Objectives

The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR.

Aims. Studies on long-term patient-reported outcomes after open surgery for triangular fibrocartilage complex (TFCC) are scarce. Surgeons and patients would benefit from self-reported outcome data on pain, function, complications, and satisfaction after this surgery to enhance shared decision-making. The aim of this study is to determine the long-term outcome of adults who had open surgery for the TFCC. Methods. A prospective cohort study that included patients with open surgery for the TFCC between December 2011 and September 2015. In September 2020, we sent these patients an additional follow-up questionnaire, including the Patient-Rated Wrist Evaluation (PRWE), to score satisfaction, complications, pain, and function. Results. A total of 113 patients were included in the analysis. At ≥ 60 months after an open TFCC reinsertion, we found a mean PRWE total score of 19 (SD 21), a mean PRWE pain score of 11 (SD 11), and a PRWE function score of 9 (SD 10). The percentage of patients obtaining minimum clinically important difference rose from 77% at 12 months to 83% at more than 60 months (p < 0.001). Patients reported fewer complications than surgeons, and overall complication rate was low. Conclusion. Outcomes of patient-reported pain, function scores, and satisfaction are improved five years after open surgery for the TFCC. Cite this article: Bone Jt Open 2021;2(11):981–987

Purpose. The minimally invasive surgery (MIS) approach has been popularised as an alternative to the standard open approach in acute Achilles tendon ruptures. Advocates of this technique suggest earlier functional recovery, due to less injury to the surrounding tissues. However, the critics argue that due to the reduced exposure risk and complications of such surgery are higher in comparison to the open technique. Methods. A systematic review and meta-analysis of randomised and prospective studies were conducted to compare the MIS and open surgery in acute Achilles tendon ruptures. Results. 13 studies were included in the meta-analysis in 4 languages involving total of 854 patients, 426 in the MIS group and 428 in the open group. Although the re-rupture rates were not significantly different between the groups (10 events in 410 patients in MIS group and 9 events in 341 patients in the open one, P=0.41), there were significantly more complications in the open surgery group (29 in 426 MIS patients versus 105 in 428 patients in open surgery group, P<0.00001). Conclusions. MIS in acute Achilles tendon ruptures results in similar re-rupture rates, in comparison with open surgical method with significantly less post-operative complications

A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis. The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years

Introduction and Objectives: Among the pathological conditions associated with the subacromial space is rupture of the rotator cuff. Patients affected by this injury have a poorer response to medical or rehabilitative treatment than do patients with subacromial injuries without concurrent tearing of the rotator cuff. For this reason, surgical treatment is more often needed. Surgical treatment includes the excision of subacromial osteophytes and repair of the affected tendon. Even though acromioplasty can be performed arthroscopically, cuff repair generally requires small incisions due to the technical complexity of the procedure. Materials and Methods: We have carried out a prospective study of 36 patients with torn rotator cuffs diagnosed by MRI who underwent acromioplasty performed with an incision of approximately 4cm when necessary and cuff repair either by direct suturing or reinforcement with rotator cuff plasty performed by the same surgeon. The rehabilitation protocol included early mobilisation at 24–48 hours, passive assisted mobilisation until the 4th week, and active mobilization after the 5th week. Follow-up time was a minimum of one year with pre- and postoperative Constant scale evaluations. We compared various results including previous duration of symptoms, the severity of cuff tearing, and the surgical technique that was used. Results: Favorable results were achieved in terms of pain relief and restoration of mobility compared to the preoperative period, even though strength was not equal to that of the contralateral shoulder. Discussion and Conclusions: Open surgery for rotator cuff tear repair continues to be the best surgical option if a small incision is made, good technique used, and early rehabilitation is performed

