Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair shown to have superior functional outcomes compared to non-surgical treatment. However, limited data exists regarding the optimal rehabilitation regime following surgical repair. The aim of this study was to investigate patient outcomes following repair of proximal hamstring tendon avulsions between a conservative (CR) versus an accelerated rehabilitation (AR) regimen. This prospective randomized controlled trial (RCT) randomised 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25). Patients were evaluated pre-operatively and at 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). Primary analysis was per protocol and based on linear mixed models. Both groups were matched at baseline with respect to patient characteristics. All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). Three re-injuries have been observed (CR=2, AR=1). After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen demonstrate comparable outcomes to a traditionally conservative rehabilitation pathway, albeit demonstrating better early physical health-related quality of life scores, without an increased incidence of early re-injury

Avulsion of the proximal hamstring tendon from the ischial tuberosity is an uncommon but significant injury. Recent literature has highlighted that functional results are superior with surgical repair over non-surgical treatment. Limited data exists regarding the optimal rehabilitation regime in post-operative patients. The aim of this study was to investigate the early interim patient outcomes following repair of proximal hamstring tendon avulsions between a traditionally conservative versus an accelerated rehabilitation regimen. In this prospective randomised controlled trial (RCT) 50 patients underwent proximal hamstring tendon avulsion repair, and were randomised to either a braced, partial weight-bearing (PWB) rehabilitation regime (CR = 25) or an accelerated, unbraced, immediate full weight-bearing (FWB) regime (AR group; n = 25). Patients were evaluated preoperatively and at 3 months after surgery, using the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT), visual analog pain scale (VASP), Tegner score, and 12-item Short Survey Form (SF-12). Patients also filled in a diary questioning postoperative pain at rest from Day 2, until week 6 after surgery. Primary analysis was by per protocol and based on linear mixed models. Both groups, with respect to patient and characteristics were matched at baseline. Over three months, five complications were reported (AR = 3, CR = 2). At 3 months post-surgery, significant improvements (p<0.001) were observed in both groups for all outcomes except the SF-12 MCS (P = 0.623) and the Tegner (P = 0.119). There were no significant between-group differences from baseline to 3 months for any outcomes, except for the SF-12 PCS, which showed significant effects favouring the AR regime (effect size [ES], 0.76; 95% CI, 1.2-13.2; P = .02). Early outcomes in an accelerated rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions, was comparable to a traditionally conservative rehabilitation pathway, and resulted in better physical health-related quality of life scores at 3 months post-surgery. Further long term follow up and functional assessment planned as part of this study

Obese patients show a higher incidence of tendon-related pathologies. These patients present a low inflammatory systemic environment and a higher mechanical demand which can affect the tendons. In addition, inflammation might have a role in the progression of the disease as well as in the healing process. A systematic review was performed by searching PubMed, Embase and Cochrane Library databases. Inclusion criteria were studies of any level of evidence published in peer-reviewed journals reporting clinical or preclinical results. Evaluated data were extracted and critically analysed. PRISMA guidelines were applied, and risk of bias was assessed, as well as the methodological quality of the included studies. We excluded all the articles with high risk of bias and/or low quality after the assessment. Due to the high heterogeneity present among the studies, a metanalysis could not be done. Thus, a descriptive analysis was performed. After applying the previously described criteria, thirty articles were included, assessed as medium or high quality. We analysed the data of 50865 subjects, 6096 of which were obese (BMI over 30 accordingly to the WHO criteria). The overall risk of re-tear after surgery is about the 10% more than normal BMI subjects. The rupture risk fluctuates in the studies without showing a significant trend. Obese subjects have a higher risk to develop tendinopathy and a worse outcome after surgery as confirmed in several human studies. The obesity influence on tendon structure and mechanical properties may rely on the fat tissue endocrine proprieties and on hormonal imbalance. Clinicians should consider obesity as a predisposing factor for the development of tendinopathies and for a higher risk of complications in patients who underwent surgical repair of tendons

