterns remains unclear.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic review was performed of multiple databases for all primary research articles between 2008 and 2023 which included advanced imaging and included rates of capsular injury in patients with glenohumeral instability.</div></div><div><h3>Results</h3><div>Twelve studies met inclusion criteria. The most prevalent capsular injury seen was in the inferior glenohumeral ligament (34.1%) across all studies, followed by anterior labroligamentous periosteal sleeve avulsions with 24.9% prevalence. Humeral avulsions of the glenohumeral ligaments lesions were the least common (6.2%) of subjects, followed closely by capsular tears (8.3%) of subjects.</div></div><div><h3>Conclusion</h3><div>Capsular injury is commonly seen in magnetic resonance imaging of patients with anterior shoulder instability. Significant heterogeneity in language and imaging techniques was found in the existing literature. Further research is needed to explore these specific capsular lesions’ clinical implications and rehabilitation strategies.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 762-767"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.xrrt.2024.08.001
Hassan Mousa MBChB, MHI, MPH, MD, Daniel Williams MBChB, FRCS(Tr&Orth), Nick Aresti MBBS, FHEA, FRCS(Tr&Orth)
Background
Arthroscopic reduction internal fixation (ARIF) is gaining popularity for displaced radial head fractures. However, it has yet to be widely performed. ARIF offers a complete view of the articular surfaces of the radial head, capitulum, and coronoid and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). ARIF requires a long learning curve and high technical skills. This systemic review aims to examine the functional outcomes and complications of ARIF.
Method
A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included “radial head fracture" OR "elbow fracture" AND “arthroscopic fixation" OR “arthroscopy” OR “arthroscopic reduction internal fixation”. Studies were limited to those published in English with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including Mayo Elbow Performance Score and the Broberg and Morrey Rating System and complications were extracted. The Institute of Health Economics checklist was used for quality assessment.
Results
Five studies met the inclusion criteria. The age ranged from 14 to 72 years, with the mean follow-up length ranging from 1 to 12 months postoperatively. The mean Mayo Elbow Performance Score and Broberg and Morrey Rating System scores for the ARIF group were significantly better than those for the ORIF group. The ARIF group reduced Stiffness and heterotopic ossification considerably compared with that in ORIF.
Conclusion
ARIF is a safe and viable option for treating displaced radial head fractures. It provides less soft tissue trauma and causes less stiffness compared to ORIF.
背景显微镜下复位内固定术（ARIF）在治疗移位的桡骨头骨折方面越来越受欢迎。然而，这种手术尚未广泛开展。ARIF 可以完整地观察桡骨头、岬和冠状面的关节面，并诊断和治疗其他相关损伤。与开放复位内固定术（ORIF）相比，ARIF造成的软组织创伤更小。ARIF 需要较长的学习曲线和较高的技术技能。本系统综述旨在研究 ARIF 的功能结果和并发症。检索词包括 "桡骨头骨折 "或 "肘部骨折 "和 "关节镜固定 "或 "关节镜 "或 "关节镜复位内固定"。研究仅限于用英语发表的、报告了功能结果和并发症的研究。研究提取了患者的人口统计学特征、临床结果（包括活动范围）、结果表现评分（包括梅奥肘关节表现评分和布罗伯格与莫雷评分系统）以及并发症。结果五项研究符合纳入标准。患者年龄从14岁到72岁不等，术后平均随访时间从1个月到12个月不等。ARIF组的平均梅奥肘关节表现评分和Broberg与Morrey评分系统评分明显优于ORIF组。结论 ARIF是治疗移位桡骨头骨折的一种安全可行的方法。结论 ARIF 是治疗移位性桡骨头骨折的一种安全可行的方法，与 ORIF 相比，它对软组织的创伤更小，造成的僵硬程度也更低。
{"title":"Arthroscopic reduction internal fixation for displaced radial head fractures: a systematic review of the outcomes and complications","authors":"Hassan Mousa MBChB, MHI, MPH, MD, Daniel Williams MBChB, FRCS(Tr&Orth), Nick Aresti MBBS, FHEA, FRCS(Tr&Orth)","doi":"10.1016/j.xrrt.2024.08.001","DOIUrl":"10.1016/j.xrrt.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic reduction internal fixation (ARIF) is gaining popularity for displaced radial head fractures. However, it has yet to be widely performed. ARIF offers a complete view of the articular surfaces of the radial head, capitulum, and coronoid and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). ARIF requires a long learning curve and high technical skills. This systemic review aims to examine the functional outcomes and complications of ARIF.</div></div><div><h3>Method</h3><div>A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included “radial head fracture\" OR \"elbow fracture\" AND “arthroscopic fixation\" OR “arthroscopy” OR “arthroscopic reduction internal fixation”. Studies were limited to those published in English with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including Mayo Elbow Performance Score and the Broberg and Morrey Rating System and complications were extracted. The Institute of Health Economics checklist was used for quality assessment.</div></div><div><h3>Results</h3><div>Five studies met the inclusion criteria. The age ranged from 14 to 72 years, with the mean follow-up length ranging from 1 to 12 months postoperatively. The mean Mayo Elbow Performance Score and Broberg and Morrey Rating System scores for the ARIF group were significantly better than those for the ORIF group. The ARIF group reduced Stiffness and heterotopic ossification considerably compared with that in ORIF.</div></div><div><h3>Conclusion</h3><div>ARIF is a safe and viable option for treating displaced radial head fractures. It provides less soft tissue trauma and causes less stiffness compared to ORIF.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 710-714"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the efficacy of pre-emptive middle glenohumeral ligament (MGHL) release during arthroscopic rotator cuff repair (ARCR) of small- to medium-sized tears to prevent postoperative stiffness.