Purpose of the study: Appropriate treatment of displaced supracondylar fractures of the distal humerus in children remains a controversial topic. Blount reduction followed by percutaneous or open pin fixation have been widely used. The purpose of this study was to analyze outcome after open surgical treatment of these fractures in pediatric trauma victims. Material and methods: The study included all pediatric patients who underwent surgical treatment for displaced supracondylar fractures of the distal humerus over a ten year period. Fractures were classified III or IV according to Lagrange and Rigault. Cross pinning was used in all cases, via a posterior approach or a double lateral and medial approach. The mechanism of the fracture and pre- and postoperative vascular and neurological complications were noted. The long-term assessment included standard x-rays of the elbow joint (ap and lateral views) and a physical examination to search for misalignment and residual neurological disorders. Results: We identified 110 patients, 61 boys and 49 girls, mean age 7.61 years (range 2–15 years). There were 96 grade IV fractures and 24 grade III. Mechanisms were: sports accident (n=44), fall from height (n=36), fall from own height (n=30). A neurological complication was observed in 29 children, skin opening in three and regressive vascular damage in six. A posterior approach was used for 95 patients and a double approach for 15. There was one revision for secondary displacement. Five patients developed transient paresthesia of the ulnar nerve which resolved without sequela. Three patients presented a moderately hypertrophic or deformed callus which had little functional impact. One patient with an open fracture required surgerical arthrolysis for stiffness six months after fracture. Discussion and conclusion: Open surgery is a very reliable treatment for supracondylar elbow fractures with a low rate of short- and long-term complications. Ulnar nerve palsy, the classical complication of percutaneous cross pinning, can be attributed to the medial pin (7–16% of cases in the literature). The Blount method and Judet or Métaizeau fixations can sometimes be complicated by secondary displacement or a deformed callus, complications which were almost never observed in our series. The results obtained in this series favor our approach for open surgery for the treatment of displaced supracondylar fractures of the distal humerus in children

Aims. The appropriate management for patients with a degenerative tear of the rotator cuff remains controversial, but operative treatment, particularly arthroscopic surgery, is increasingly being used. Our aim in this paper was to compare the effectiveness of arthroscopic with open repair of the rotator cuff. Patients and Methods. A total of 273 patients were recruited to a randomised comparison trial (136 to arthroscopic surgery and 137 to open surgery) from 19 teaching and general hospitals in the United Kingdom. The surgeons used their usual preferred method of repair. The Oxford Shoulder Score (OSS), two years post-operatively, was the primary outcome measure. Imaging of the shoulder was performed at one year after surgery. The trial is registered with Current Controlled Trials, ISRCTN97804283. Results. The mean OSS improved from 26.3 (standard deviation (. sd. ) 8.2) at baseline, to 41.7 (. sd. 7.9) two years post-operatively for arthroscopic surgery and from 25.0 (. sd. 8.0) to 41.5 (. sd. 7.9) for open surgery. Intention-to-treat (ITT) analysis showed no statistical difference between the groups at two years (difference in OSS score -0.76; 95% confidence interval (CI) -2.75 to 1.22; p = 0.452). The confidence interval excluded the pre-determined clinically important difference in the OSS of three points. The rate of re-tear was not significantly different between the two groups (46.4% for arthroscopic and 38.6% for open surgery; 95% CI -6.9 to 25.8; p = 0.256). Healed repairs had the most improved OSS. These findings were the same when analysed per-protocol. Conclusion. There is no evidence of difference in effectiveness between open and arthroscopic repair of rotator cuff tears. The rate of re-tear is high in both groups, for all sizes of tear and ages and this adversely affects the outcome. Cite this article: Bone Joint J 2017;99-B:107–15

Aims

Patients with a triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. The surgical procedure of TFCC reinsertion aims to improve function in patients with this injury in whom conservative treatment has failed. The purpose of this study was to investigate the outcomes of open TFCC reinsertion.