Introduction and Aims: Isolated rupture of the subscapularis tendon is an uncommon condition that has generally been treated by early surgical repair. However, very little information is available regarding functional outcome following surgery. The purpose of this study was to evaluate patient reported outcome following surgical repair with a minimum follow-up of 12 months. Method: Thirteen consecutive patients underwent arthroscopy followed by open surgical repair of an isolated traumatic rupture of the subscapularis tendon. A deltopectoral approach was used in all cases with repair of the tendon using suture anchors. Tenodesis of the long head of the biceps tendon was carried out in all patients because of instability or rupture. Standardised pre- and post-operative examinations were performed which included goniometric measurements of range of motion and an assessment of subscapularis function and strength. The ASES Shoulder Assessment Form was completed both pre-operatively and at final review. Results: All patients reported significant pain and functional limitations pre-operatively, with an average pain score of 7/10 and ASES score of 41.2. Limitation of active arm elevation and clinical evidence of sub-scapularis rupture was present in all but one patient. At an average follow-up of 18 months all patients were satisfied and would undergo the procedure again. The average ASES score improved to 91.9, with all patients reporting minimal or no pain. All patients regained overhead elevation and external rotation to within 10 degrees of the other side. Internal rotation and subscapularis function improved in all patients. There were no complications. Conclusion: Early surgical repair of isolated tears of the subscapularis tendon provides excellent pain relief and reliable restoration of shoulder function and strength. Patient satisfaction is high and the average ASES score can be significantly improved. Associated abnormalities of the long head of biceps tendon are common and should be addressed at the time of surgery

Lateral sided hip pain frequently presents to the orthopaedic clinic. The most frequent cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn’t settle and warrants further investigation and treatment. Between July 2006 and February 2008, 28 patients underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. They had a mean age of 62. All patients completed a self-administered questionnaire pre-operatively and 1 year postoperatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D’Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores. Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant (p< 0.05) improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10. The mean change of Oxford hip score was 20.5. The mean improvement in SF-36 PCS was 8.5 and MCS 13.7. 6 patients who had a Trendelenberg gait pre-surgery had normal gait 1 year following surgery. We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate

We reviewed Complete Proximal Hamstring Ruptures to assess the functional disability and to describe the early and late surgical repair. In the last two years five patients have been seen and treated with this relatively uncommon injury. A retrospective review of the patients diagnosed with complete proximal hamstring rupture, the method of injury, investigations to confirm injury, and the surgical technique was undertaken. Patient assessment using a questionnaire and VAS to compare pre and post operative functional abilities was also performed. All patients reported a significant improvement in functional ability and a decrease in pain. Surgical repair of complete proximal hamstring rupture is a worthwhile procedure and can be performed both early and late

Lateral hip pain is a common problem in middle-aged females. After investigation, a group of patients remain who are given the diagnosis of ‘trochanteric bursitis’. Treatment to date has included physiotherapy, non-steroidal anti inflammatory medication and judicious use of a combined corticosteroid and local anaesthetic preparation injected into the bursa with or without imaging control. Some surgical procedures have been described. The aims of this study are to document and describe our experience with 88 patients and to raise awareness of the condition as a common cause of lateral hip pain which is amenable to surgical repair. This study has the approval of the Western Sydney area health service. Between 2000 and 2008, 161 patients were referred to the senior author for management of lateral hip pain. 121 patients underwent surgery to repair a gluteal tendon detachment. 32 patients were excluded from the study due to concurrent or previous surgery to the area. A surgical audit was performed on the remaining 88 patients. Assessment was performed using the Merle d’Aubigne and Postel scoring system. The average duration of symptoms was 6 – 144 months. At 6 months, 88% patients had minimal or no pain. There were also significant improvements in range of motion and ability to walk. The most significant complication was deep vein thrombosis (6%). Based on our experience, any patient who does not respond to treatment for trochanteric bursitis should be investigated for a gluteal tendon tear. Those with a positive MRI scan of the trochanteric region can be offered surgery for gluteal tendon repair

Surgical repair of rotator cuff tendon is one of the most common orthopaedic procedures performed in the United States. This prospective single-surgeon study reports the long-term results of chronic rotator cuff repair. Vigorous statistical analysis was carried out to detect any association of various outcome parameters with the exact surgical pathology. 105 consecutive shoulders (97 patients) undergoing open repair of chronic (> 3 months) rotator cuff tear between 1975 to 1983 by the senior author were recruited to the study. Pain unresponsive to nonoperative treatment was the indication for surgery. The details of patient’s medical records, radiographic data, and the operative findings were prospectively reviewed. There were 67 males and 30 females with a mean age of 58 years (range, 38 to 75). Follow-up averaged 11 years with no patients lost to follow-up. There were 16 small, 40 medium, 38 large and 11 massive tears. Surgical repair relieved pain in 92% of patients (p< 0.0001). There was also a significant improvement in range of motion (p< 0.0001) and strength of abduction and external rotation following surgery (p< 0.0001). Return of movement and strength decreased with increasing tear size. At the latest follow-up results were rated as excellent in 68 shoulders, satisfactory in 12, and unsatisfactory in 25. 8 out of the 11 massive tears had unsatisfactory outcome. There were eight reoperations for traumatic retears. Standard tendon repair techniques combined with adequate postoperative protection and monitored physical therapy produced consistently satisfactory results. Introduction of experimental repair methods should be confined to those patients with massive tendon tears and only then with the hope of increasing function, as pain relief is satisfactory with usual treatment methods

