The purpose of this systematic review was to determine the return-to-sport rate following arthroscopic Bankart repair, and it was hypothesized that patients would experience a high rate of return to ...sport.
The MEDLINE, Embase, and PubMed databases were searched by 2 reviewers, and the titles, abstracts, and full texts were screened independently. The inclusion criteria were English-language studies investigating arthroscopic Bankart repair in patients of all ages participating in sports at all levels with reported return-to-sport outcomes. A meta-analysis of proportions was used to combine the rate of return to sport using a random-effects model.
Overall, 34 studies met the inclusion criteria, with a mean follow-up time of 46 months (range, 3-138 months). The pooled rate of return to participation in any sport was 81% (95% confidence interval CI, 74%-87%). In addition, the pooled rate of return to the preinjury level was 66% (95% CI, 57%-74%) (n = 1441). Moreover, the pooled rate of return to a competitive level of sport was 82% (95% CI, 79%-88%) (n = 273), while the pooled rate of return to the preinjury level of competitive sports was 88% (95% CI, 66%-99%).
Arthroscopic Bankart repair yields a high rate of return to sport, in addition to significant alleviation of pain and improved functional outcomes in the majority of patients. However, approximately one-third of athletes do not return to their preinjury level of sports.
Polyvinylidene fluoride (PVDF) has been considered as an alternative suture material to replace polypropylene (PP) due to its superior biocompatibility and mechanical properties, but it has never ...been examined for use in barbed sutures, particularly for tendon repair. This study fabricated size 2–0 PVDF and PP bidirectional barbed sutures and compared their mechanical properties and anchoring performance in patellar tendons. The mechanical properties were evaluated via tensile testing, and the anchoring performance of the barbed sutures was assessed by a tendon suture pullout test. Sixty porcine patellar tendons were harvested, transected to mimic a full‐thickness injury, and repaired using a cross‐locked cruciate suturing technique. The ultimate tensile force was 60% higher for the PVDF barbed sutures (22.4 ± 2.1 N) than for the PP barbed sutures (14.0 ± 1.7 N). The maximum pullout force was 35% higher for PVDF barbed sutures (70.8 ± 7.8 N) than for PP barbed sutures (52.4 ± 5.8 N). The force needed to form a 2‐mm gap, indicative of repair failure, was similar between the PVDF (29.2 ± 5.0 N) and PP (25.6 ± 3.1 N) barbed sutures, but both were greater than the 2‐mm‐gap forces for non‐barbed sutures of the same size. In this study, PVDF barbed sutures provided better mechanical properties and improved tissue anchoring performance compared to the barbed PP sutures for porcine patellar tendon repair, demonstrating that PVDF monofilament sutures can be barbed and used effectively for tendon repair.
Purpose Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). ...Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management. Methods We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented. Results Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score ( P = .008), Hip Outcome Score–Activities of Daily Living ( P = .02), and Hip Outcome Score–Sport ( P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported. Conclusions This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes. Level of Evidence Systematic review of Level IV and V (case report) studies.
Background:
Debate exists on whether hip labral tears should be surgically repaired, partially resected, or reconstructed. Furthermore, limited data exist regarding the fluid seal properties of hip ...labrum repair and/or reconstruction with iliotibial band autograft when compared with the labrum-intact condition.
Hypothesis/Purpose:
The purpose of this study was to investigate the fluid seal properties of hip labral repair and reconstruction techniques. We hypothesized that hip labral repair preserves the acetabular labral fluid seal greater than labral tear, partial-resection, and reconstruction conditions.
Study Design:
Controlled laboratory study.
Methods:
Six human cadaveric hemipelvises were dissected of all soft tissue, leaving the hip capsule intact. Fluid efflux was measured under 5 conditions using a custom fluid infusion device: (1) hip labrum intact, (2) labral tear, (3) labral repair with suture anchors, (4) partial labral resection, and (5) labral reconstruction using ipsilateral iliotibial band autograft. Joint fluid expression was measured as flow rate under 3 different pressure settings (2, 3, and 4 psi). Statistical differences between conditions were assessed using 2-way, repeated-measures analysis of variance. The Student-Newman-Keuls (SNK) multiple comparison test was used to determine differences between levels.