Methods
Patients who underwent ARCR of small- to medium-sized tears were enrolled and allocated into 2 groups retrospectively: the pre-emptive MGHL release group (MGHL+ group, n = 34) and pre-emptive MGHL nonrelease group (MGHL− group, n = 32). The rotator interval and coracohumeral ligament release were performed in all patients with or without MGHL release in both groups. Clinical outcomes including the range of motion; Constant Shoulder score; and the University of California, Los Angeles score preoperatively and at 3 months, 6 months, and 12 months postoperatively and complications were assessed and compared between the 2 groups. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging.
Results
The MGHL+ group showed a significantly higher external rotation; Constant Shoulder score; and the University of California, Los Angeles score than the MGHL− group at 6 months postoperatively (P = .03, <.001, .01, respectively). The range of motion and functional scores were not significantly different between the groups at 3 and 12 months postoperatively (P > .05). The retear rate, postoperative stiffness, and postoperative instability were not significantly different between the groups (all, P > .05).
Conclusion
Pre-emptive MGHL release in ARCR of small- to medium-sized tears could be an effective method to prevent early postoperative shoulder stiffness but does not significantly change the overall clinical outcome after ARCR.
{"title":"The effect of preemptive middle glenohumeral ligament release, following release of the rotator interval and coracohumeral ligament, in arthroscopic rotator cuff repair of small- to medium-sized tears to prevent postoperative stiffness: a retrospective comparative study","authors":"Ryosuke Takahashi MD , Ryosuke Sagami MD , Yohei Harada MD, PhD , Yukihiro Kajita MD, PhD","doi":"10.1016/j.xrrt.2024.08.002","DOIUrl":"10.1016/j.xrrt.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the efficacy of pre-emptive middle glenohumeral ligament (MGHL) release during arthroscopic rotator cuff repair (ARCR) of small- to medium-sized tears to prevent postoperative stiffness.</div></div><div><h3>Methods</h3><div>Patients who underwent ARCR of small- to medium-sized tears were enrolled and allocated into 2 groups retrospectively: the pre-emptive MGHL release group (MGHL+ group, n = 34) and pre-emptive MGHL nonrelease group (MGHL− group, n = 32). The rotator interval and coracohumeral ligament release were performed in all patients with or without MGHL release in both groups. Clinical outcomes including the range of motion; Constant Shoulder score; and the University of California, Los Angeles score preoperatively and at 3 months, 6 months, and 12 months postoperatively and complications were assessed and compared between the 2 groups. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging.</div></div><div><h3>Results</h3><div>The MGHL+ group showed a significantly higher external rotation; Constant Shoulder score; and the University of California, Los Angeles score than the MGHL− group at 6 months postoperatively (<em>P</em> = .03, <.001, .01, respectively). The range of motion and functional scores were not significantly different between the groups at 3 and 12 months postoperatively (<em>P</em> > .05). The retear rate, postoperative stiffness, and postoperative instability were not significantly different between the groups (all, <em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>Pre-emptive MGHL release in ARCR of small- to medium-sized tears could be an effective method to prevent early postoperative shoulder stiffness but does not significantly change the overall clinical outcome after ARCR.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 774-778"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.xrrt.2024.07.004
Nikita Golovachev BS, Kassem Ghayyad MD, Olamide Oshikoya MD, PharmD, G. Russell Huffman MD, MPH
Massive rotator cuff tears constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length–tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired massive rotator cuff tear with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly and 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length–tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.