Purpose of the study:. Improved technology, increasing experience and techniques warrant an analysis of cost effective ways of medical management in general and shoulder decompression specifically. The question raised was whether a less invasive technique is necessarily the most cost effective way or merely the surgeons' preferred technique. This is a retrospective study of patients at Tertiary Academic Institution who underwent an open or arthroscopic shoulder decompression in the past 3 years. The aim of the study is to do a cost analysis of shoulder surgery as private health care (medical aid) is demanding more cost effective procedures and we have limited funds in the Government setting. Methods:. We focused on the following: the surgeon; the procedure; operating time; inpatient time; intraoperative block; physiotherapy costs, time off work and the cost of instrumentation used. Patients had to comply with specific inclusion and exclusion criteria. Inclusion: All patients that had shoulder decompression surgery in the past three years by a qualified orthopaedic surgeon; Exclusion: sepsis, tumours, rotator cuff tears, conversion of an arthroscopic procedure to an open procedure intraoperatively, inadequate notes, multiple surgical procedure under the same anaesthetic (e.g. scope with a trapezium excision). Results:. We evaluated 260 patients. Only 147 complied with the inclusion and exclusion criteria, of which 54 were open decompressions and 73 were arthroscopic decompressions. Arthroscopic surgery was significantly more expensive than open surgery (p<0.0001). Conclusion:. With a 95% confidence level, we concluded that the total cost of an arthroscopic decompression can be between 257.5% and 285.0% higher than that of an open decompression. The outcome of this study has proven that we need to take the cost of every procedure into consideration as our patients can benefit more by the redistribution of funds for other possible procedures. Level of evidence:. Level III

Purpose of the study: Coxofemoral conflicts can sometimes lead to early degenerative disease in young patients. Open surgery for surgical dislocation with joint cleaning had provided promising short- and mid-term results. Arthroscopy of the hip joint is a less invasive alternative. The purpose of this work was to compare prospectively the outcome achieved with open surgical or arthroscopic treatment of coxofemoral conflicts after a minimum follow-up of two years. Material and methods: Sixty-three patients, mean age 30 years (range 19–54) with arthroMRI-proven coxofemoral conflict were evaluated two years after treatment. Surgical dislocation was used for 31 patients and arthroscopy for 32. Clinical outcome was assessed on the basis of WOMAC scores noted preoperatively, postoperatively and at two years follow-up. Complications were noted. Results: Results were similar in the two groups at two years: preoperative WOMAC score: 65/100 (41–95) pour open dislocation, 57/100 (15–96) for arthroscopy; postoperative WOMAC score at two years: 79/100 (41–99) for open dislocation, 84/100 (50–99) for arthroscopy. The rate of patient satisfaction was similar: (open dislocation: 75% and arthroscopy: 82%). Complications: open dislocation : 3 case of POA including 1 Brooker stage III and one 1 case of ossifying myositis of the thigh; arthroscopy: 2 case of hematoma (spontaneous resolution) and 1 case of transient irritation (48 h) of the lateral femoral cutaneous nerve. Surgical revisions at two years: open dislocation: one total hip arthroplasty at 15 months and one resection of ossification (POA) at 15 months; arthroscopy: two total hip arthroplasties at 5 and 15 months. Discussion: The results obtained with the two methods are encouraging at two years. A satisfaction rate of 80% can be expected. Conclusion: Arthroscopy appears to be the more advantageous alternative for young patients since it is less invasive and provides similar results at two years

Introduction

Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Introduction: Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Methods: Functional outcome was measured using the Oxford hip and McCarthy non-arthritic hip scores pre and post-operatively.

Results: Since January 2003, 36 hips in 34 patients (average age of 43 years (14–65)) underwent surgical hip dislocation for treatment of FAI. In 9 hips, grade 4 osteoarthritis was present in greater than 10 x 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed.

Of the 27 hips preserved, 14 had chondral ‘carpet’ flaps debrided, 17 underwent recession of the acetabular rim at the site of impingement, 6 had removal of medial osteophytes, 6 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft.

Oxford Hip Score improved from an average 36 (range 17–59) to 23 (12–45) and McCarthy hip score from 43 (9–74) to 62 (36–72) in the preserved hips at an average 15 months following surgery (range 6–33 months).

Discussion: The early results of surgical hip dislocation are encouraging. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis.

Introduction: Femoro-acetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Methods: functional outcome was measured using the oxford hip and McCarthy non-arthritic hip scores pre and post-operatively.

Results: Since January 2003, 36 hips in 34 patients (average age of 43 years (14–65)) underwent surgical hip dislocation for treatment of FAI. In 9 hips, grade 4 osteoarthritis was present in greater than 10 x 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed.