Results:
There was a significant increase in fluid efflux with a simulated labral tear (0.54 ± 0.3 mL/sec) when compared with the intact hip labrum condition (0.006 ± 0.008 mL/sec, P < .05). The labrum-repaired condition (0.21 ± 0.2 mL/sec) demonstrated significantly less fluid efflux when compared with the labral-tear condition. Hip labral repair significantly prevented greater fluid efflux when compared with partial labral resection (0.60 ± 0.4 mL/sec) and reconstruction with iliotibial band autograft (0.54 ± 0.3 mL/sec; P < .05). Labral repair did not preserve fluid efflux as effectively as in the labrum-intact condition (0.21 ± 0.2 > 0.006 ± 0.008 mL/sec; P < .05). There was no difference observed in fluid efflux between the labral reconstruction, tear, or resection conditions (P > .05).
Conclusion:
In this human cadaveric model, hip labral repair outperforms partial labral resection and reconstruction in preserving the joint fluid seal; however labral repair does not restore fluid seal characteristics as effectively as in the labrum-intact condition.
Clinical Relevance:
Further prospective studies are needed to determine whether hip labral repair outperforms partial labral resection and/or reconstruction in clinical practice.
Background:
Injury to the ulnar collateral ligament of the elbow is relatively common among baseball pitchers. Ulnar collateral ligament reconstruction (UCLR) has revolutionized the management of ...this injury, allowing a greater proportion of pitchers to return to play.
Purpose:
To assess the return to play and in-game performance specific to baseball pitchers who have undergone primary UCLR.
Study Design:
Systematic review.
Methods:
This review was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies, and pertinent data were abstracted. Only studies reporting in-game performance statistics (earned run average ERA, pitching velocity, innings pitched per season, etc) of pitchers after UCLR were included. The methodological index for nonrandomized studies (MINORS) was used to assess study quality.
Results:
A total of 14 studies and 1520 pitchers were included in this systematic review. All studies were of level 3 or 4 evidence, and the mean ± SD MINORS score was 14.4 ± 3.0, which indicates fair quality of evidence for nonrandomized studies. The rates of return to any level of pitching after UCLR ranged from 79% to 100%. Subgroup analysis revealed that 79% to 87% of Major League Baseball (MLB) pitchers returned to preinjury levels of pitching. The mean time to return to play was 19.8 ± 13.5 months, and the mean time to return to competition for MLB pitchers was 17.3 ± 2.4 months. Of the 5 studies reporting ERA, 2 cited a significant increase after UCLR, and 1 indicated a significant decrease. Of the 4 studies reporting fastball velocity, 3 cited decreased pitching velocities after UCLR. All studies found that pitchers pitched, on average, fewer innings per game or season after UCLR.
Conclusion:
There was a high rate of return to pitching after UCLR. However, most studies showed that UCLR was associated with a prolonged recovery and significant decline in pitching performance as objectively measured by in-game statistics. The strength of these conclusions is limited by the quality of the available literature and inconsistencies in the reporting of outcomes.
Displaced three- and four-part proximal humerus fractures are among the most challenging shoulder conditions to manage. Because of the risk of symptomatic malunion, nonunion, and humeral head ...osteonecrosis, surgical management is preferred. Locking plate technology has provided an alternative to hemiarthroplasty for certain three- and four-part fracture patterns, even in the setting of osteopenic bone. Prosthetic humeral head replacement has been advocated for head-splitting fractures and fracture-dislocations as well as four-part fractures with significant initial varus displacement (>20°). Technical challenges, including obtaining proper humeral head height, retroversion, and optimal positioning and fixation of the tuberosities, have a substantial effect on patient outcomes.
Background
Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, ...however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.