Purpose: Demonstrate the importance of surgical repair of soft tissue damage in an orthopaedic surgery unit. Material and methods: This retrospective study included 455 patients who underwent soft tissue flap surgery between April 1980 and April 2000. There were a total of 556 flaps, hand and finger flaps were excluded from the analysis. Overall results concerning the general treatment for the underlying conditions was not analysed. There were 132 women and 313 men, mean age 42 years. Among these patients 276 (60%) were referred from other hospitals for secondary care. Most of the tissue damage (373 patients among the 455) concerned the lower limb. The soft tissue loss was part of a bone and joint problem in most cases, including: septic nonunion and osteitis (189 patients), trauma and complications after planned orthopaedic surgery (74 patients), grade IIB or IIIC open fractures according to the Gustilo classification (66 patients). There were a total of 485 pediculated or fasciocutaneous muscle flaps and 71 free flaps. Results: Flap survival rate was 90.32%. The result was total necrosis of the flap in 9.68%. The rate of failure was 30% for free flaps and 5% for pediculated flaps. Discussion: This study demonstrated the usefulness of surgical care of soft tissue damage in an orthopaedic surgery unit, particularly for trauma and infection patients. The large number of pediculated flaps is an expression of the reliability of this technique easily applied in a polyvalent orthopaedics traumatology unit. The high rate of failure for free flaps is related to the inherent risk of secondary repair and the inflammatory or infected nature of the soft tissues and also the difficulty encountered in controlling this type of surgery under such conditions. The data reported here allow individual analysis by type of pathology. Conclusion: Overall management of bone and joint disease patients requires proper skill in soft tissue repair

Purpose: Radial paralysis is a major complication of humeral shaft fractures. In most cases, the paralysis is regressive but in certain patients surgical repair is required to achieve full neurological recovery. We reviewed retrospectively our patients to determine the causes of non-recovery and evaluate the efficacy of different treatments. Material and methods: Thirty patients were operated between 1990 and 1997 for radial nerve paralysis that was observed immediately after trauma or developed secondarily. Mean follow-up after surgery was 6.3 years. There were 22 men and 8 women, 16 right side and 14 left side. Mean delay from injury to surgery was four months (0–730 days). Elements that could be involved in radial paralysis were noted: type of fracture, level of the fracture, treatment, approach, material used. There were ten cases with non-union. Neurological recovery at three years was assessed with muscle tests and with the Alnot criteria. An electrical recording was also made in certain patients. Surgery involved neurolysis in 23 cases, nerve grafts in five and tendon transfers in two. Results: Outcome was very good and good in 22 patients, good in one and could not be evaluated in one (tendon transfer). There were three failures (two neurolysis and one graft) and two patients were lost to follow-up. After neurolysis, mean delay to recovery was seven months; it was 15 months after nerve grafts. Recovery always occurred proximally to distally. Discussion: Radial paralysis after femoral shaft fracture regresses spontaneously in 76% to 89% of the cases, depending on the series. There is a predominance in the 20 to 30 year age range. Several factors could be involved in radial paralysis (fracture of the distal third of the humerus, spiral fracture, plate fixation, nonunion). The anterolateral approach allows a better exposure of the nerve. Unlike other authors, we do no advocate exploration of the injured nerve during surgical treatment of the fracture because it is most difficult to determine the potential for recovery of a continuous nerve. Conclusion: The risk of radial nerve paralysis is greatest for spiral fracture of the distal third of the humerus. In such cases, it may be useful to explore the nerve during the primary procedure and insert a plate. For other cases, we prefer to wait for spontaneous nerve recovery. If reinnervation is not observed at 100 days, we undertake exploration

