Background Tenodesis of the long head of the biceps tendon is a common procedure used to alleviate pain caused by instability or inflammation of the tendon. The purpose of this study is to report on ...the incidence and types of complications following an open subpectoral biceps tenodesis (OBT) procedure. Hypothesis Our hypothesis was that the rate of adverse events after OBT was low. Methods From January 2005 to December 2007, all patients that underwent an OBT with bioabsorbable interference screw fixation performed by 1 of the 2 senior authors for biceps tendonitis were reviewed, excluding tenotomy, revision cases, or fixation methods other than interference screw fixation. Results Over a 3-year period, 7 of 353 patients had complications with OBT with an incidence of 2.0%. The mean age of patients with complications was 44.67 years, with 57.1% males and 42.9% females. There were 2 patients (0.57%) with persistent bicipital pain. Two patients (0.57%) had failure of fixation resulting in a Popeye deformity. One patient (0.28%) presented with a deep postoperative wound infections that necessitated irrigation and debridement with intravenous antibiotics. Another patient (0.28%) developed a musculotaneous neuropathy. Another patient (0.28%) developed reflex sympathetic dystrophy necessitating pain management and stellate ganglion block. Conclusion The incidence of complications after subpectoral biceps tenodesis with interference screw fixation in a population of 353 patients over the course of 3years was 2.0%.
The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a ...semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery.
Background Subpectoral biceps tenodesis with interference screw fixation allows reproducible positioning of the tendon to help maintain the length–tension relationship. The aim of our study was to ...evaluate the role of cortical button fixation in isolation or as an augment to interference screw fixation and to determine if the diameter of the interference screw affected fixation strength. Materials and methods Thirty-two cadaveric shoulders were dissected and randomized to 1 of 4 groups: (1) 7-mm interference screw and cortical button, (2) cortical button alone, (3) 7-mm interference screw, or (4) 8-mm interference screw. Testing was performed on a materials testing system with a 100-N load cycled at 1 Hz for 5000 cycles, followed by an axial load to failure test. Cyclic displacement, ultimate load to failure, and site of failure were recorded for each specimen. Results The mean ultimate failure loads were 7-mm interference screw with cortical button augmentation, 237.8 ± 120.4 N; cortical button alone, 99.4 ± 16.9 N; 7-mm interference screw, 275.5 ± 56 N; 8-mm interference screw, 277.1 ± 42.1 N. All specimens failed through tendon failure at the screw–tendon–bone interface. Conclusions The biomechanical performance of subpectoral biceps tenodesis with interference screw fixation was not improved with cortical button augmentation. In addition, cortical button fixation alone yielded a significantly lower ultimate load to failure compared with interference screws. Finally, the biomechanical performance of smaller-diameter interference screws with matching bone tunnels was not affected by interference screw diameter.
The anatomy of the distal biceps tendon and bicipital tuberosity (BT) is important in the pathophysiology of tendon rupture, as well as surgical repair. Understanding the dimensions of the BT and its ...angular relationship to the radial head and radial styloid will facilitate surgical procedures such as reconstruction of the distal biceps tendon, radial head prosthesis implantation, and reconstruction of proximal radius trauma. We examined 178 dried cadaveric radii, and the following measurements were collected: radial length, length and width of the BT, diameter of the radius just distal to the BT, distance from the radial head to the BT, radial head diameter, width of the radius at the BT, radial neck-shaft angle, and styloid angle. Furthermore, the morphology of the BT ridge was defined as smooth (absent), small, medium, large, or bifid. Of the specimens, 48 were further analyzed with a computed tomography scanner at the level of the BT to determine the distance to traverse both the anterior and posterior cortex and the anterior cortex alone. Eighteen fresh-frozen cadaveric elbows were dissected, and the insertion footprint of the distal biceps tendon was defined. The BT has a mean length of 22 ± 3 mm and a mean width of 15 ± 2 mm. The tendon insertion footprint is a ribbon-shaped configuration on the most ulnar aspect of the BT, and it occupies 63% of the length and 13% of the width of the BT. The BT ridge is absent in 6% of specimens and bifid in 6%, and the remaining 88% of specimens have a single ridge that may be classified as small, medium, or large. The mean diameter of the radial head is 22 ± 3 mm. The mean radial neck-shaft angle is 7° ± 3°, and the mean BT-radial styloid angle is 123° ± 10°. None of the measurements correlated with patient age, sex, or race. We concluded that the morphology of the BT ridge is variable. The insertion footprint of the distal biceps tendon is on the ulnar aspect of the BT ridge. The dimensions of the radius and BT are applicable to several surgical procedures about the elbow.