{"title":"Anterior cable reconstruction using subpectoral biceps tenodesis with biceps transfer in rotator cuff tears: a surgical technique","authors":"Nikita Golovachev BS, Kassem Ghayyad MD, Olamide Oshikoya MD, PharmD, G. Russell Huffman MD, MPH","doi":"10.1016/j.xrrt.2024.07.004","DOIUrl":"10.1016/j.xrrt.2024.07.004","url":null,"abstract":"<div><div>Massive rotator cuff tears constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length–tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired massive rotator cuff tear with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly and 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length–tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 727-732"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.xrrt.2024.07.005
Benjamin M. Ose MPH , Henry Wang BS , Christopher D. Bernard MD , Erik Mersereau MD , Rachel Long BS , Bryan G. Vopat MD , Erik Henkelman MD , Matthew L. Vopat MD
Background
The ulnar collateral ligament (UCL) is frequently injured in overhead throwing athletes, leading to elbow instability, pain and decreased performance, and requiring surgical intervention. Augmenting with suture tape provides a novel approach to UCL repair, offering stability while preserving native anatomy, proprioception, and minimizing bone loss, with the added benefit of an expected faster rehabilitation and return to sport (RTS) compared to traditional UCL reconstruction. The purpose of this study is to assess the variability of the current publicly available rehabilitation protocols for elbow UCL repair with suture tape augmentation.
Methods
A systematic review of Google and PubMed was performed to find rehabilitation protocols for UCL repair with suture tape augmentation. Two hundred nine orthopedic surgery residency programs were identified using the Fellowship and Residency Electronic Interactive Database Access. The programs were searched on Google, a broad nonspecific Google search, and a systematic literature search of journal databases for UCL repair with suture tape augmentation rehabilitation protocols was conducted.
Results
Thirteen rehabilitation protocols met the inclusion criteria for analysis. Of these, 12 protocols outlined the use of an articulating brace at varying range of motion settings for the first 4-6 weeks following surgery. Return to throwing was included in all 13 protocols and began between 10 and 12 weeks following surgery. RTS was included in 11 protocols and expected athletes competing as early as 16 weeks with a mean recommended RTS at 21.5 weeks.
Conclusion
Rehabilitation protocols for UCL repair with suture tape augmentation were often structured around a 5-phase program with RTS approaching 20 weeks. They utilized immobilization and range of motion restriction as well as strengthening and gradual RTS procedures. Overall, the included protocols had mild variability with initiation of throwing and RTS 12 to 24 weeks faster than traditional UCL reconstruction.
