Is There a Correlation Between the Change in the Interscrew Angle of the Eight-Plate and the Delta Joint Orientation Angles?

Objectives It is known that the screws of the eight-plate hemiepiphysiodesis construct diverge as growth occurs through the physis. Our objective was to investigate whether there is a correlation between the amount of change of the joint orientation angle (JOA) and that of the interscrew angle (ISA) of the eight-plate hemiepiphysiodesis construct before and after correction. Patients and methods After the institutional review board approval, medical charts and X-rays of all patients operated for either genu valgum or genu varum with eight-plate hemiepiphysiodesis were analyzed retrospectively. All consecutive patients at various ages with miscellaneous diagnoses were included. JOA and ISA were measured before and after correction. After review of the X-rays, statistical analyses were performed which included Pearson correlation coefficient and regression analyses. Results There were 53 segments of 30 patients included in the study. Eighteen were males, and 12 were females. Mean age at surgery was 9.1 (range 3–17). Mean follow-up time was 21.5 (range, 7–46) months. The diagnoses were diverse. A strong correlation was found between the delta JOA (d-JOA) and delta ISA (d-ISA) of the eight-plate hemiepiphysiodesis construct (r = 0.759 (0.615–0.854, 95%CI), p < 0.001). This correlation was independent of the age and gender of the patient. Conclusions There is a strong correlation between the d-ISA and the d-JOA. The d-ISA follows the d-JOA at a predictable amount through formulas which regression analysis yielded. This study confirms the clinical observation of the diverging angle between the screws is in correlation with the correction of the JOA. Level of evidence Level IV, Therapeutic study.PubMedWoSScopu

Translation, cross-cultural adaptation, reliability, and validity of Turkish version of the university of California Los Angeles (UCLA) shoulder scale into Turkish

Purpose To translate and culturally adapt the University of California Los Angeles (UCLA) shoulder scale into Turkish (T-UCLA) and determine its psychometric properties. Material and methods The UCLA scale was translated into Turkish using Beaton guidelines. Ninety-one patients (46 male; mean age: 46.0 +/- 13.7 years) with shoulder disorders completed T-UCLA and American Shoulder and Elbow Score (ASES), Simple Shoulder Test (SST) and 36-Item Short Form (SF-36). Test-retest reliability was tested in 50 patients at a mean of 5.2 +/- 2.2 days after initial assessment. Validity was evaluated in 91 patients, and correlations between ASES, SST and SF-36 were analyzed. Responsiveness was assessed in 33 patients who underwent arthroscopic rotator cuff repair with a mean follow-up of 12.8 +/- 0.5 months. Results Test-retest reliability of overall T-UCLA, pain and function subscales were 0.96, 0.94 and 0.86, respectively. The correlation coefficients between T-UCLA and SST and ASES were r = 0.752 and r = 0.783, respectively (p < 0.001). The highest correlations between T-UCLA and SF-36 were observed in physical functioning (r = 0.64) and bodily pain subscales (r = 0.66). No ceiling or floor effect observed. Overall and subscales of T-UCLA were highly responsive (ES = 3.22-4.31). Conclusion T-UCLA has sufficient reliability and validity similar to original and translated versions. T-UCLA is responsive in patients who underwent rotator cuff repair

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Allograft Bone Dowels

Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. Management of previously malpositioned or widened tunnels often requires innovative approaches for managing bony defects. Massive osteolysis with poor bone stock and convergence or overlapping of revision tunnels into the previously placed tunnels may necessitate a staged revision procedure. In this surgical technique description, we describe a method for the management of bony deficiencies using allograft bone dowels in staged revision ACL reconstruction

Surgical Management of the Multiple-Ligament Knee Injury

The management of multiligament knee injury is a complex process starting with the adequate identification of the injury. A detailed physical and radiographic examination with a thorough understanding of knee anatomy is crucial to assess all damaged structures: anterior cruciate ligament, posterior cruciate ligament, posteromedial corner including the medial collateral ligament, and posterolateral corner including the lateral collateral ligament. Several surgical techniques have been developed throughout the years to adequately address these ligament insufficiencies. In this surgical technique description, we describe a reproducible method for the assessment and surgical management of a knee dislocation (KDIV) injury. Our approach includes using anatomic single-bundle cruciate ligament reconstructions with modified Bosworth technique for medial-side injuries and a combination of Müller popliteal bypass and Larson figure-of-8 techniques for posterolateral corner injuries. The orders of surgical steps is described concisely, and technical controversies such as graft choice, tunnel positioning, and sequence of graft fixation are discussed in detail

