Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

Publisher Copyright: © 2021 Arthroscopy Association of North AmericaPurpose: The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. Methods: Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. Results: The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤.05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤.05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ±.63 (P ≤.05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤.05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. Conclusions: In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. Level of Evidence: Level IV, therapeutic case series.Peer reviewe

Strength Measurements and Results of Surgical Treatment of Complete Rectus Femoris Mid-substance Rupture: A Case Report

Introduction: Rectus femoris injuries are common in sports requiring sprinting and kicking, especially in football. In addition to sports injuries, rectus femoris injuries can occur during physically active daily living and physical work. Most muscle injuries heal well by conservative treatment, but more severe ruptures often require surgical treatment, especially in athletes. Some ruptures can cause so severe functional loss of the muscle that it causes problems also in everyday life. Complete rectus femoris mid-substance rupture is a rare injury type, which tends to recover poorly and cause significant functional deficit. Descriptions of this injury type are mainly lacking in the literature and there is no consensus on the management of these injuries. To the best of our knowledge, this is the first report of this kind in the literature including strength measurements pre- and post-operatively.Case report: We report a case of a 48-year-old Caucasian man who suffered a complete rectus femoris mid-substance rupture at physically active work. The injury mechanism was slipping on an asphalt ramp, leading to rapid eccentric contraction of rectus femoris involving knee flexion and hip extension. The rupture was treated surgically and the muscle strength of quadriceps femoris was measured pre- and postoperatively.Conclusion: This case report showed that muscle strength in knee extension recovers well after an operative treatment of complete rectus femoris mid-substance rupture. Therefore, it can be concluded that operative treatment is beneficial for this specific injury type. This case report brings important and objective evidence on the relevance of surgical treatment in these injuries that are mainly lacking the consensus about the best treatment methods. To the best of our knowledge, this case report is also the first one which indirectly shows the value of isolated rectus femoris muscle in the whole quadriceps muscle group.</p

Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.</p

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

PurposeThe purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants.MethodsThirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively.ResultsThe mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation.ConclusionsIn this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing.Level of EvidenceLevel IV, therapeutic case series.</p

Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.Peer reviewe

Trampoline-related proximal tibia impaction fractures in children:a population-based approach to epidemiology and radiographic findings between 2006 and 2017

Abstract Purpose: Proximal tibia impaction fractures are specific injuries, usually caused by trampolining. They may associate with later growth disturbances. There is sparse understanding about their recent epidemiology, in particular the changing incidence. Their typical radiographic findings are not completely known. Methods: All children, aged &lt; 16 years, who had suffered from proximal tibia fracture in Oulu Arc and Oulu between 2006 and 2017 were enrolled (n = 101). Their annual incidence was determined using the official population-at-risk, obtained from the Statistics Finland. The specific characteristics and risk factors of the patients and their fractures were evaluated. Radiographic findings were analyzed, in particular the anterior tilting of the proximal growth plate, due to impaction. Results: The annual incidence increased two-fold from 9.5 per 100 000 children (2006 to 2009) to 22.0 per 100 000 (2014 to 2017) (difference: 12.5; 95% confidence interval 5.1 to 20.3 per 100 000; p = 0.0008). The mean annual incidence of trampoline impaction leg fractures was 15.4 per 100 000 children. In 80% of the cases multiple children had been jumping together on the trampoline. Anterior tilting (mean 7.3°, SD 2.5°, 6.1° to 19.1°) ) of the proximal tibial plate was seen in 68.3% of the patients. Satisfactory bone union was found in 92.7% during follow-up. Isolated patients presented delayed bone healing. Conclusion: The incidence of trampoline leg fractures has increased 130% during the 12 years of the study period. Many of these injuries could have been prevented by avoiding having several jumpers on the trampoline at the same time. Anterior tilting of the growth plate was a common finding and should be recognized in the primary radiographs. Level of evidence: I

Calcaneal bone bruise after surgery for insertional Achilles tendinopathy

Abstract Objectives: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB). Design: Case series, level of evidence IV. Setting: University teaching hospital. Patients: This study reports 8 patients who developed postoperative CBB after having started impact training too early. Intervention: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI. Main Outcome Measures: Detection of CBB after EPCC. Results: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5‐11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6‐16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2‐9 months) after the diagnosis of postoperative CBB. Conclusions: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented

Proximal adductor longus tendon repair with a concomitant distal fascial release for complete hip adductor tendon tears:surgical technique and outcomes in 40 male athletes

Abstract Background: The optimal treatment for complete avulsions of the proximal adductor longus (AL) is still debatable, and different operative and nonoperative treatment options have been suggested. Purpose: To report surgical techniques and functional outcomes of a series of athletes who were treated operatively for proximal AL tears. Study Design: Case series; Level of evidence, 4. Methods: A retrospective evaluation of patients who underwent surgical repair of complete proximal AL tear with concomitant distal fascial release with or without lesions of the neighboring soft tissue structures was performed. This included preinjury Tegner score, age, number of tendons involved, time interval from injury to surgery, and postoperative complications. Self-reported outcomes were defined based on the ability to regain sports activities (excellent, good, moderate, fair, or poor). Between-group comparisons were performed to identify factors associated with improved outcomes. The Mann-Whitney nonparametric test was used for comparing continuous variables, and the Fisher exact test was used for comparing nominal variables. Results: A total of 40 male athletes were included in the evaluation, with an average follow-up of 11 months (range, 6 months-8 years). Self-reported outcome was excellent in 23 (57.5%), good in 13 (32.5%), and moderate in 4 (10%) patients. Comparisons between patients with excellent versus good/moderate outcomes revealed nonsignificant differences regarding age at injury and preinjury Tegner score. Athletes with excellent outcomes received surgery sooner after the injury compared with athletes with good/moderate outcomes (2.4 ± 1.8 vs 11.4 ± 11.0 weeks, respectively; P &lt; 0.01). Conclusion: Surgical repair for complete proximal AL tears with a concomitant distal fascial release resulted in outcomes rated as good or excellent in 90% of the cases. This treatment should be considered particularly in high-level athletes with a clear tendon retraction and within the first month after the injury. Further research is nevertheless needed to compare these outcomes with other treatment alternatives to better define criteria advocating surgery

Long-term outcomes of tibial spine avulsion fractures after open reduction with osteosuturing versus arthroscopic screw fixation:a multicenter comparative study

Abstract Background: More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years. Purpose: To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 61 patients &lt;16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24-189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport. Results: The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P &lt; .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement >3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups. Conclusion: Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP

Tears of biceps femoris, semimembranosus, and semitendinosus are not equal:a new individual muscle-tendon concept in athletes

Abstract Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing. Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced. Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience. Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes