This is largest collection of outcomes of distal biceps reconstruction in the literature. 8 subjects prospectively measured pre and post reconstruction Strength deficit in patients with chronic tendon deficit is described. To describe outcomes for 53 chronic distal biceps reconstructions with
Purpose. To evaluate the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with four fold Hamstring
Rotator cuff tears remain a problem, with massive tears having a failure rate of repair reported of up to 60%, despite advances in surgical techniques. Tissue engineering techniques offers the possibility of regenerating damaged tendon tissue to a pre-injury state. We explore these techniques by implanting two novel tendon augmentation grafts with use of platelet rich plasma (PRP) in sheep. A total of 24 sheep were operated on, with the infraspinatus being surgically cut from its attachment to the humeral head. Each tendon was repaired using suture anchors and an interpositional implant according to 4 groups: (1) Empty control, (2) Novel collagen fibre implant with PRP (3) A novel collagen sponge implant (4) and the collagen sponge with PRP. The sheep were killed at 12 weeks and the implant site harvested and its histology evaluated.Introduction
Methods
There is no consensus for the appropriate surgical management of chronic ulnar collateral ligament (UCL) injuries of the thumb. A systematic review of Pubmed, MEDLINE, EMBASE and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-analysis (PRISMA) guidelines and formal protocol registered with PROSPERO. Two authors collated data from 10 studies that met strict inclusion criteria, using various surgical techniques in 131 thumbs. Results were heterogenous and metanalysis of results not possible. These data were, therefore, qualitatively assessed and synthesised. Bias was assessed using the ROBINS-I tool. Direct repair, reconstruction with free tendon or bone-tissue-bone grafts and arthrodesis all demonstrated favourable outcomes with Patient Reported Outcome Measures. Direct repair can be safely performed more than two months following injury, with a positive mean Disabilities of the Arm, Shoulder and Hand (DASH) score of 13.5 despite evidence of radiographic osteoarthritis. Arthrodesis should be considered in heavy manual laborers or those at risk of osteoarthritis as it provides significant reduction in pain (Mean Visual Analogue Score of 1.2) when compared to other methods. Free
Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (FCR) tendon is one of the most common procedures for the treatment of thumb carpometacarpal (CMC) arthritis. An alternative method involves trapeziectomy alone (TA). The trapeziectomy with LRTI procedure was developed to theoretically improve biomechanical strength and hand function when compared to TA, which leaves an anatomical void proximal to the first metacarpal. The LRTI procedure takes longer to perform and includes an autologous
Hamstring grafts have been associated with reduced strength, donor site pain and muscle strains following Anterior Cruciate Ligament Reconstruction (ACLR). Traditional graft fixation methods required both semitendinosus and gracilis tendons to achieve a graft of sufficient length and diameter, but newer techniques allow for shorter, broad single
The Adams-Berger reconstruction is an effective technique for treating distal radioulnar joint (DRUJ) instability. Graft preparation techniques vary amongst surgeons with insufficient evidence to support one technique over another. Our study evaluated the biomechanical properties of four graft preparation techniques. Extensor tendons were harvested from fresh frozen porcine trotters obtained from a local butcher shop and prepared in one of three configurations (n=5 per group): tendon only; tendon prepared with non-locking, running suture (2-0 FiberLoop, Arthrex, Naples, FL) spaced at 6 mm intervals; and tendon prepared with suture spaced at 12 mm intervals. A fourth configuration of suture alone was also tested. Tendons were allocated in a manner to ensure comparable average diameters amongst groups. Biomechanical testing occurred using custom jigs simulating radial and ulnar tunnels attached to a Bose Electroforce 3510 mechanical testing machine (TA Instruments). After being woven through the jigs, all tendons were sutured end-to-end with 2-0 PROLENE suture (Ethicon). Tendons then underwent a staircase cyclic loading protocol (5-25 Newtons [N] at 1 hertz [Hz] for 1000 cycles, then 5-50 N at 1 Hz for 1000 cycles, then 5-75 N at 1 Hz for 1000 cycles) until graft failure; if samples did not fail during the protocol, they were then loaded to failure. Samples were visually inspected for mode of failure after the protocol. A one-way analysis of variance was used to compare average tendon diameter; post-hac Tuhey tests were used to compare elongation and elongation rate. Survival to cyclic loading was analyzed using Kaplan-Meier survival curves with log rank. Statistical significance was set at a = 0.05. The average tendon diameter of each group was not statistically different [4.17 mm (tendon only), 4.33 mm (FiberLoop spaced 6 mm), and 4.30 mm (FiberLoop spaced 12 mm)]. The average survival of tendon augmented with FiberLoop was significantly higher than tendon only, and all groups had significantly improved survival compared to suture only. There was no difference in survival between FiberLoop spaced 6 mm and 12 mm. Elongation was significantly lower with suture compared to tendon augmented with FiberLoop spaced 6 mm. Elongation rate was significantly lower with suture compared to all groups. Modes of failure included rupture of the tendon, suture, or both at the simulated bone and suture and/or tendon interface, and elongation of the entire construct without rupture. In this biomechanical study, augmentation of porcine tendons with FiberLoop suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol, as suture material was significantly stiffer than any of the