{"title":"Variability of rehabilitation protocols for ulnar collateral ligament repair with suture tape augmentation","authors":"Benjamin M. Ose MPH , Henry Wang BS , Christopher D. Bernard MD , Erik Mersereau MD , Rachel Long BS , Bryan G. Vopat MD , Erik Henkelman MD , Matthew L. Vopat MD","doi":"10.1016/j.xrrt.2024.07.005","DOIUrl":"10.1016/j.xrrt.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>The ulnar collateral ligament (UCL) is frequently injured in overhead throwing athletes, leading to elbow instability, pain and decreased performance, and requiring surgical intervention. Augmenting with suture tape provides a novel approach to UCL repair, offering stability while preserving native anatomy, proprioception, and minimizing bone loss, with the added benefit of an expected faster rehabilitation and return to sport (RTS) compared to traditional UCL reconstruction. The purpose of this study is to assess the variability of the current publicly available rehabilitation protocols for elbow UCL repair with suture tape augmentation.</div></div><div><h3>Methods</h3><div>A systematic review of Google and PubMed was performed to find rehabilitation protocols for UCL repair with suture tape augmentation. Two hundred nine orthopedic surgery residency programs were identified using the Fellowship and Residency Electronic Interactive Database Access. The programs were searched on Google, a broad nonspecific Google search, and a systematic literature search of journal databases for UCL repair with suture tape augmentation rehabilitation protocols was conducted.</div></div><div><h3>Results</h3><div>Thirteen rehabilitation protocols met the inclusion criteria for analysis. Of these, 12 protocols outlined the use of an articulating brace at varying range of motion settings for the first 4-6 weeks following surgery. Return to throwing was included in all 13 protocols and began between 10 and 12 weeks following surgery. RTS was included in 11 protocols and expected athletes competing as early as 16 weeks with a mean recommended RTS at 21.5 weeks.</div></div><div><h3>Conclusion</h3><div>Rehabilitation protocols for UCL repair with suture tape augmentation were often structured around a 5-phase program with RTS approaching 20 weeks. They utilized immobilization and range of motion restriction as well as strengthening and gradual RTS procedures. Overall, the included protocols had mild variability with initiation of throwing and RTS 12 to 24 weeks faster than traditional UCL reconstruction.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 703-709"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.xrrt.2024.07.003
Antoine Vanderlinden MD , Romain Carlat MD , Bruno Vincent MD , Christine Detrembleur PhD , Serge Ayong MD
Background
Rupture of the long head of the distal bifid biceps tendon is a rare injury, for which surgical anatomical repair should be considered in active patients. The aim of this study was to review our patients who benefited from the EndoButton technique via a single anterior approach, comparing the clinical outcomes with the contralateral uninjured side and assessing their quality of life. Our hypothesis was that an “anatomical” insertion, through an anterior approach, by reinserting the 2 distinct tendons on the radial tuberosity, would restore the supination ability of the forearm more effectively than flexion strength.
Methods
This study included 25 patients who underwent surgery between June 2015 and January 2021. All patients underwent distal biceps reattachment using an endo-osseous fixation technique with the same device. Each patient completed a quality-of-life questionnaire and participated in biomechanical performance tests.
Results
We observed a significant 14% reduction in strength during flexion on the operated side compared to the healthy side. However, no significant differences in strength were found for supination, extension, and pronation between the operated and nonoperated limbs in these same patients. In terms of endurance, flexion on the operated side tended to exhibit greater endurance than on the healthy side, while endurance in supination appeared similar between the operated and healthy sides. This finding held irrespective of whether the operated limb was dominant or nondominant. We also discovered a strong correlation between the time elapsed since surgery and differences in strength during both flexion and supination.
Conclusion
The ultimate goal is to achieve an anatomical surgical repair to restore all functions and maximize patient outcomes. As demonstrated, we have obtained good clinical results with EndoButton repair and a single anterior approach. The results in terms of strength and endurance are similar to those reported in the literature, and all our patients are satisfied. No postoperative complications were found.