Of the 27 hips preserved, 14 had chondral ‘carpet’ flaps debrided, 17 underwent recession of the acetabular rim at the site of impingement, 6 had removal of medial osteophytes, 6 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft.

In 3 hips (12%) osteoarthritis progressed requiring hip resurfacing within the first year.

Oxford Hip Score improved from an average 36 (range 17–59) to 23 (12–45) and McCarthy hip score from 43 (9–74) to 62 (36–72) in the preserved hips at an average 15 months following surgery (range 6–33 months).

Discussion: The early results of surgical hip dislocation are encouraging. The open procedure has distinct advantages compared to arthroscopy enabling a wider range of lesions to be treated. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis

Supracondylar fractures of the humerus have historically been treated as an emergency case and operated on at the earliest opportunity. We undertook a study to examine whether surgical timing affects the need for open reduction or peri-operative complications in the type III injuries.

Between August 1995 and August 2004, 534 patients presented and were referred to our unit with these fractures. Those with closed, type III injuries without vascular compromise were selected (171 patients). These were divided into 2 groups: those undergoing surgery less than 8 hours from presentation (126 patients) and those undergoing surgery more than 8 hours from presentation (45 patients).

The two major differences between the two groups were: the delayed group were more likely to undergo open reduction (33.3% v 11.2%, p<0.05) and the mean length of the surgical procedure was increased (105.1 minutes v 69.2 minutes, p<0.05). Delay in treatment of the type III supracondylar fractures is associated with an increased need for open reduction and a longer procedure. We would recommend treating these injuries at the earliest opportunity.

Purpose of the study: The aim of this work was to compare the long-term clinical, ultrasonographic and iso-kinetic results obtained with two approaches to repair of the torn Achilles tendon.

Material and methods: The patients were reviewed at mean six years follow-up (range 2–12 years) and served as their own control. The series was composed of two groups of ten patients. The first group underwent open suture (OS) (mean age 48 years, age range 38–64 years) and the second was treated percutaneously with Tenolig® (PCS) (mean age 43 years, age range 25–68 years). The Mann, McComis and Kitaoka scores were noted as was the distance from the heal to the ground in one leg stance (comparison with opposite side). Cybex® was used to measure the isokinetic force and an ultrasound control was performed (tendon structure, dimensions).

Results: The calf of the operated side displayed amyot-rophy compared with the healthy side in all cases of PCS (mean 2 cm, range 0.5–6 cm). The heal-ground distance was often smaller compared with the healthy side in PCS. The Mann scores were equivalent for OS and PCS. The Kitaoka and McComis scores were, on average 86 (80–100) and 94 (60–95) respectively for OS versus 82 (85–100) and 91 (60–95) for PCS. Mean caliber of the operated Achilles tendon increased compared with the healthy side for both suture techniques. Isokinetic force was 3–6% greater with OS for peak force, average force, and total work.

Discussion and conclusion: Both techniques have specific complications: recurrent tears and sural nerve injury for PCS, risk for the skin and adherences for OS. The long-term outcome after PCS of the Achilles tendon is comparable with that of OS in terms of healing quality. Recorded values are however slightly higher with OS. Our results are in line with data in the literature. OS can be reserved for particularly active patients who wish to recover maximum function.

Introduction: Mac Farland fracture is a joint fracture of the ankle in children, which involves the medial malleolus (Salter-Harris type III or IV) and is frequently associated with a fracture of the distal fibula. These injuries have a major risk of resulting in a medial epiphysiodesis bridge which, in turn, can lead to a varus deformity. As of today, recommended treatment for displacements wider than 2mm is open reduction with screw fixation. The aim of this study is to evaluate functional and radiological results of a new less invasive surgical procedure.

Materials and Methods: We retrospectively analyzed a case series of patients who suffered from a Mac Farland fracture and underwent percutaneous screw fixation with arthrographic control. Data collected for each child included age at diagnosis, gender, mechanism and side of injury, radiological Salter-Harris classification of medial and lateral malleolus fracture, size of the fracture line gap before and after treatment, and duration of cast immobilization. Results are given according to the classification by Gleizes (2000), based on clinical and radiological criteria: good, fair, and poor.