Purpose This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive ...form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. Methods Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. Results Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). Conclusions Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. Clinical relevance Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
Background Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents, particularly motorcycle ...crashes. High-grade ACJ disruptions (type IV-VI) are managed surgically through a variety of procedures. These range from simple plate and screw fixation to more complex procedures involving ligament repair, transfer, and reconstruction. Methods This paper describes a new technique utilizing a direct subacromial arthroscopic approach to performing a reconstruction of the ruptured coracoclavicular ligaments. The appropriately over-engineered fixation device is made up of a subcoracoid button secured via nonabsorbable sutures to a special clavicular washer and augmented by a centrally placed soft tissue graft. Results To date, the senior author has performed 10 cases on both acute and chronic high-grade ACJ separations. All patients greater than 6 months out from surgery have returned to their normal pre-injury level of activity. No complications (infection, hardware, or graft failure) have been documented, and all have maintained the interoperative reduction of the acromioclavicular joint and coracoclavicular space. Conclusion The arthroscopic reconstruction of the AC separation is a low-morbidity, safe, and reproducible operation that provides adequate fixation and stability combined with the use of a soft tissue graft to promote sound biologic healing.
Abstract Platelet-rich plasma (PRP) has been the subject of hundreds of publications in recent years. Reports of its effects in tissue, both positive and negative, have generated great interest in ...the orthopaedic community. Protocols for PRP preparation vary widely between authors and are often not well documented in the literature, making results difficult to compare or replicate. A classification system is needed to more accurately compare protocols and results and effectively group studies together for meta-analysis. Although some classification systems have been proposed, no single system takes into account the multitude of variables that determine the efficacy of PRP. In this article we propose a simple method for organizing and comparing results in the literature. The PAW classification system is based on 3 components: (1) the absolute number of Platelets, (2) the manner in which platelet Activation occurs, and (3) the presence or absence of White cells. By analyzing these 3 variables, we are able to accurately compare publications.
This article summarizes both the various techniques for an open subpectoral biceps tenodesis as well as the biomechanics associated with these procedures. It provides information regarding the ...indications and contraindications to support the surgeon's decision. Furthermore, a postoperative protocol as well as an outcome overview is presented to address postoperative care. A short summary of the recent literature regarding potential complications is included to provide further insight on this technique. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps.
A Substantial Clinical Benefit (SCB) value is the amount of change in a patient-reported outcome measure required for a patient to feel they significantly improved from an intervention. Previously ...published SCB values are often cited by researchers when publishing outcomes data. Where these SCB values are set can have a large impact on the conclusions drawn from a study citing them. As such, the goal of this study was to determine the generalizability of SCB values for a procedure when stratified by time from surgery and geographic region.
A nationwide outcomes database was utilized to obtain preoperative, one-year, and two-year postoperative outcome measurements for patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse TSA. The data were divided into three geographic regions: the South, the Midwest, and the West. An East region was not included due to its limited number of patients. SCB values were calculated for four outcomes measures: Single Assessment Numeric Evaluation score, American Shoulder Elbow Surgeons score, Visual Analog Scale, and Western Ontario Osteoarthritis of the Shoulder score. SCB values were calculated for each region, for each procedure, and at both one and two years postoperatively. To determine the variability of potential SCBs within each region, simulated datasets were created to determine a distribution of possible calculated SCBs.
A total of 380 anatomic TSA patients and 543 reverse TSA patients were included for analysis. There was a high degree of variability of SCB values when stratified by procedure, time, and region. While some simulated datasets did produce homogenous SCB distributions among regions, some outcome measures demonstrated a large heterogeneity in distribution among regions, with concomitant large distributions of values within individual regions.
There is notable heterogeneity of SCB values when stratified by region or time. The current method of citing previously published SCB values for determining the efficacy of an intervention may be inappropriate. It is likely that this variability holds true in other areas of orthopedics.
Intra-articular distal humerus fractures frequently require olecranon osteotomies for adequate exposure, but fixation of olecranon osteotomies is associated with high rates of hardware-related ...complications requiring subsequent reoperation for removal. Intramedullary screw fixation is an attractive option to attempt to minimize hardware prominence. The purpose of this biomechanical study is to directly compare intramedullary screw fixation (IMSF) with plate fixation (PF) of chevron olecranon osteotomies. It was hypothesized that PF would be biomechanically superior to IMSF.
Chevron olecranon osteotomies of 12 matched pairs of fresh-frozen human cadaveric elbows were repaired with either precontoured proximal ulna locking plates or cannulated screws with a washer. Displacement and amplitude of displacement at the dorsal and medial aspects of the osteotomies under cyclic loading conditions were measured. Finally, the specimens were loaded to failure.
The IMSF group had significantly greater medial displacement (P = .034) and dorsal amplitude (P = .029) than the PF group. Medial displacement was negatively correlated with bone mineral density in the IMSF group (r = −0.66, P = .035) but not in the PF group (r = .160, P = .64). Mean load to failure between groups, however, was not statistically significant (P = .183).
While there was no statistically significant difference in the load to failure between the two groups, IMSF repair resulted in significantly greater displacement of the medial osteotomy site during cyclic loading and greater amplitude of displacement dorsally with loading force. Decreased bone mineral density was associated with an increased displacement of the medial repair site. These results suggest that IMSF of olecranon osteotomies may result in increased fracture site displacement when compared to PF; this displacement may be greater in patients with poor bone quality.