Introduction. Hip and groin injuries are common in athletes participating in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion injuries involving tendons attaching to the symphysis pubis have previously been described and can be managed both operatively and non-operatively. The aim is to describe a rare variant of this injury; complete avulsion of the adductor sleeve complex including adductor longus, pectineus and rectus abdominus. A surgical technique is then outlined which promotes a full return to pre-injury level of sporting activity. Patients/Materials & Methods. Fifteen high level athletes with an MRI confirmed acute adductor complex avulsion injury (6–34 days) were identified from the institution's sports injury database over a 10 year period. All underwent surgical repair. The operative procedure comprised anatomical attachment of the avulsed tissues in all cases (plus mesh reinforcement of the inguinal wall in 7 patients). All underwent a standard format of rehabilitation which was then individualised to be sport specific. Results. One patient developed a superficial wound infection which was successfully treated with antibiotics. 12 out of 15 patients complained of transient local numbness which resolved in all cases. All patients (including 7 elite athletes) returned to their previous level of participation in sport. Discussion. Injury to the triad of adductor longus, pectineus and rectus abdominus should be considered in athletes presenting with groin pain following forced adduction. All athletes underwent early surgical exploration, previous studies have shown prolonged symptoms in early conservative management. Adductor tenotomy has shown previously acceptable results but may be less suitable in elite athletes with higher functional demands when operative repair has been shown to be successful. Conclusion. Operative repair of acute sleeve avulsion of the adductor complex in high level athletes, followed by sport specific rehabilitation promotes return to previous level of participation in sport

Purpose: We conducted a prospective preliminary study of ten cases of surgical repair of massive rotator cuff tears using a free quadriceps bone-tendon transplant. All procedures were performed between May 1998 and May 2000. Material and methods: The series included seven men and three women (mean age 51 years 9 months). The dominant limb was involved in nine cases. Six of the patients were working. Mean duration of symptoms was 15 months (6–36 months). Mean preoperative Constant score was 49.1/100 points. The three most frequent signs were daily pain, limited amplitude, and loss of force. A MRI was obtained in nine cases and an arthroscan in one. There was a full-thickness tear of the rotator cuff with proximal retraction in eight cases and intermediary retraction in two. Fatty degneration (Goutallier-Bernageau) was basically grade II for the supraspinatus, and grade III for the infraspinatus. At MRI the tear measured more than 16 cm. 2. Acromioplasty was performed in all cases, tenotomy and long-biceps tenodesis in seven. Sutures were made with Mersuture n° 2 using the Mason-Allen technique along the tear contour. The superficial portion of the quatriceps tendon was harvested via a longitudinal prepatellar incision. The quadriceps tendon was harvested with the trapezoidal patellar bony attachement. The free quadriceps tendon flap was sutured to the borders of the cuff and a bony tunnel was made to impact the bony attachment. Postoperative immobilisation was achieved with an abduction sling and a removable flexion brace for the knee. All patients participated in the centre’s rehabilitation programme and were reviewed at consultation. An MRI was obtained for five patients with the longest follow-up. Results: Mean follow-up was 18 months. Mean Constant score at last follow-up was greater than 70 points. Mean force was less than 5 kg. The MRI obtained in five cases demonstrated a normal tendon with no signs of necrosis. There was one tear of the quadriceps tendon at the knee. This patient experienced persistent fatigability at 12 months. Discussion: Treatment of full-thickness tears of the rotator cuff remains problematic, particularly in young active patients. Acromioplasty and bursectomy only provide pain relief. There is an ascension of the humeral head with an excentrated scapula. Classical transosseous reinsertion is not possible when there is major retraction. Certain teams advance the supraspinatus and the infraspinatus. Deltoid flaps only provide pain relief by their interposition in the subacromial space. Tendon transfer using the rectus is highly invasive and difficult to perform. The quadriceps tendon transplant is resistant and integrates perfectly in this reconstruction. Conclusion: Repair of massive full-thickness rotator cuff tears in young patients with limited fatty degeneration remains a difficult challenge. For these patients, we propose repair using a free quadriceps bone-tendon transplant

The axillary nerve injuries most commonly are observed after trauma such as contusion-stretch, gunshot wound, laceration and iatrogenic injuries. Two of the most commons causes seem to be the glenohumeral dislocation and the proximal humerus fractures. The axillary nerve may sustain a simple contusion, or its terminal elements may be avulsed from the deltoid muscle. Compressive neuropathy in the quadrilateral space also has been reported (quadrilateral space syndrome, Calhill and Palmer, 1983). The axillary nerve injuries incidence represents less than 1% of all nerve injuries.

Aim: The purpose of this study was to analyze outcome in patients, who presented with injuries to the axillary nerve

Material and methods: We report a series of 15 cases of axillary nerve lesions, which were operated between 1995 and 2002. These injuries resulted from shoulder injury either with or without fracture and or dislocation.

