Supercharged end-to-side nerve transfer for severe cubital tunnel syndrome is a recently developed technique which involves augmenting the ulnar motor branch with anterior interosseous nerve (AIN). Previous studies suggested that this technique augments or “babysits” the motor end plates until reinnervation occurs, however, some authors suggested possible reinnervation by the donor nerve. We present two cases where this transfer was done for rapid progressive (6–9 months) cubital tunnel syndrome.

The first case was a 57 year-old right hand dominant female who presented to us with severe right cubital tunnel syndrome clinically, including intrinsic wasting and claw deformity. The patient had significant loss of function and visible atrophy to her hand intrinsics over the last few months. Electrodiagnostic studies confirmed the diagnosis of severe cubital tunnel syndrome demonstrating axonal loss, positive sharp waves and fibrillations in the ulnar nerve distribution distally. The patient underwent cubital tunnel ulnar nerve release, subcutaneous anterior transposition, Guyon's canal release along with an AIN to ulnar motor nerve end-to-side transfer. Patient-based functional outcome instruments were prospectively collected with improved overall pain and function as demonstrated from a quickDASH score of 9.1 1 year post-op in comparison to a score of 34.1 pre-op. Recovery was monitored clinically and electrodiagnostic studies at 6 months and 1 year post-operatively. She demonstrated improved intrinsic muscle bulk and strength. The nerve studies at one year showed reinnervation with large amplitude motor unit potentials in the 1st dorsal interosseous and abductor digiti minimi but the 5th finger sensory response remained absent. The second case was a 58 year-old right hand dominant male diagnosed with severe and progressive right cubital tunnel syndrome. Clinically, he had significant muscle wasting and weakness and confirmed denervation on electrodiagnostic studies. He underwent the same surgical procedure as described for the first case and follow-up regimen. The patient demonstrated improved pain score and significant overall function recovery with a quickDASH score of 11.4 one year post-op in comparison to 72.7 pre-op. Nerve studies at one year confirmed our clinical impression, showing ulnar nerve reinnervation with large amplitude motor unit potentials in the 1st dorsal interosseous, while sensory response remained absent.

It is yet unclear if end-to-side nerve transfers allow reinnervation of the target muscles. Previous studies have demonstrated clinical improvement with this transfer, however we are unaware of any electrodiagnostic studies demonstrating this effect. These two cases support the notion of reinnervation after an end-to-side procedure. Further studies are needed to assess outcomes of such nerve transfers.

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 tendon graft. Clinical outcomes as well as strength and endurance in supination and flexion are reported. To examine eight patients measured pre- and post-reconstruction. To identify deficit in supination and flexion in chronic reconstruction.

53 reconstructions of chronic distal biceps with tendon graft were carried out between 1999 and 2015. 26 subjects agreed to undergo strength testing after minimum one year follow up. Eight subjects were tested both before and after reconstruction. Primary outcomes were strength in elbow flexion and forearm supination. Strength testing of supination and flexion included maximum isokinetic power and endurance performed on a Biodex. Clinical outcomes measures included pre-operative retraction severity, surgical fixation technique, postoperative contour, range of motion, subjective satisfaction, SF-12, DASH, MAYO elbow score, ASES and pain VAS Non-parametric data was reported as median (interquartile range), while normally-distributed data was reported as mean with 95% Confidence Limits. Hypothesis testing was performed according to two-tailed, paired t-tests.

Median time from index rupture to reconstructions 9.5 (range 3–108) months. Strength measurements were completed at a median follow-up time of 29 (range 12–137) months on 26 subjects. The proportion of patients that achieved 90% strength of the contralateral limb post-reconstruction was 65% (17/26) for peak supination torque, and 62% (16/26) for peak flexion torque. Supination and flexion endurance was 90% of the contralateral arm in 81% (21/26) and 65% (17/26) of subjects, respectively. Ten subjects (39%) achieved 90% strength of the contralateral arm on at least four of five strength tests. Eight of the 26 patients were evaluated pre- and post-surgery. As compared to the contralateral limb, chronic distal biceps rupture was found to have a mean [95%CI] deficit in peak supination torque of 31.0 [21.0, 42.9]% (p=0.002). Mean deficit in peak flexion torque of 34.2 [23.1, 45.4]% (p <0.001). Reconstruction resulted in an increase in peak supination torque of 33.5 [8.7, 58.3]% (p=0.0162), increase in peak flexion torque of 35.0 [6.4, 63.6]% (p=0.023), increase in isometric strength of 57.6 [36.1, 79.1]% (p<0.001), increase in supination endurance of 0.6 [-22.2, 23.4]% (p=0.668), and a decrease in flexion endurance of 4.8 [-23.3, 13.7](p=0.478). Ninety-six percent of the patients (25/26) were satisfied, or very satisfied with the overall outcome of the surgery, while median Mayo score post-reconstruction was 100 (range: 55–100).

Chronic distal biceps tendon rupture results in less supination loss and greater flexion loss than previously reported. Reconstruction with tendon graft results in a significant, but incomplete recovery of peak supination and flexion torque, but no significant change in endurance. Clinical patient satisfaction with surgical outcomes is high.

Introduction

Ankle arthrodesis is a common treatment for destroyed ankle arthrosis with sacrificing the range of motion. On the other hand, total ankle arthroplasty (TAA) is an operation that should develop as a method keeping or improving range of motion (ROM); however, loosening and sinking of the implant have been reported in especially constrained designs of the implant. The concept of FINE TAA is the mobile bearing system (Nakashima Medical Co., Ltd, Okayama Japan) that can reduce stress concentration to implants. The purpose of this study is to evaluate the short-term results of FINE TAA.