Abstract. Background. The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft augmentation with suture tape (internal brace) are techniques purported to reduce the risk of rupture and hasten recovery. Our aim was to assess the short-term outcome of ACL-R using fibre tape augmented and non-augmented hamstring
Anatomic all-inside ACL reconstruction using TransLateral technique is a relatively new technique that reduces surgical invasion and pain leading to early recovery. We evaluated clinical outcomes of patients undergoing primary anatomic all-inside ACL reconstruction using TransLateral technique. Retrospective case-series evaluating patients undergoing surgery from June 2013 – December 2017. Patients were followed up clinically and using PROMS including EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests were used to assess clinical significance. 138 patients were included (115 males, 23 females). Mean age was 30 years (range 16.0 – 60.2). Graft choice included isolated semitendinosus (n=115) or both semitendinosus and gracilis (n=26). Mean graft length and diameter were 62.1mm and 8.7mm. Sixteen cases (11.3%) returned to theatre; MUA for arthrofibrosis (n=4), infection (n=2), haemarthrosis (n=1) and metalwork failure (n=1). Incidence of graft re-rupture was 5.7% (n=8); 7 cases were in the mid-bundle femoral tunnel placement. 52.5% (n=74) had complete peri-operative PROMS scores. Mean peri-operative EQ-5D VAS scores were 69.8 and 78.2 (p=0.02). Mean peri-operative KOOS scores for all domains demonstrated significant improvements (p<0.001). Mean peri-operative IKDC scores were 46.1 and 72.5 (p<0.05) and peri-operative Tegner activity scores were 3.3 and 5.3 (p<0.001). Anatomic all-inside ACL reconstruction using TransLateral technique demonstrates favourable clinical and biomechanical advantages including independent anatomic femoral tunnel placement, bone preservation and use of single
Medial patellofemoral ligament (MPFL) reconstruction is an effective procedure to address patellofemoral instability, however there remains no clear consensus on the optimum technique. Variations in patella tunnel and the use of patella fixation devices are reported in the literature, as are the associated complications of patella fracture and hardware irritation. We present the early results using a two tunnel, Endobutton free technique. 24 MPFL reconstructions (14 female, 10 male) were performed by a single surgeon, using two 3.5mm medial patellar tunnels exiting anteriorly and a looped, extra-synovial hamstring autograft. Femoral fixation was achieved using an non-absorbable interference screw. Mean age was 25.5 years, with a mean follow-up of 21.7 months. Mean Kujala scores were 60.8 preoperatively and 87.9 postoperatively (p<0.0001). No patient experienced further dislocation or patella fracture post-operatively. One patient required interference screw removal. The surgical technique presented has outcomes comparable with the literature. It requires a shorter
The aim of this study was to evaluate the functional and clinical outcome following medial patello-femoral ligament reconstruction using autogenous hamstring
The management of scapho-lunate (SL) instability remains controversial. Since 2001, the senior author has used a modified Brunelli tenodesis to achieve soft tissue stabilization in patients presenting with dynamic or static SL instability. From 2001 to 2009, 13 patients were prospectively studied. All patients complained of painful clicking in the wrist, inability to use the wrist for loading activities, and all had a positive scaphoid shift test (Kirk Watson). Wrist arthroscopy was performed to confirm the diagnosis and to confirm the absence of degenerative change in all cases. Data collection pre-operatively included, range of motion, grip strength, DASH score and pain score. All patients had wrist immobilisation in a forearm cast for six weeks post operatively. Physiotherapy commenced at that stage and clinical assessment was performed at 3 months, six months and 12 months post surgery. Patients were discharged from follow-up after 12 months. A significant improvement in grip strength and DASH score was documented at the 12 month post operative assessment. The range of wrist flexion was decreased in all patients. The majority returned to their original employment. All patients reported that their wrist instability symptoms were improved. Conclusion. Scapho-lunate ligament reconstruction using a split flexor carpi radialis
Aims. Interest in soft tissue Radiostereometric Analysis (RSA) is rising. Previous authors have tried, with varying levels of success, to use this technique to analyse the intra-substance portion of anterior cruciate ligament (ACL) graft constructs. These methods were either prone to large amounts of marker migration, deemed unsuitable for in-vivo use or, where alternative markers such as stainless steel sutures were used, lost the inherent accuracy that made RSA an attractive tool in the first place. We describe a modification of tantalum marker balls that allows for a new method of secure fixation to soft tissue in order to accurately analyse stretch, displacement and, potentially, dynamic movement using RSA. Methods. 1.5 mm tantalum tendon markers were predrilled with 0.3 mm holes, allowing them to be sutured directly to soft tissue. Using a previously described ACL graft model, the amount of marker ball migration was then analysed using RSA after cyclical loading between 20 N and 170 N at 25 Hz for 225,000 cycles. Results. None of 40 balls loosened or became detached from the
Surgical marking during tendon surgery is often used for technical
and teaching purposes. This study investigates the effect of a gentian
violet ink marker pen, a common surgical marker, on the viability
of the tissue and cells of tendon.
Objectives
Methods