Internal bracing in the treatment of elbow instabilities

AbstractInternal bracing is an augmentation of ligament repair or reconstruction using a non-absorbable suture tape. The suture reinforcement of the ligament is intended to absorb the forces applied to the joint while the ligament repair or reconstruction underneath is healing. The rigidity of the construct is expected to improve primary stability, which should facilitate and accelerate postoperative mobilization and rehabilitation. Nevertheless, internal bracing is a novel treatment and data is limited. Therefore, this review describes the surgical techniques and provides an overview of the current literature regarding acute and chronic instabilities of the medial and lateral elbow treated with internal bracing.

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Posteromedial Ligament Repair of the Knee With Suture Tape Augmentation: A Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/0363546519868961 ◽

2019 ◽

Vol 47 (12) ◽

pp. 2952-2959 ◽

Cited By ~ 5

Author(s):

Julian T. Mehl ◽

Cameron Kia ◽

Matthew Murphy ◽

Elifho Obopilwe ◽

Mark Cote ◽

...

Keyword(s):

Internal Rotation ◽

Knee Flexion ◽

Primary Repair ◽

Cruciate Ligament ◽

Surgical Techniques ◽

Ligament Repair ◽

Acl Injuries ◽

Tendon Reconstruction ◽

Reasonable Alternative ◽

Suture Tape

Background: In cases of acute combined posteromedial and anterior cruciate ligament (ACL) injuries, primary repair of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with suture tape augmentation may be a reasonable alternative to standard tendon reconstruction techniques. Purpose/Hypothesis: The purpose was to examine the rotational and valgus laxity with ACL strain following sMCL and POL repair with suture tape augmentation at various degrees of knee flexion. It was hypothesized that this technique would restore knee laxity and kinematics comparable with those of the intact state. Study Design: Controlled laboratory study. Methods: Ten cadaveric knee specimens (mean ± SD, 57.9 ± 5.9 years) were obtained. Specimens were tested with the tibia fixed and the femur mobile on an X-Y table. Each specimen was tested in 4 conditions according to the state of the sMCL and POL: native, deficient, repaired with suture tape augmentation, and reconstructed with tendon allografts. Valgus laxity was tested with 40-N force applied in the lateral direction of the femur, and rotational motion was tested with 5-N torque applied to the tibia. ACL strain during valgus stress was also measured. Each condition was tested in 0°, 15°, 30°, 45°, and 60° of knee flexion. Results: Dissection of the sMCL and POL led to significantly increased valgus laxity in all flexion angles, with a significant increase in ACL strain at 30° ( P < .001) and 45° ( P < .001). Ligament repair with suture tape augmentation demonstrated similar valgus and rotational laxity as compared with intact specimens, with the exception of increased internal rotation at 30° ( P = .005). Ligament reconstruction resulted in significantly increased valgus opening at 45° ( P = .048) and significantly increased internal rotation at 30° ( P < .001) as compared with the native state. Direct comparison between surgical techniques showed no significant differences. Conclusion: At time zero, ligament repair of the posteromedial knee with suture tape augmentation restored close-to-native valgus and rotatory laxity, as well as native ACL strain for cases of complete sMCL and POL avulsion. Clinical Relevance: Ligament repair of the sMCL and POL with suture tape augmentation may be a reasonable alternative to tendon reconstruction techniques in cases of acute combined posteromedial and ACL injuries with valgus and rotatory instability.

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Comparative In Vitro Evaluation of the Primary Stability in D3 Synthetic Bone of Two Different Shapes and Pitches of the Implant Threads

Applied Sciences ◽

10.3390/app11125612 ◽

2021 ◽

Vol 11 (12) ◽

pp. 5612

Author(s):

Stefano Fanali ◽

Margherita Tumedei ◽

Pamela Pignatelli ◽

Alessandra Lucchese ◽

Francesco Inchingolo ◽

...

Keyword(s):

Surgical Techniques ◽

Primary Stability ◽

Implant Design ◽

Insertion Torque ◽

Synthetic Bone ◽

One Stage ◽

Prosthetic Joint ◽

Joint Connection ◽

The One

Background: Implant primary stability can be affected by several factors related to implant macrogeometry, local anatomy, and surgical techniques. The aim of this research was to study primary stability on polyurethane foam sheets of wide-threaded implant design compared to narrow-threaded implants. Materials and methods: Two different implant designs were positioned on D3 density polyurethane blocks in a standardized environment: the wide-threaded implant and the narrow-threaded implant, for a total of 160 specimens. Moreover, for each group, two different sizes were considered: 3.8mm × 12mm and 4.8mm × 12 mm. The insertion torque (IT) values, the removal strength (RT), and the Periotest analyses were evaluated. Results: A significantly higher IT and RT was reported for wide-threaded implants and two-stage implants (p < 0.01), compared to the narrow-threaded implants. The diameters seemed to provide a significant effect on the primary stability for both implants’ geometry (p < 0.01). A higher mean of the one-stage implant was evident in the Periotest measurements (p < 0.01). Conclusions: Both of the implants showed sufficient stability in polyurethane artificial simulation, while the wide-threaded implant design showed a higher primary stability on alveolar cancellous synthetic bone in vitro. Additionally, the prosthetic joint connection seemed to have a determinant effect on Periotest analysis, and the one-stage implants seemed to provide a high stability of the fixture when positioned in the osteotomy, which could be important for the immediate loading protocol.