{"title":"Biomechanical and clinical outcomes after distal biceps tendon reattachment using an endo button technique and an interference screw","authors":"Antoine Vanderlinden MD , Romain Carlat MD , Bruno Vincent MD , Christine Detrembleur PhD , Serge Ayong MD","doi":"10.1016/j.xrrt.2024.07.003","DOIUrl":"10.1016/j.xrrt.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Rupture of the long head of the distal bifid biceps tendon is a rare injury, for which surgical anatomical repair should be considered in active patients. The aim of this study was to review our patients who benefited from the EndoButton technique via a single anterior approach, comparing the clinical outcomes with the contralateral uninjured side and assessing their quality of life. Our hypothesis was that an “anatomical” insertion, through an anterior approach, by reinserting the 2 distinct tendons on the radial tuberosity, would restore the supination ability of the forearm more effectively than flexion strength.</div></div><div><h3>Methods</h3><div>This study included 25 patients who underwent surgery between June 2015 and January 2021. All patients underwent distal biceps reattachment using an endo-osseous fixation technique with the same device. Each patient completed a quality-of-life questionnaire and participated in biomechanical performance tests.</div></div><div><h3>Results</h3><div>We observed a significant 14% reduction in strength during flexion on the operated side compared to the healthy side. However, no significant differences in strength were found for supination, extension, and pronation between the operated and nonoperated limbs in these same patients. In terms of endurance, flexion on the operated side tended to exhibit greater endurance than on the healthy side, while endurance in supination appeared similar between the operated and healthy sides. This finding held irrespective of whether the operated limb was dominant or nondominant. We also discovered a strong correlation between the time elapsed since surgery and differences in strength during both flexion and supination.</div></div><div><h3>Conclusion</h3><div>The ultimate goal is to achieve an anatomical surgical repair to restore all functions and maximize patient outcomes. As demonstrated, we have obtained good clinical results with EndoButton repair and a single anterior approach. The results in terms of strength and endurance are similar to those reported in the literature, and all our patients are satisfied. No postoperative complications were found.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 743-749"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.xrrt.2024.07.002
Julia C. Mastracci MD , Andrew B. Rees MD , Michael B. Geary MD , Daniel R. Lewis MD , R. Glenn Gaston MD , Bryan J. Loeffler MD
{"title":"Reverse shoulder arthroplasty following end-to-end triceps to axillary nerve transfer: a case series","authors":"Julia C. Mastracci MD , Andrew B. Rees MD , Michael B. Geary MD , Daniel R. Lewis MD , R. Glenn Gaston MD , Bryan J. Loeffler MD","doi":"10.1016/j.xrrt.2024.07.002","DOIUrl":"10.1016/j.xrrt.2024.07.002","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 805-811"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.xrrt.2024.01.001
Background
The incidence of proximal humerus fractures (PHFs) continues to increase with an aging population, and intramedullary nailing (IMN) and locking plate fixation are two commonly employed techniques for the surgical management of PHF. However, the optimal fixation method can be a source of ongoing controversy. Some influencing factors include the extent of humeral head involvement, fracture complexity, patient age, and surgeon preference. There are many studies that provide a mix of data either when comparing the two techniques or analyzing them in isolation. The aim of this review is to further elucidate the indications and technical considerations involved specifically in IMN vs. locking plate fixation for PHF to further aid orthopedic surgeons when choosing surgical management.
Methods
A narrative approach was chosen for this review allowing for a comprehensive review of literature, including recent findings pertaining to the comparison of management options for PHF. A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The inclusion criteria involved studies that discussed “proximal humerus fracture” and either “intramedullary nail” or “locking plate fixation.”
Results
Complications such as avascular necrosis, hardware failure, additional surgical interventions, infection, fracture redisplacement, rotator cuff rupture, and nonunion did not show significant differences between the two groups. Newer generation humeral nails have minimized early complications. As both techniques undergo further refinement and utilization when specifically indicated, functional outcomes, potential complications, and postoperative pain continue to be improved.
Conclusion
The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. The choice of technique should be tailored to patient factors such as fracture type, age, bone quality, and functional expectations. Surgeon experience also plays a role. While certain presentations may exhibit trends that favor one fixation, no specific technique can be universally recommended. Both IMN and LP have shown comparable and satisfactory outcomes, and the final fixation method chosen should take into account the unique characteristics of each patient.
