Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament Lesion With Capsular Plication in the Lateral Decubitus Position

Humeral avulsion of the glenohumeral ligament (HAGL) lesions can lead to persistent shoulder instability. While rare, HAGL lesions may present as a concomitant injury following shoulder dislocation events. Traditionally, an open approach has been used to repair the inferior glenohumeral ligament and restore shoulder stability. Modern arthroscopic techniques and instrumentation have permitted a minimally invasive approach for treating HAGL lesions. While technically demanding, arthroscopic repair of HAGL lesions has demonstrated favorable outcomes with less soft-tissue disruption. The following Technical Note describes a safe and effective method for the arthroscopic repair of HAGL lesions. Our technique highlights the use of the lateral decubitus position, a 70° arthroscope, a curved anchor device, and a 90° SutureLasso device

Effect of Achilles Tendon Rupture on Player Performance and Longevity in Women\u27s National Basketball Association Players

Background: Women\u27s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR). Purpose: To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups. Results: Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (+/- SD) of 12.5 +/- 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 +/- 6.9 fewer games, starting in 12.7 +/- 15.4 fewer games, and playing 10.2 +/- 9.1 fewer minutes per game (P \u3c .05 for all). After the index date of injury, the players with Achilles repair played 2.1 +/- 1.2 more years in the WNBA, while control players played 5.35 +/- 3.2 years (P \u3c .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 +/- 5.3 vs 11.0 +/- 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls (P \u3c .05 for both). Conclusion: The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls

Percutaneous Achilles Tendon Repair Using Ultrasound Guidance: An Intraoperative Ultrasound Technique

Rupture of the Achilles tendon is a common injury seen in patients of varying ages and activity levels. There are many considerations for treatment of these injuries, with both operative and nonoperative management providing satisfactory outcomes in the literature. The decision to proceed with surgical intervention should be individualized for each patient, including the patient\u27s age, future athletic goals, and comorbidities. Recently, a minimally invasive percutaneous approach to repair the Achilles tendon has been proposed as an equivalent alternative to the traditional open repair, while avoiding wound complications associated with larger incisions. However, many surgeons have been hesitant to adopt these approaches due to poor visualization, concern that suture capture in the tendon is not as robust, and the potential for iatrogenic sural nerve injury. The purpose of this Technical Note is to describe a technique using high-resolution ultrasound guidance intraoperatively during minimally invasive repair of the Achilles tendon. This technique minimizes the drawbacks of poor visualization associated with percutaneous repair, while providing the benefit of a minimally invasive approach

PROMIS MCID and SCB Achievement in Rotator Cuff Repair

The purpose of this study was to establish threshold score changes to determine minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in PROMIS computer adaptive test (CAT) scores following rotator cuff repair (RCR). Patients undergoing arthroscopic RCR were identified over a 24-month period. PROMIS CAT forms for upper extremity physical function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. Analysis of variance testing with post hoc least significant difference pairwise comparisons and Tukey’s B subset analysis were used in determining if anchor question responses showed statistically significant differences between answers. These findings were used to establish two clinically significant outcome (CSO) groups, MCID and substantial clinical benefit (SCB). Patients were then dichotomized into two separate analyses, no MCID achievement compared with MCID achievement and no SCB achievement compared with SCB achievement. Of the 198 eligible patients, 168 patients (84.8%) were included in analysis. Receiver operating curve analysis determined delta PROMIS-UE values of 5.8 and 9.7 (area under the curve (AUC) = 0.906 and 0.949, respectively) and delta PROMIS-PI values of -11.4 and -12.9 (AUC = 0.875 and 0.938, respectively) to be excellent threshold predictors of MCID and SCB achievement. On average, 81.1%, 65.0%, and 54.5% of patients achieved MCID for PROMIS-UE, PROMIS-PI, and PROMIS-D while 70.7%, 60.7%, and 37.7% of patients in the cohort respectively achieved SCB