Patients were operated between 3 to 6 months after trauma and an anterior deltopectoral approach was usually followed during surgery. The follow up period ranged from 1 to 8 years.

Results: The results were considered as satisfactory in 11 out of 15 axillary nerve lesions. According to clinical examination, of the function of the shoulder and the muscle strength the results were classified as excellent in 5 cases, good in 6 cases and poor in 4 cases.

Conclusions: If indicated, nerve repair can lead to useful function in carefully selected patients

Type II SLAP lesions account for 22–55% of all SLAP lesions and are described as detachment of the superior labrum along with the biceps anchor from the superior glenoid rim. This detachment may be associated with glenohumeral joint instability. The majority of SLAP lesions are associated with other pathologies such as rotator cuff tears, Bankart and other instability lesions. The purpose of this study was to evaluate the effectiveness of arthroscopic repair of type II SLAP lesions, two years following arthroscopic repair with suture anchors.

Data on thirty-eight consecutive patients (thirty-four males, four females, mean age: forty-five years, range, twenty-two to seventy years) were used for analysis. Outcome measures were the American Shoulder and Elbow Surgeons (ASES) assessment form and the Constant-Murley score. Thirteen patients had work-related injuries. Specific tests for SLAP lesion (i.e. New pain provocation test, O’Brien test, Yergason’s Test) were conducted pre-operatively.

Twenty-three patients had surgery on the right side. The O’Brien test was positive in 51% of the patients. The minimum follow up period was twenty-four months. Five patients had isolated SLAP type II lesion. Thirty-three had associated pathologies. Ten patients had rotator cuff repair. Twelve patients required acromioplasty and one patient underwent the long head of biceps tenodesis. Three patients had associated Bankart lesions. All patients showed significant improvement in ASES scores (p< 0.0001). However, Patients with work-related injuries did not show a significant improvement in Constant-Murley scores (p=0.20). Associated pathologies did not affect level of disability or subjective scores post-operatively. Strength did not change to a statistically significant level following SLAP repairs.

Arthroscopic SLAP repair provides significant improvement in subjective scores of the ASES. Patients with work-related injuries demonstrate a different pattern of recovery.

Background: The aim of our prospective, randomized study was to compare two operative techniques for the treatment of acute Achilles tendon rupture and question the necessity of augmented repair. Null hypothesis: Augmentation with a down-turned gastrocnemius fascia flap does not give any better result than end-to-end suturation by the Krackow locking loop surgical technique.

Study Design: A prospective, randomized clinical trial.

Methods: Sixty patients with acute Achilles tendon rupture were randomized preoperatively to receive end-to-end suturation by the Krackow locking loop technique either without augmentation (Group I) or with one down-turned gastrocnemius fascia flap, as described by Silfverskiöld (Group II). A dorsal brace allowed free active plantar flexion of the ankle postoperatively, whereas dorsiflexion was restricted to neutral for the first three weeks. Weight bearing was limited for six weeks. The follow-up period was one year, and evaluation was performed in terms of clinical measurements, an outcome score, isokinetic calf muscle performance tests and tendon elongation measurements.

Results: The mean operation time was 25 minutes longer in the augmentation group and the incision 7 cm longer (p< 0.001 both). The overall ankle scores were excellent in 70% of cases and good in 30% in both groups. The isokinetic calf muscle strength scores were excellent in 41% of cases, good in 52%, and fair in 7% in group I, whereas those in the group II were excellent in 45% of cases, good in 35%, fair in 15% and poor in 5%. Achilles tendon elongation occurred in both groups and elongation correlated significantly with previous AT problems (ρ= 0.47, p=0.040), isokinetic peak torque deficits (ρ= 0.64, p=0.001) and isometric strength deficits (ρ= 0.48, p=0.026) in the nonaugmentation group. No significant differences were seen between the two groups at the 3-month and 12-month check-ups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, overall outcome, iso-kinetic calf muscle strength, mean peak work-displacement relationships or tendon elongation. Six re-ruptures (three in each group) and two deep infections in group II were regarded as treatment failures and were excluded. The final results in all the rerupture cases were good.

Conclusions: Routine use of augmentation does not seem to be necessary in surgery for fresh total Achilles tendon ruptures.

Introduction: Type II SLAP lesion account for 22–55% of all SLAP lesions and described as detachment of the superior labrum along with the biceps anchor from the superior glenoid rim. This detachment leads to a significant Gleno Humeral Joint instability at the anterior-posterior and superior inferior directions. Majority of SLAP lesions are associated with rotator cuff tears, and partial or complete Bankart lesions.

