Improvement of Segmental Lordosis in Transforaminal Lumbar Interbody Fusion: A Comparison of Two Techniques

Study Design Retrospective review. Objective The purpose of this study was to determine the radiographic impact of a transforaminal lumbar interbody fusion (TLIF) versus a cantilever TLIF technique on segmental lordosis, segmental coronal alignment, and disk height. Methods A retrospective review was done of all patients undergoing TLIF procedures from 2006 to 2011 by three spine surgeons. Traditional TLIF versus cantilever TLIF results were compared, and radiographic outcomes were assessed. Results One hundred one patients were included in the study. Patients undergoing the cantilever TLIF procedure had a significantly greater change in segmental lordosis and disk height compared with those who underwent the traditional procedure (p \u3e 0.0001). Conclusions The cantilever TLIF technique can lead to greater change in segmental lordosis based upon radiographic outcomes

Rehabilitation Following Posterior Shoulder Stabilization

Posterior shoulder instability has been noted in recent reports to occur at a higher prevalence than originally believed, with many cases occurring in active populations. In most cases, primary surgical treatment for posterior shoulder instability—a posterior labral repair—is indicated for those patients who have failed conservative management and demonstrate persistent functional limitations. In order to optimize surgical success and return to a prior level of function, a comprehensive and focused rehabilitation program is crucial. Currently, there is a limited amount of literature focusing on rehabilitation after surgery for posterior instability. Therefore, the purpose of this clinical commentary is to present a post-surgical rehabilitation program for patients following posterior shoulder labral repair, with recommendations based upon best medical evidence. # Level of Evidence

Open Repair of Complete Proximal Hamstring Avulsions in Workers\u27 Compensation Patients

Background: Several studies have reported excellent results after surgical repair of proximal hamstring avulsions. However, the effect on these patients of receiving workers\u27 compensation has not yet been explored. Hypothesis: Workers\u27 compensation patients undergoing proximal hamstring repair of complete tears will have similar outcomes when compared with a matched control group of non-workers\u27 compensation patients. Study Design: Cohort study; Level of evidence, 3. Methods: Workers\u27 compensation patients who underwent complete proximal hamstring avulsion open repair between 2010 and 2019 were identified (WC group). A control group was matched by age (±3 years), sex, and body mass index (BMI; ±3). Demographics and patient-reported outcome measures were compared, including standard and custom Marx activity rating scale (MARS), standard and custom lower extremity functional scale (LEFS), and visual analog scale (VAS) for pain. Rate and time to return to work were recorded. Results: The WC group was composed of 20 patients (8 men, 12 women) with a mean age of 52.3 years and BMI of 32.4. The 20 matched controls (8 men, 12 women) who underwent repair had a mean age of 50.6 years and a mean BMI of 31.2. There was no difference between the groups regarding age ( Conclusion: Workers\u27 compensation patients who underwent open proximal hamstring repair for complete avulsions experienced inferior patient-reported outcomes, required more time to return to work, and returned to work at a lower rate than a matched control group

Post-capitalist property

When writing about property and property rights in his imagined post-capitalist society of the future, Marx seemed to envisage ‘individual property’ co-existing with ‘socialized property’ in the means of production. As the social and political consequences of faltering growth and increasing inequality, debt and insecurity gradually manifest themselves, and with automation and artificial intelligence lurking in the wings, the future of capitalism, at least in its current form, looks increasingly uncertain. With this, the question of what property and property rights might look like in the future, in a potentially post-capitalist society, is becoming ever more pertinent. Is the choice simply between private property and markets, and public (state-owned) property and planning? Or can individual and social property in the (same) means of production co-exist, as Marx suggested? This paper explores ways in which they might, through an examination of the Chinese household responsibility system (HRS) and the ‘fuzzy’ and seemingly confusing regime of land ownership that it instituted. It examines the HRS against the backdrop of Marx’s ideas about property and subsequent (post-Marx) theorizing about the legal nature of property in which property has come widely to be conceptualized not as a single, unitary ‘ownership’ right to a thing (or, indeed, as the thing itself) but as a ‘bundle of rights’. The bundle-of-rights idea of property, it suggests, enables us to see not only that ‘individual’ and ‘socialized’ property’ in the (same) means of production might indeed co-exist, but that the range of institutional possibility is far greater than that between capitalism and socialism/communism as traditionally conceived

Arthroscopic Repair of a 360° Labrum and Full-Thickness Rotator Cuff Tear After Shoulder Dislocation