Results: There were twelve patients, five girls and seven boys, with a mean age of twelve years and six months (range: 10–15). Average follow-up was eighteen months (range: 9–57). Medial malleolus fracture was Salter-Harris type III in seven patients and type IV in five. The mean preoperative fracture line gap was 2.7mm (range: 2–4). All the patients underwent closed reduction and ankle arthrography to check for anatomical reposition. The fracture was then percutaneously fixed with two screws in nine patients and one screw in three. Duration of cast immobilization after surgery was forty-five days in average. At the time of last follow-up the functional and radiological results were good for all the patients according to Gleizes’ classification.

Conclusion: Closed reduction combined to ankle arthrography followed by percutaneous osteosynthesis is, in our opinion, an interesting less invasive surgical alternative to classic open reduction and internal fixation for displaced Mac Farland fractures.

We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability

Introduction. Open hip debridement surgery has been used for treatment of femoral acetabular impingement pain for over ten years in our unit. While literature has reported promising short term outcomes, longer term outcomes are more sparsely reported. We aim to assess survivorship and functional outcome at ten years, in patients who have undergone open hip debridement. Patients/Materials & Methods. All patients who had undergone open debridement surgery were identified on our database. The electronic, radiographic and paper records were reviewed. Demographic data, radiological and operative findings were recorded. All patients underwent ten year review with a standardised AP hips radiograph, questionnaire, non-arthritic hip score (NAHS), oxford hip score (OHS) and SF12 score. Results. A total of 1626 operations were identified of which 37 had reached the tenth anniversary of their surgery. There were 14 females and 22 males. The average age was 41. 10 (45%) had undergone subsequent hip arthroplasty. Those who underwent hip arthroplasty were older at initial surgery than those who survived. However, this was not statistically significant (p= 0.127). Those who failed had a higher Tonnis and UCLA grade at time of surgery. The majority failed within the first 2 years. In those whose hip survived, the average NAHS was 87. 100% of survivors deemed there surgery to have been worthwhile. Discussion. These results represent the first cohort of our patients to reach ten year follow up. The results represent a learning curve in patient selection. It is unsurprising that those with more arthritic change were more likely to fail. Conclusion. In patients with clearly defined CAM impingement without joint space narrowing, open hip debridement remains an operation with worthwhile outcomes at ten years

Introduction. The Achilles tendon is the thickest and strongest tendon in the human body. Even though the tendon is so strong, it is one of the most frequently injured tendons. Treatment of patients after rupture is planned conservatively and surgically. Conservative treatment is generally applied to elderly patients with sedentary lives. If the treatment is surgical, it can be planned as open surgery or percutaneous surgery. In our study with rabbits, we wrapped a membrane made of plga (polylactic-co-glycolic acid) nanotubes impregnated with type 1 collagen around the tendon in rabbits that underwent open Achilles tendon repair surgery. After surgery, biomechanical and histological tests were performed on the tendons. Method. In the study consisting of 24 rabbits, 2 groups were created by random distribution. In the study group, after the Achilles tendon rupture was created, a type 1 collagen-impregnated plga-based membrane was placed around the tendon after the repair of 1 modified Kesslerr suture. In the control group, after the Achilles tendon rupture was created, 1 modified Kessler suture and Tendon repair was performed with the application of 3 primary sutures. At the end of the 6th week of the study, the rabbits in 2 groups were randomly distributed and histological examination was performed. Additionally, biomechanical testing was performed. Bonar and Movın scoring were used in histological examinations. Result. As a result of biomechanical tests, it was seen that the resistance of the tendon against rupture was higher in the study group than in the control group. In addition, it was observed that the tendon rupture time was longer in the study group than in the control group. Histological examinations gave supportive results from biomechanical tests. Conclusion. We think that the use of collagen-impregnated plga-based nanotubes in the surgical treatment of Achilles tendon ruptures has a positive healing effect. Although we think that the return to normal life after surgery may be faster, we believe that more clinical studies are needed

Aims. Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods. The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results. Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s. -1. ). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s. -1. ). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion. This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure. Cite this article: Bone Joint Res 2023;12(10):636–643