Purpose: The purpose of this study was to evaluate the effectiveness of arthroscopic repair of type II SLAP lesions 2 years following arthroscopic repair with suture anchors.

Type of study: Prospective historical.

Methods: Data of consecutive thirty-eight patients (34 males, 4 females, mean age: 45 years, range, 22 to 70 years were used for analysis. Outcome measures were the ASES and Constant Murley. Thirteen patients had work-related injuries. Specific tests for SLAP lesion (i.e. New pain provocation test, O’Brien test, Yergason’s Test) were conducted pre-operatively.

Results: Twenty-three patients had surgery on the right side. The minimum follow up period was 24 months. Five patients had isolated SLAP II lesion repair. Thirty-three had associated pathologies. Ten patients had rotator cuff repair. Twelve patients required acromioplasty and 12 patients underwent the long head of biceps tenodesis. Three patients had associated Bankart lesions. ALL patients showed significant improvement in ASES scores (p< 0.0001). However, Patients with work-related injuries did not show a significant improvement in Constant scores (p=0.20). Pathology did not affect level of disability or subjective scores post-operatively. Strength did not change following SLAP repairs.

Conclusions: Arthroscopic SLAP repair provides significant improvement in subjective scores of joint-specific measures (ASES). Patients with work-related injuries demonstrate a different pattern of recovery.

Introduction

Avulsion of abductors from hip is a debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the hip.

Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN).

Background

Adductor muscle and tendon injuries are commonly seen in sport. Complete adductor avulsions have been described and can be managed non-operatively or operatively. A rare variant of this injury is the complete avulsion of the adductor complex with the pectineus and rectus abdominus amounting to a complete sleeve avulsion from the pubis. This is a severe injury that is increasingly recognised due to improved imaging and lower diagnostic threshold.

Aims. Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation. Methods. This retrospective cohort study analyzed a total of 43,287 patients from national health claims data spanning 2008 to 2018, focusing on patients who underwent surgical treatment for primary Achilles tendon rupture. Short-term ATRR was defined as cases that required revision surgery occurring between six weeks and one year after the initial surgical repair, while omitting cases with simultaneous infection or skin necrosis. Variables such as age, sex, the presence of Achilles tendinopathy, and comorbidities were systematically collected for the analysis. We employed multivariate stepwise logistic regression to identify potential risk factors associated with short-term ATRR. Results. From 2009 to 2018, the short-term re-rupture rate for Achilles tendon surgeries was 2.14%. Risk factors included male sex, younger age, and the presence of Achilles tendinopathy. Conclusion. This large-scale, big-data study reaffirmed known risk factors for short-term Achilles tendon re-rupture, specifically identifying male sex and younger age. Moreover, this study discovered that a prior history of Achilles tendinopathy emerges as an independent risk factor for re-rupture, even following initial operative fixation. Cite this article: Bone Joint Res 2024;13(7):315–320

The jackaling position within rugby has not been previously described as a mechanism for proximal hamstring injuries. This prospective single surgeon study included 54 professional rugby players (mean age 26 ± 4.8 years) undergoing acute primary surgical repair of complete, proximal hamstring avulsion injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardised postoperative rehabilitation programme. Predefined outcomes were recorded at regular intervals. Mean follow-up time was 17 months (range, 12 months to 24 months) from date of surgery. 51 patients (94.4%) returned to their pre-injury level of sporting activity. Mean time from surgical repair to full sporting activity was 7 months (range, 4 months to 12 months). Zero patients had recurrence of the primary injury. At 1 year after surgery compared to 3 months after surgery, patients had increased mean isometric hamstring muscle strength at 0° (98.4 ± 2.8% vs 88.1% ± 5.4%, p<0.001), 15° (95.9 ± 2.9 vs 88.2 ± 8.1%, p<0.001) and 45° (92.9% ± 4.1% vs 76.8% ± 9.7%, p<0.001), higher mean lower extremity functional scores (77.0 ± 2.3 vs 64.5 ± 4.5, p<0.001), and improved Marx activity rating scores (14.3 ± 1.5 vs 10.7 ± 2.6, p<0.001). Acute surgical repair of proximal hamstring avulsion injuries caused by the contact jackaling position produces high patient satisfaction, high return to preinjury level of sporting activity, with low risk of recurrence at short-term follow-up