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Hohe Myopie und Innenschielen: ein Update zum Heavy-Eye-Syndrom

Karger Kompass Ophthalmologie ◽

10.1159/000511784 ◽

2020 ◽

Vol 6 (4) ◽

pp. 178-179

Author(s):

Santa Heede ◽

Stephan Johannes Linke

Keyword(s):

Differential Diagnosis ◽

Current Literature ◽

Surgical Techniques ◽

Rectus Muscle ◽

Pulley System ◽

Important Type ◽

Hohe Myopie ◽

Salient Features

Heavy eye syndrome is an important type of myopia-induced strabismus. We provide an overview of heavy eye syndrome, from its history to its most salient features. The theory of the orbital and rectus muscle pulley system as it relates to heavy eye syndrome and the prevailing theories on the pathophysiology of heavy eye syndrome in the current literature are discussed. We also highlight the presentation of heavy eye syndrome, its typical features on imaging, and differential diagnosis. Finally, we provide an overview on the management of heavy eye syndrome, including a description of several current surgical techniques.

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Comparative radiographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: An experimental study on domestic pigs

Vojnosanitetski pregled ◽

10.2298/vsp1306586v ◽

2013 ◽

Vol 70 (6) ◽

pp. 586-594 ◽

Cited By ~ 6

Author(s):

Zoran Vlahovic ◽

Branko Mihailovic ◽

Zoran Lazic ◽

Mileta Golubovic

Keyword(s):

Bone Resorption ◽

Resonance Frequency ◽

Dental Implants ◽

Dental Implant ◽

Surgical Techniques ◽

Primary Stability ◽

Implant Stability ◽

Domestic Pigs ◽

Flap Technique ◽

Implant Placement

Background/Aim. Flapless implant surgery has become very important issue during recent years, mostly thanks to computerization of dentistry and software planning of dental implants placements. The aim of this study was to compare flap and flapless surgical techniques for implant placement through radiographic and radiofrequency analyses. Methods. The experiment was made in five domestic pigs. Nine weeks following domestic pigs teeth extraction, implants were placed, on the right side using surgical technique flap, and flapless on the left side. Digital dental Xrays were applied to determine primary dental implant stability quality (ISQ). At certain intervals, not later than three months, the experimental animals were sacrificed, and just before it, control X-rays were applied to measure dental implants stability. Results. Radiographic analysis showed that peri-implant bone resorption in the first 4 weeks following placement implants with flap and flapless surgical techniques was negligible. After the 3 months, mean value of peri-implant bone resorption of the implants placed using flap technique was 1.86 mm, and of those placed using flapless technique was 1.13 mm. In relation to the primary dental implant stability in the first and second week there was an expected decrease in ISQ values, but it was less expressed in the dental implants placed using the flapless technique. In the third week the ISQ values were increased in the dental implants placed by using both techniques, but the increase in flapless implant placement was higher (7.4 ISQ) than in flap implant placement (1.5 ISQ). The upward trend continued in a 4- week period, and after 3 months the dental implant stability values in the implants placed using flap technique were higher than the primary stability for 7.1 ISQ, and in the implants placed using flapless technique were higher comparing to the primary stability for 10.1 ISQ units. Conclusion. Based on the results of radiographic and resonance frequency analyses it can be concluded that the flapless technique in surgical implants placemat, leads to better results.

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Arthroscopic Anatomic Coracoclavicular Ligament Repair Using a 6-Strand Polyester Suture Tape and Cortical Button Construct

Arthroscopy Techniques ◽

10.1016/j.eats.2015.07.023 ◽

2015 ◽

Vol 4 (6) ◽

pp. e757-e761 ◽

Cited By ~ 7

Author(s):

Todd P. Balog ◽

Kyong S. Min ◽

Jacob C.L. Rumley ◽

David J. Wilson ◽

Edward D. Arrington

Keyword(s):

Coracoclavicular Ligament ◽

Ligament Repair ◽

Polyester Suture ◽

Cortical Button ◽

Suture Tape

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Developing Stability of Posterior Mandibular Implants Placed With Osteotome Expansion Technique Compared With Conventional Drilling Techniques

