Latissimus Dorsi Tendon Repair

Background: Latissimus dorsi tendon ruptures are rare injuries that can occur in overhead or throwing motions and are almost always sports related. Indications: Latissimus dorsi tendon ruptures are largely treated nonoperatively, although surgical repair is indicated for the young active patient looking to return to a high level of sport and for those with complete avulsion injuries or mid-substance tendon tears. Technique Description: Depending on the degree of tendon retraction, anteroinferior or posteroinferior axillary incision is made. After the tendon is mobilized, sutures are placed in a Krackow fashion through the bulk of the tendon, and the tendon footprint is prepared by gently decorticating the surface of the humerus, just anterior and inferior to the teres major insertion point. Two Arthrex Pec Buttons are then loaded into the superior and inferior limbs of the suture tape and 2 unicortical holes are drilled into the footprint of the insertion site. The superior button is placed first and then tensioned to allow the latissimus dorsi to be pulled to the bone. Next, the second button is placed, though this is not tensioned until later at the time of the biceps tenodesis. Finally, the procedure is visualized and well inspected to ensure appropriate location of the tendon and securing hardware. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, acute repair of a ruptured latissimus dorsi tendon allows for near to complete restoration of patient functionality and strength, with return to full activity possible within 6 to 8 months. Conclusion: Surgical repair of a ruptured latissimus dorsi tendon is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication

Osteochondral Allograft Transplantation

Background: Articular cartilage lesions are a significant cause of morbidity and impaired knee function, and attempts to surgically repair damaged cartilage have failed to reliably reproduce native cartilage. Thus, osteochondral allograft transplantation is an effective one-step procedure to repair large cartilage defects. Indications: Osteochondral allograft transplantation is indicated for young active patients with large focal defects, those with a history of previous cartilage repair, and those with cartilage-related degenerative disorders such as osteonecrosis, osteochondritis dissecans, and/or post-traumatic osteochondral defects. Technique Description: In short, after the focal chondral defect is identified, a socket is created with specific dimensions in depth and diameter. The donor cartilage is then secured in a graft station, and a sizing guide is placed through a bushing to confirm the allograft harvest location. Using stabilization from the graft station arm, a coring reamer is then advanced through the donor cartilage, and a saw is used to allow for easy removal of the graft from the donor condyle. The plug is then fashioned to fit the exact dimensions of the socket created earlier in the procedure. A cut on the donor plug is made to fashion the plug to the appropriate depth. A rongeur is used to make the plug more bullet shaped at the end to allow the plug to enter the socket more easily. Small holes are then drilled into the base of the socket to help promote incorporation of the plug into the socket during the healing process. After the socket is irrigated, the plug is then placed into the socket, and a tamp is used to gently tap the cartilage until it is flush with the surrounding surface. Results: After an appropriate rehabilitation protocol is followed for up to 10 months postoperatively, osteochondral allograft transplantation allows for near-to-complete restoration of patient functionality and strength, with return to full activity possible within 1 year. Conclusion: Acute repair of large focal chondral defects is effective in restoring knee strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication

Outcomes of meniscal repair: minimum of 2-year follow-up.

PURPOSE: The purpose of this study was to determine the success rate of meniscal repair achieved in our sports medicine practice, particularly with interest in characterizing the outcomes observed with the newer all-inside repair devices. TYPE OF STUDY: Retrospective chart review with telephone follow-up. METHODS: 157 patients that had undergone a meniscal repair procedure between 1996 and 2001 were identified. Twenty-four of these patients were lost to follow-up. Thus, the study group consisted of 133 patients providing a follow-up rate of 85%. All patients included had a minimum of two years of follow up. Failure was defined as the need for meniscectomy in the area of the meniscus that was initially repaired. The time interval from injury to surgery was divided into less than six weeks (acute) and greater than six weeks (chronic). The etiology of the meniscal tear was broken down into three categories; sports related trauma, non-sports trauma, and atraumatic. The repair techniques used in these patients included outside-in sutures, inside-out sutures, darts, arrows, meniscal screws, T-fix, FasT-fix, and the RapidLoc. RESULTS: The failure rate was 36%. No association was found between failure and the length of preoperative symptoms, rim width, etiology, concomitant meniscectomy, chondroplasty or anterior cruciate ligament (ACL) reconstruction. There was a higher rate of failure of tears in the medial versus lateral meniscus (20.3% vs. 44.8%). No statistical comparisons could be made between devices due to small sample sizes. CONCLUSIONS: The all-inside meniscal repair devices have simplified the meniscal repair procedure. This may have lead to a broadening of the indications for repair CLINICAL RELEVANCE: The newer generation meniscal repair devices, while simplifying the procedure, do not appear to lead to an increased clinical success rate