Questions/purposes
We compared the outcomes after precontoured and noncontoured superior plating of acute displaced midshaft clavicle fractures. Primary outcomes were rate of plate prominence, rate of hardware removal, and rate of complications. Secondary outcomes were ROM and pain and function scores.
Patients and Methods
We retrospectively reviewed 52 patients with 52 acute, displaced midshaft clavicle fractures treated with either noncontoured or precontoured superior clavicle plate fixation. Fourteen patients with noncontoured plates and 28 with precontoured plates were available for followup at a minimum of 1 year postoperatively. Postoperative assessment included ROM, radiographs, and subjective scores including visual analog scale for pain, American Shoulder and Elbow Surgeons questionnaire, and Simple Shoulder Test.
Results
Patients complained of prominent hardware in nine of 14 in the noncontoured group and nine of 28 in the precontoured group. Hardware removal rates were three of 14 in the noncontoured group and three of 28 in the precontoured group. Postoperative ROM and postoperative subjective scores were similar in the two groups.
Conclusions
Precontoured plating versus noncontoured plating of displaced midshaft clavicle fractures results in a lower rate of plate prominence in patients who do not undergo hardware removal.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Septic arthritis following anterior cruciate ligament reconstruction is a rare and potentially devastating complication that often leads to articular destruction and adverse clinical outcomes. ...Because of its rare occurrence, best practices for diagnosis and management have yet to be established. However, graft retention and favorable outcomes are possible with early diagnosis, surgical intervention, and appropriate antibiotic management. Clinicians must be familiar with the diagnostic criteria and management options for septic arthritis. Most patients require multiple procedures to effectively eradicate infection. When the original reconstructed graft cannot be salvaged, a staged anterior cruciate ligament reconstruction revision is required.
Background: Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface
pressure of the rotator cuff tendon to the greater ...tuberosity for different rotator cuff repair techniques.
Hypothesis: The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint
than do suture anchor techniques.
Study Design: Controlled laboratory study.
Methods: Simulated rotator cuff tears over a 1 Ã 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous
tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n =
8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined
using pressure-sensitive film placed between the tendon and the tuberosity.
Results: The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous
technique (67.7 ± 5.8 mm 2 ) compared with the suture anchor simple (34.1 ± 9.4 mm 2 ) and suture anchor mattress (26.0 ± 5.3 mm 2 ) techniques ( P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique
(0.32 ± 0.05 MPa) compared with the suture anchor simple (0.26 ± 0.04 MPa) and suture anchor mattress (0.24 ± 0.02 MPa) techniques
( P < .05).
Conclusion: The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution
over a defined footprint when compared with suture anchor techniques.
Clinical Relevance: Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired
rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in
the development of improved open and arthroscopic rotator cuff repair techniques.
Keywords:
rotator cuff
footprint
transosseous
suture anchor
pressure
Proximal Humerus and Humeral Shaft Nonunions Cadet, Edwin R; Yin, Bob; Schulz, Brian ...
Journal of the American Academy of Orthopaedic Surgeons,
09/2013, Letnik:
21, Številka:
9
Journal Article
Recenzirano
The rate of nonunion is estimated to be 1.1% to 10% following closed treatment of proximal humerus fracture and 5.5% following closed treatment of humeral shaft fracture. Surgical management should ...be considered for fractures that demonstrate no evidence of progressive healing on consecutive radiographs taken at least 6 to 8 weeks apart during the course of closed treatment. In the case of proximal humerus nonunion, recent series have demonstrated union in >90% of patients treated with reconstruction using locking plates and autogenous bone graft. Shoulder arthroplasty is reserved as a salvage option in cases in which the humeral head is not viable or the proximal fragment will not support osteosynthesis. For humeral shaft nonunions, open reduction and internal fixation with compression plating and bone graft remains the standard of care, with a >90% rate of union and good functional outcomes. Recent studies support the use of locked compression plates, dual plating, and cortical allograft struts in patients with osteopenic bone.
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