Prominent hardware post Latarjet mimicking shoulder instability symptoms

A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthrosco-py and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication

Arthroscopic suprascapular neurectomy for the management of severe shoulder pain.

Hypothesis: Arthroscopic suprascapular neurectomy is an effective option in the management of patients with severe shoulder pain. Materials and methods: We describe and evaluate a technique of suprascapular neurectomy, performed arthroscopically for the treatment of severe shoulder pain in 20 patients (17 with a rotator cuff arthropathy, two with glenohumeral arthritis and one with a rotator cuff deficient shoulder following an unsuccessful arthrodesis). Post-operative pain relief was measured using a new pain scoring system, which combined an assessment of the frequency and severity of pain experienced at night, at rest, with activities and any change in analgesic consumption. Results: At an average follow-up of 29 months, 75% of our patients reported good to excellent pain relief scores, 85% reported less night pain, 90% had less rest pain, 70% reported less pain on movement, whilst 75% reported less consumption of pain medication. There were no surgical complications. Discussion: Suprascapular neurectomy performed arthroscopically provides an additional surgical option in the management of pain in patients with cuff tear arthropathy and in other selected patients with no functioning rotator cuff. The pain scoring system introduced in this article provides a more comprehensive assessment of shoulder pain than existing pain scores. Conclusion: We conclude that arthroscopic suprascapular neurectomy introduces an additional effective option in the management of pain in patients with these pathologies. Level of evidence: Level 4; Retrospective case series, no control group

The PUTRA press-fit system as an alternative femoral fixation technique for posterior cruciate ligament reconstruction – a technical note and outcome evaluation

We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit system. 9 patients underwent PCL reconstruction using our pressfit system. The surgical procedure is described in detail. Post-operatively, 5 patients were available for assessment and review. Four patients gave a final Lysholm score of 92 – 100%. Three patients gave a Hospital for Special Surgery (HSS) score of excellent, one fair and one poor. Two patients gave a reduced Tegner activity score post-operatively while the other three gave a similar score post-operatively. Assessment using KT-1000 revealed four patients with a side-to-side difference of less than 3 mm (average side-to-side difference, 1.87 mm), while one patient exhibited a side-to-side difference of 5.8 mm. We believe that our technique enhances tunnel healing through usage of a bone-plug fixation and provides a cheap alternative for graft fixation on the femoral side in PCL reconstruction

Acute post-traumatic locked knee - an unmasking of a rare knee disorder

Locked knees are commonly caused by meniscal tears, floating osteochondral bodies, ruptured anterior cruciate ligament (ACL) stump, or other mechanical origins in the knee. Some locked knees occur spontaneously, while in most cases, by a preceding knee trauma. Locked knees are rarely caused by a pathological growth in the knee. More unusually is the occurrence of locked knee caused by a pre-existing pathological entity after a traumatic event. We report a rare case of locking in the knee by a pre-existing knee condition presented only after trauma to the knee. This case emphasizes that locking in the knee can be caused by a pathology that may be asymptomatic until it is revealed by a traumatic event

Degenerative osteophyte causing acute locked knee in a young man: a case report

Acute locked knee is usually caused by mechanical blockage. We report an unusual case of a locked knee due to tibial osteophyte in a young man following a sport injury. To the best of our knowledge, there has been no previous report describing the same etiology. This case report emphasizes the need for thorough history taking and careful assessment to aid us in the diagnosis. The findings made by arthroscopy confirmed our diagnosis

Arthroscopic Mumford procedure utilizing the anteromedial and Neviaser portals – a pilot cadaveric study on neurovascular structures at risk

Introduction: Degenerative disorder involving the acromio-clavicular joint (ACJ) is quite common especially in the elderly. One of the surgical modalities of treatment of this disorder is the Mumford Procedure. Arthroscopic approach is preferred due to its reduced morbidity and faster post-operative recovery. One method utilizes the anteromedial and Neviaser portals, which allow direct and better visualization of the ACJ from the subacromial space. However, the dangers that may arise from incision and insertion of instruments through these portals are not fully understood. This cadaveric study was carried out to investigate the dangers that can arise from utilization of these portals and which structures are at risk during this procedure. Methods: Arthroscopic Mumford procedures were performed on 5 cadaver shoulders by a single surgeon utilizing the anteromedial and Neviaser portals. After marking each portals with methylene blue, dissection of nearby structures were carried out immediately after each procedure was completed. Important structures (subclavian artery as well as brachial plexus and its branches) were identified and the nearest measurements were made from each portal edges to these structures. Results: The anteromedial portal was noted to be closest to the suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal was noted to be closest also to the SSN at 1.60 cm. The suprascapular nerve was the structure most at risk during the Mumford procedure. The anteromedial portal was noted to be the most risky portal to utilize compared to the Neviaser portal. Conclusion: Extra precaution needs to be given to the anteromedial portal while performing an arthroscopic distal clavicle resection in view of the risk of injuring the suprascapular nerve of the affected limb

Coracoid process morphology using 3D-CT imaging in a Malaysian population

Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length × 10.03 + 1.48mm height × 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length × 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher

Popliteal artery to tibial plateau distance at the knee level: a radiological study to assess injury risks in osteoarthritic knees using dual source dual energy CT scan

Popliteal artery injury is the most disastrous intraoperative complication during total knee replacement. This study aims to determine the mean distance between the popliteal artery (PA) and the tibial plateau in normal and osteoarthritic patients who underwent Dual Energy CT Angiography (CTA) of the lower limb. Materials and Methods: All CTA lower limb examinations from January 2013 to October 2014 were retrospectively reviewed. The distance between the PA the tibial plateau distance and the thickness of popliteus muscle were electronically measured. We used modified Kellgren and Lawrence's Classification to grade the osteoarthritis in patients who underwent CT examinations regardless of symptoms. Results: There were a total of 126 patients who underwent CTA (93 males and 33 females). 54 of them were Malays, 47 Indians, and 24 Chinese. The mean age of patients was 58 years (range 16 to 92). The mean PA-to-tibial plateau distance was 9.9 mm for the right lower limb (range 2.5 mm to 17.2 mm) and 10.24 mm for the left (range 5.5 mm to 15.4 mm). There were no significant correlations between PA-to-tibial plateau distance with osteoarthritis grade, age, gender, and racial origin (P > 0.05); however, there was a positive correlation between PA-to-tibial plateau distances with popliteus muscle thickness (P = 0.000). Conclusion: Osteoarthritic condition in the knee does not reduce the popliteal artery to the tibial plateau distance. Hence, a higher osteoarthritic grade does not impose additional risks with regards to popliteal artery to tibial plateau distance, with relatively similar arterial injury risks compared to normal knees

The 'Chalky Culprit' of acute locked knee

Acute locked knee is commonly caused by tears of the menisci in the knee, osteochondral injuries and also by the stump of a ruptured anterior cruciate ligament. We present two cases of acute locked knee atypically caused by gouty tophaceous lesions in the knee

Short-term functional outcomes of a delayed single-stage reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency

Aims To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Patients and Methods Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7–51 months) and duration of follow-up was 22 months (range, 12–48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. Results At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in competitive sport, 5 patients were able to be involved in recreational sports for at least 5 times per week, 10 patients were able to perform heavy labour and recreational sports for at least twice weekly, 4 patients were able to engage in moderately heavy labour work and one patient was only able to perform light labour work. There was no significant statistical association found between the time-to-surgery and the final patients’ outcomes. Conclusions A delayed simultaneous reconstruction of chronic grade III PCL and PLC deficiencies can restore sufficient function for standard daily and recreational sports activities to the patient