Meniscal Ramp Lesion Repair by a Trans-septal Portal Technique

The identification of meniscal ramp lesions can be quite difficult or even impossible with conventional anterior arthroscopic viewing and working portals. Although even the use of transnotch viewing maneuvers into the posteromedial compartment increases the likelihood of diagnosis, it is the posteromedial and trans-septal portals that provide the best direct visualization of these many times “hidden lesions.” In this surgical technique description, we describe a method to not only adequately visualize the ramp lesion, but also provide subtle variations to existing surgical techniques that can help limit injury to neurovascular structures as well as gain satisfactory vertical suture repair of this posteromedial meniscocapsular injury

Peritoneum and omentum are natural reservoirs for chondrocytes of osteochondral autografts: A comparative animal study

The purpose of this study was to investigate the effects of the omentum, peritoneum, paratenon and skeletal muscle on the proliferation of the cartilage tissue using rabbit model as an in vivo culture medium. 6 months old forty-five New Zealand rabbits were randomized into omentum, peritoneum, muscle, and Achilles paratenon groups. Standard sized osteochondral grafts were harvested from right knees and immediately placed into the specified tissues. Control group was fresh cartilage at the end of follow-up. After five months, samples were collected and evaluated macroscopically by measuring their dimensions (vertical = D1, horizontal = D2, and depth = D3) and volumes, and histologically by counting the chondrocyte number using camera lucida method. Macroscopically, increase in mean values for D1 and D2 dimensions of specimens from paratenon and omentum compared to pretransplant dimensions was statistically significant (p 0.05). Histologically, mean chondrocyte count was 14.0 ± 0.6 in fresh articular cartilage. Mean chondrocyte counts were 14.4 ± 0.9 in omentum group, 15.4 ± 1.0 in peritoneum group, 9.7 ± 1.3 in muscle group and 9.2 ± 0.4 in Achilles paratenon group respectively. However, mean chondrocyte counts were higher in samples of omentum and peritoneum group compared to fresh articular cartilage, increase was not statistically significant (p > 0.05). Transplantation of the cartilage grafts into mesothelium enhanced the chondrocyte counts and volumes compared with the pretransplant measurements. Mesothelium may have the potential to be used as an in vivo culture medium for osteochondral tissue growth

Peritoneum and Omentum are Natural Reservoirs for Chondrocytes of Osteochondral Autografts: A Comparative Animal Study

Objective The purpose of this study was to investigate the effects of the omentum, peritoneum, paratenon and skeletal muscle on the proliferation of the cartilage tissue using rabbit model as an in vivo culture medium. Methods 6 months old forty-five New Zealand rabbits were randomized into omentum, peritoneum, muscle, and Achilles paratenon groups. Standard sized osteochondral grafts were harvested from right knees and immediately placed into the specified tissues. Control group was fresh cartilage at the end of follow-up. After five months, samples were collected and evaluated macroscopically by measuring their dimensions (vertical = D1, horizontal = D2, and depth = D3) and volumes, and histologically by counting the chondrocyte number using camera lucida method. Results Macroscopically, increase in mean values for D1 and D2 dimensions of specimens from paratenon and omentum compared to pretransplant dimensions was statistically significant (p  0.05). Histologically, mean chondrocyte count was 14.0 ± 0.6 in fresh articular cartilage. Mean chondrocyte counts were 14.4 ± 0.9 in omentum group, 15.4 ± 1.0 in peritoneum group, 9.7 ± 1.3 in muscle group and 9.2 ± 0.4 in Achilles paratenon group respectively. However, mean chondrocyte counts were higher in samples of omentum and peritoneum group compared to fresh articular cartilage, increase was not statistically significant (p > 0.05). Discussion Transplantation of the cartilage grafts into mesothelium enhanced the chondrocyte counts and volumes compared with the pretransplant measurements. Mesothelium may have the potential to be used as an in vivo culture medium for osteochondral tissue growth.PubMedWoSScopu

Arthroscopic Knotless Separate Layer Transosseous Equivalent Repair of Delaminated Rotator Cuff Tears

Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair

Ultrasound-Guided Intralesional Methylene Blue Injection for the Arthroscopic Decompression of Spinoglenoid Notch Cyst Causing Suprascapular Neuropathy

Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection

Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve

Hip arthroscopy is a technically demanding procedure that is currently characterized by a “steep” learning curve. Therefore, achieving an advanced technical level is often challenging, especially for the amateur hip arthroscopist. Hand laterality when training in hip arthroscopy is an aspect that has been omitted. In addition, the technical differences regarding the handling of the surgical instruments when performing hip arthroscopy on the left versus right hip can influence the technical excellence. This Technical Note summarizes our preferred hip arthroscopy technique by comparing the surgeon's hand position when operating on the left versus right hip. We also emphasize how the surgeon's hand laterality affects the instrument manipulation during the procedure and potentially the clinical outcomes