Quadriceps Tendon Repair Using Double-Row Suture Anchor Fixation

Quadriceps tendon ruptures compromise the knee extensor mechanism and cause an inability to ambulate and significant functional limitations. Therefore, the vast majority of quadriceps tendon ruptures are indicated for operative intervention to restore patient mobility and function. Although these injuries were traditionally repaired using a transosseous repair technique, recent literature has shown that suture anchor repair may offer biomechanical advantages. Additionally, research in other areas of orthopaedics has found that a double-row suture anchor construct can offer additional biomechanical strength to tendinous repair. This technical note describes a safe and effective quadriceps tendon repair using a double-row suture anchor construct

Preoperative PROMIS Scores Predict Postoperative Improvements Following Rotator Cuff Repair

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a valid and efficient means of collecting patient outcomes in patients with rotator cuff tear. The purpose of this study was to examine the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting post-operative PROMIS CAT scores as well as likelihood of achieving minimal clinically important difference (MCID) following rotator cuff repair. We hypothesize that pre-operative PROMIS CAT scores will directly impact both post-operative PROMIS CAT scores and likelihood of achieving MCID.Methods: Patients undergoing arthroscopic rotator cuff repair by one of three fellowship-trained surgeons were identified over a 12-month period. Only patients that completed pre-operative and 6-month post-operative PROMIS CAT assessments were included in this cohort. PROMIS CAT forms for upper extremity physical function (PROMIS-U), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Preoperative cutoffs were used to predict which patients would likely meet MCID using 95% specificity. Results: A total of 80 patients met our inclusion criteria. PROMIS-UE, PROMIS-PI and PROMIS-D improved 6 months after surgery (p\u3c0.001). 76% of patients met MCID for PROMIS-UE, while 89% met MCID for PROMIS-PI, and 54% met MCID for PROMIS-D. Preoperative PROMIS scores were predictive of post-operative outcomes based on ROC analysis which demonstrated significant area under the curve (AUC) of .725 (p=0.003), .757 (p=0.013), and .789 (p\u3c0.001) for PROMIS-UE, PROMIS-PI, and PROMIS-D, respectively. Individuals with PROMIS-UE scores below 24.95 and PROMIS-PI scores above 65.65 yielded a 100% probability of achieving MCID, while a cutoff of 56.45 for PROMIS-D yielded a 91% probability of achieving MCID with 95% specificity. Conclusion: Patients undergoing arthroscopic rotator cuff repair experience significant improvements in upper extremity physical function, pain interference and depression as measured by PROMIS CAT domains. In particular, patients presenting with PROMIS upper extremity scores of \u3c24.95 are especially likely to achieve MCID.https://scholarlycommons.henryford.com/merf2019clinres/1053/thumbnail.jp

Simultaneous, Ipsilateral Distal Biceps and Distal Triceps Rupture in Healthy Weight Lifter: A Case Report

CASE: A 38-year-old weight lifter presented with a complete distal biceps rupture with retraction and a near complete ipsilateral distal triceps tear sustained during the bench press exercise. The tendons were fixed operatively using a simultaneous posterior and anterolateral approach to the elbow. CONCLUSION: Simultaneous, ipsilateral distal biceps and distal triceps tendon injury is a rare occurrence that leads to significant functional loss. Repair of distal biceps rupture using a single-incision technique with a cortical button and distal triceps using a double-row suture anchor repair was successful in restoring functional anatomy to our patient

Evaluating Bone Loss in Anterior Shoulder Instability

Anterior shoulder instability is a common orthopaedic condition that often involves damage to the bony architecture of the glenohumeral joint in addition to the capsulolabral complex. Patients with recurrent shoulder dislocations are at increased risk for glenohumeral bone loss, as each instability event leads to the accumulation of additional glenoid and/or humeral head bone defects. Depending on the degree of bone loss, successful treatment may need to address bony lesions in addition to injured soft-tissue structures. As such, a thorough understanding of methods for evaluating bone loss preoperatively, in terms of location, size, and significance, is essential. Although numerous imaging modalities can be used, three-dimensional imaging has proven particularly useful and is now an integral component of preoperative planning

Diagnostic Accuracy of Ultrasound for Rotator Cuff Tears

Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate the shoulder. It does not expose the patient to harmful radiation and can be used to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears (RCTs), despite its operatordependence. The usage of US for diagnosing RCTs in orthopedic practice varies depending on practitioners\u27 familiarity with the exam and the availability of experienced technicians. The purpose of this article is to review the diagnostic accuracy of US for identifying RCTs