Trochleoplasty is an effective surgical procedure for patients with severe trochlear dysplasia and recurrent patella instability. Previous work has suggested patients demonstrate early improvements in knee function and quality of life. However, concerns regarding longer term outcomes due to the development of stiffness and patellofemoral osteoarthritis remain a concern for these patients. Our aim was to assess mid-term patient-reported outcome and quality of life measures for trochleoplasty performed at a single centre for severe trochlear dysplasia. Retrospective review of 28 knees (23 patients) having undergone trochleoplasty for severe trochlear dysplasia were reviewed. Due to the non-parametric nature of the data, median and interquartile range (IQR) were determined for pre-operative and mid-term follow-up scores. Statistically significant differences between groups were assessed using paired Wilcoxon-signed rank test with statistical significance set at p<0.05. Data were analysed using a statistical software package (IBM® SPSS® Statistics 26.0).Introduction
Methods
Clinical outcome after reverse total shoulder arthroplasty (RTSA) can be influenced by technical and implant-related factors, so the purpose of this study was to investigate whether individualizing humeral retroversion and subscapularis repair affect the clinical outcomes after RTSA. Authors retrospectively analyzed the prospectively collected data from 80 patients who underwent RTSA from January 2007 to January 2015 using same implant (Biomet Comprehensive® Reverse Shoulder System, Warsaw, Indiana). The mean follow up was 23.3 ± 1.7 (range, 12 ∼ 70) months. The retroversion of humeral component was decided according to native version estimated using shoulder CT in Group I (n=52), and fixed in 20° retroversion in Group II (n=28). Group I was subdivided into Group Ia (n=21, mean 19.3°), less than 20° of retroversion, and Group Ib (n=31, mean 31.9°), more than 20°. Intraoperative tenotomized subscapularis was repaired in 40 patients in Group I, and could not be repaired due to massive tear including subscapularis in remaining 12 patients. Clinical outcomes were evaluated with range of motion (ROM) and several clinical outcome scores.Introduction & Background
Material & Method
The results of PLLA screws for ACL reconstruction have demonstrated no significant clinical differences when compared to metallic screws up to two years. However, studies examining PLLA-HA screws are lacking, as are medium term outcomes of bioresorbable screws. This study aims to compare the clinical outcome of ACL reconstruction with a PLLA-HA to a titanium screw, and to assess the extent of resorption of the PLLA-HA screw at two and five years after ACL reconstruction. Forty patients were randomised to receive either a PLLA-HA or titanium RCI interference screw for ACL reconstruction. Both examiners and patients were blinded to screw type. Patients were prospectively reviewed at 24 and 60 months after surgery with full IKDC assessment, Instrumented Ligament Testing, Lysholm knee score. MRI scans were performed at two and five years following surgery. Five years after surgery, one patient with a titanium screw had an ACL graft rupture and had undergone revision surgery. Of the remaining 39 patients, 38 (97%) were reviewed at five years. There was no significant difference between the two groups in the volume of the tibial (p=0.89) or femoral (p=0.22) tunnels at five years. Significant screw resorbtion at five years was seen in 77% on the tibial side and 88% on the femoral side in the PLLA group. Good ossification was evident on five year MRI in 94% of the tibial screws and 56% of the femoral screws. In the PLLA-HA group peri tunnel bone marrow oedema was present in 35% of patients on the tibial side and 53% of patients on the femoral side at five years. There was no peri-tunnel bone marrow oedema evident in the titanium group. Peri-graft ganglion cyst was evident on MRI scan on the tibial side in 24% of patients from the PLLA-HA group and 18% of the titanium group (p=0.67). There was no significant difference between the PLLA-HA group and the titanium group on any of the other clinical parameters including IKDC subjective knee score (mean 93), symptoms, range of motion, instrumented ligament laxity (mean 1.8 mm) or overall IKDC grade (90% normal or nearly normal). ACL reconstruction with PLLA-HA bioabsorbable screws affords comparable clinical and subjective results to titanium screws at five years after surgery. Significant progression of PLLA HA screw resorption occurs between two and five years, with over 75% of screws demonstrating some resorption by five years. However, complete resorption was only evident in a small number of patients. ACL reconstruction with a PLLA HA screw has excellent clinical outcomes and progressive screw resorption and ossification is evident at five years.