{"title":"Intramedullary versus locking plate fixation for proximal humerus fractures: indications and technical considerations","authors":"","doi":"10.1016/j.xrrt.2024.01.001","DOIUrl":"10.1016/j.xrrt.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of proximal humerus fractures (PHFs) continues to increase with an aging population, and intramedullary nailing (IMN) and locking plate fixation are two commonly employed techniques for the surgical management of PHF. However, the optimal fixation method can be a source of ongoing controversy. Some influencing factors include the extent of humeral head involvement, fracture complexity, patient age, and surgeon preference. There are many studies that provide a mix of data either when comparing the two techniques or analyzing them in isolation. The aim of this review is to further elucidate the indications and technical considerations involved specifically in IMN vs. locking plate fixation for PHF to further aid orthopedic surgeons when choosing surgical management.</p></div><div><h3>Methods</h3><p>A narrative approach was chosen for this review allowing for a comprehensive review of literature, including recent findings pertaining to the comparison of management options for PHF. A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The inclusion criteria involved studies that discussed “proximal humerus fracture” and either “intramedullary nail” or “locking plate fixation.”</p></div><div><h3>Results</h3><p>Complications such as avascular necrosis, hardware failure, additional surgical interventions, infection, fracture redisplacement, rotator cuff rupture, and nonunion did not show significant differences between the two groups. Newer generation humeral nails have minimized early complications. As both techniques undergo further refinement and utilization when specifically indicated, functional outcomes, potential complications, and postoperative pain continue to be improved.</p></div><div><h3>Conclusion</h3><p>The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. The choice of technique should be tailored to patient factors such as fracture type, age, bone quality, and functional expectations. Surgeon experience also plays a role. While certain presentations may exhibit trends that favor one fixation, no specific technique can be universally recommended. Both IMN and LP have shown comparable and satisfactory outcomes, and the final fixation method chosen should take into account the unique characteristics of each patient.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 615-624"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000154/pdfft?md5=526d5cbc650f5f00c05d2c7df02f8311&pid=1-s2.0-S2666639124000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139829122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.xrrt.2023.09.014
A lesser tuberosity osteotomy (LTO) is commonly performed during total shoulder arthroplasty to access the glenohumeral joint. Healing of the LTO is critical to optimizing the outcome of the procedure and is enhanced by a repair that provides stability and compression across the osteotomy site. The purpose of this article is to describe a technique that uses a tensionable suture construct to repair the LTO during anatomic total shoulder arthroplasty using a stemless humeral component. The technique involves passing a row of high-tensile sutures through bone tunnels lateral to the osteotomy site (transosseous sutures) and another row of sutures through the humeral implant (implant sutures). One limb of each bone tunnel suture is then tied to its corresponding limb of implant suture and the remaining free strands of the tied sutures are manually tensioned and tied to each other. This technique is an efficient and reproducible method for creating compression and stability across the osteotomy site that facilitates bony healing.
{"title":"Tensionable lesser tuberosity osteotomy repair for anatomic total shoulder arthroplasty","authors":"","doi":"10.1016/j.xrrt.2023.09.014","DOIUrl":"10.1016/j.xrrt.2023.09.014","url":null,"abstract":"<div><p>A lesser tuberosity osteotomy (LTO) is commonly performed during total shoulder arthroplasty to access the glenohumeral joint. Healing of the LTO is critical to optimizing the outcome of the procedure and is enhanced by a repair that provides stability and compression across the osteotomy site. The purpose of this article is to describe a technique that uses a tensionable suture construct to repair the LTO during anatomic total shoulder arthroplasty using a stemless humeral component. The technique involves passing a row of high-tensile sutures through bone tunnels lateral to the osteotomy site (transosseous sutures) and another row of sutures through the humeral implant (implant sutures). One limb of each bone tunnel suture is then tied to its corresponding limb of implant suture and the remaining free strands of the tied sutures are manually tensioned and tied to each other. This technique is an efficient and reproducible method for creating compression and stability across the osteotomy site that facilitates bony healing.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 600-606"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639123001013/pdfft?md5=e63efedf74933cbcabeb5c82de2d2ccf&pid=1-s2.0-S2666639123001013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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