Aims

The traditional transosseus flexor hallucis longus (FHL) tendon transfer for patients with Achilles tendinopathy requires two incisions to harvest a long tendon graft. The use of a bio-tenodesis screw enables a short graft to be used and is less invasive, but lacks supporting evidence about its biomechanical behaviour. We aimed, in this study, to compare the strength of the traditional transosseus tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis screw, in cyclical loading and ultimate load testing.

A new technique of trapeziometacarpal suspension arthroplasty is described. Suspension arthroplasty as a treatment for trape-ziometacarpal arthritis has been studied extensively in the literature, but only using relatively weak forms of tendon-bone fixation. Interference screw fixation for tendon grafts has been proven in other areas of the body such as the knee and shoulder. Our technique involves trapeziectomy and suspension arthroplasty using one half of the flexor carpi radialis tendon, left attached distally. A short segment (approximately 2 cm) is harvested and passed through a 4 mm drill hole in the proximal thumb metacarpal. This is accurately positioned using an initial K-wire and then a cannulated drill. Fixation is achieved with a 4 mm Bio-tenodesis screw (Arthrex) and enhanced using a 4/0 Fibrewire (Arthrex) Krackow suture weave. Due to the strength of fixation, no supplemental fixation is required and immobilisation is only used in the initial postoperative period. There is no need for additional support in the form of tendon interposition. Although these are preliminary results, this technique shows promise for an improvement in outcome for the surgical treatment of thumb carpometacarpal arthritis, compared to current methods

A 16-year-old professional female ballet student sustained a plantar flexion-inversion injury to her left ankle while dancing. Clinical examination and MRI suggested subluxation of the tibiotalar joint. However, accurate diagnosis was hampered by a transient palsy of the common peroneal nerve. It was subsequently established that she had also sustained a dislocation of her calcaneocuboid joint, a rare injury, which was successfully stabilised by using a hamstring graft. The presentation and management of this rare condition are discussed.