Background: Rotator cuff tears after anterior shoulder instability are more common in patients >40 years of age and rare in younger patients where shoulder instability is most common. Although infrequent, little data exist on the evaluation of combined labral and rotator cuff tears in athletes. Indications: Combined rotator cuff and labral tears in the young patient population have a high risk of recurrent instability and require unique intraoperative and postoperative considerations. This patient is a Division 1 collegiate wrestler who sustained a 360° labral and full-thickness rotator cuff tear after an acute traumatic anterior shoulder dislocation. Technique Description: The lateral decubitus position is utilized and a posterior viewing portal is established along with anterior and accessory lateral portals. The 360° labral tear is first addressed by appropriately preparing the glenoid creating a quality healing surface. Tape sutures are then utilized to perform a knotless anterior labral repair. The superior labrum, anterior to posterior (SLAP) and then posterior labral repair are sequentially performed. The posterior portal is closed with a polydioxanone (PDS) suture to prevent a stress riser in the capsule. The rotator cuff tear is then repaired in a knotless double row configuration after appropriate greater tuberosity preparation. Results: Recent studies evaluating athletes with combined rotator cuff and labral pathology who underwent arthroscopic repair reported 90% good to excellent satisfaction with 77% returning to pre-injury level of athletics. Although few studies have evaluated combined labral and rotator cuff repair and concerns with stiffness exist, the current literature and the authors own experience have found good outcomes following single-stage repair. Discussion/Conclusion: Combined labral and rotator cuff tears after anterior shoulder dislocation in the young athletic population are rare and can be challenging to treat. Although there is limited data on these combined injuries in young athletic populations, the current literature and authors’ experience support single stage surgical treatment of combined labral and rotator cuff tears which typically result in improved patient reported outcomes and return to sport. Patient Consent Disclosure Statement: 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

Arthroscopic Repair of a Type VIII Superior Labrum Anterior Posterior Tear

Background: Type VIII superior labrum anterior posterior (SLAP) tears are described as SLAP type II tears with posterior extension to the posterior inferior glenohumeral ligament. These tears are a common source of pain, instability, and decreased function in active individuals, particularly overhead or throwing athletes. Indications: Type VIII SLAP tears can cause pain and loss of sports performance, especially in a throwing athlete. This patient is a quarterback and pitcher who had magnetic resonance imaging and arthroscopic evidence of a type VIII SLAP tear with pain and inability to throw at his preinjury level. Technique Description: In the lateral decubitus position, a standard posterior portal is established along with anterior and accessory lateral portals. A type VIII SLAP tear is identified and the arm is taken out of balanced suspension traction and placed in abduction and external rotation which shows displacement of the posterior labrum and peelback of the superior labrum indicating pathologic labral instability. The labrum is then elevated and glenoid prepared to achieve healthy bleeding bone. Tape sutures are then passed around the labrum and placed into a glenoid anchor starting superiorly and continuing the repair posteroinferiorly. Three anchors were placed in the superior labrum using a percutaneous technique, with 2 more placed from the posterior portal to complete the 5-anchor repair. The posterior portal is then closed with a single monofilament suture to prevent a potential stress riser in the capsule. Results: The literature suggests that athletes with type VIII SLAP tears can expect improved functional outcomes and high return to play rates (>90%); however, only 50% to 70% of throwing athletes return to the same level of play. Discussion/Conclusion: Type VIII SLAP tears are an important cause of shoulder pain and dysfunction, particularly in overhead athletes. Arthroscopic repair of type VIII SLAP tears can improve functional outcomes and ability to return to sport; however, throwing athletes experience lower rates of return to previous level. Patient Consent Disclosure Statement: 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

The Saber Technique for Biceps Tenotomy

Long head of the biceps (LHB) pathology is a prevalent cause of shoulder pain. Arthroscopic tenotomy and tenodesis are performed for treatment at increasing frequency. When LHB pathology is the only glenohumeral intra-articular pathology that needs to be addressed, and an LHB tenotomy or subpectoral LHB tenodesis is planned, it is unnecessary and potentially harmful to establish an anterior rotator interval portal. The objective of this Technical Note is to describe a minimally invasive technique for LHB tenotomy at the supraglenoid tubercle without the need for establishing an accessory portal

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture

Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis. An emerging option is minimally invasive laparoscopic fixation using knotless anchors with a tape suture in a crisscross configuration. This possibly allows more physiological movement of the pubic symphysis in a less invasive manner. A detailed technical description and discussion of the technique are provided