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-16-00101 ◽

2017 ◽

Vol 43 (2) ◽

pp. 131-138 ◽

Cited By ~ 1

Author(s):

Yen-Ting Lin ◽

Adrienne Hong ◽

Ying-Chin Peng ◽

Hsiang-Hsi Hong

Keyword(s):

Bone Density ◽

Surgical Techniques ◽

Primary Stability ◽

Conventional Technique ◽

Implant Stability ◽

Implant Stability Quotient ◽

Expansion Technique ◽

The Stability ◽

Conventional Drilling ◽

Secondary Stability

Clinical decisions regarding the stability and osseointegration of mandibular implants positioned using the bone expansion techniques are conflicting and limited. The objective was to evaluate the stability of implants placed using 2 surgical techniques, selected according to the initial width of the mandibular posterior edentulous ridge, with D3 bone density, during a 12-week period. Fifty-eight implants in 33 patients were evaluated. Thirty-two implants in 24 patients were positioned using the osteotome expansion technique, and 26 fixtures in 17 patients were installed using the conventional drilling technique. The implant stability quotient values were recorded at weeks 0, 1, 2, 3, 4, 6, 8, 10, and 12 postsurgery and evaluated using analysis of variance, independent, and paired t tests. Calibrated according to the stability reading of a 3.3-mm diameter implant, the osteotome expansion group was associated with a lower bone density than the conventional group (64.96 ± 6.25 vs 68.98 ± 5.06, P = .011). The osteotome expansion group achieved a comparable primary stability (ISQb-0, P = .124) and greater increases in secondary stability (ISQb-12, P = .07) than did the conventional technique. A D3 quality ridge with mild horizontal deficiency is expandable by using the osteotome expansion technique. Although the 2 groups presented similar implant stability quotient readings during the study period, the osteotome expansion technique showed significant improvement in secondary stability. The healing patterns for these techniques are therefore inconsistent.

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Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens

The American Journal of Sports Medicine ◽

10.1177/0363546520939882 ◽

2020 ◽

Vol 48 (10) ◽

pp. 2525-2533

Author(s):

Daichi Morikawa ◽

Joel B. Huleatt ◽

Lukas N. Muench ◽

Cameron Kia ◽

Daniel P. Berthold ◽

...

Keyword(s):

Surgical Techniques ◽

Biomechanical Analysis ◽

Rotational Stability ◽

Posterior Instability ◽

Ligament Repair ◽

Ac Joint ◽

Improved Stability ◽

Horizontal Stability ◽

Posterior Translation ◽

Joint Biomechanics

Background: Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC). Purpose/Hypothesis: The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability. Study Design: Controlled laboratory study. Methods: A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair. Results: For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P < .001, P = .008, P < .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P < .001, P = .003, P < .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs ( P < .001, P = .002, P < .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs ( P = .006, P = .003, P = .002). Conclusion: ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery. Clinical Relevance: Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.

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Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.101b1.bjj-2018-0374.r1 ◽

2019 ◽

Vol 101-B (1_Supple_A) ◽

pp. 19-24 ◽

Cited By ~ 15

Author(s):

R. R. Thakrar ◽

S. Horriat ◽

B. Kayani ◽

F. S. Haddad

Keyword(s):

Soft Tissue ◽

Current Literature ◽

Surgical Techniques ◽

Revision Arthroplasty ◽

Single Stage ◽

Cochrane Library ◽

Exchange Arthroplasty ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Aims Prosthetic joint infections (PJIs) of the hip and knee are associated with significant morbidity and socioeconomic burden. We undertook a systematic review of the current literature with the aim of proposing criteria for the selection of patients for a single-stage exchange arthroplasty in the management of a PJI. Material and Methods A comprehensive review of the current literature was performed using the OVID-MEDLINE, EMBASE, and Cochrane Library databases and the search terms: infection and knee arthroplasty OR knee revision OR hip arthroplasty OR hip revision, and one stage OR single stage OR direct exchange. All studies involving fewer than ten patients and follow-up of less than two years in the study group were excluded as also were systematic reviews, surgical techniques, and expert opinions. Results The initial search revealed 875 potential articles of which 22 fulfilled the inclusion and exclusion criteria. There were 16 case series and six comparative studies; five were prospective and 14 were retrospective. The studies included 962 patients who underwent single stage revision arthroplasty of an infected hip or knee joint. The rate of recurrent infection ranged from 0% to 18%, at a minimum of two years’ follow-up. The rate was lower in patients who were selected on the basis of factors relating to the patient and the local soft-tissue and bony conditions. Conclusion We conclude that single-stage revision is an acceptable form of surgical treatment for the management of a PJI in selected patients. The indications for this approach include the absence of severe immunocompromise and significant soft-tissue or bony compromise and concurrent acute sepsis. We suggest that a two-stage approach should be used in patients with multidrug resistant or atypical organisms such as fungus.

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