Repair Technique for Displaced Meniscal Flap Tears Indicated by MRI Comma Sign

Background: Reconstruction of the nose can be difficult due to its complex anatomical features. In 1989, Zitelli described a modified version of the bilobed flap design technique using 45° and 90° angles to improve nasal reconstructions. While the bilobed flap is still frequently referenced in scholarly literature, there seems to be inconsistency in preoperative flap design; these deviations can lead to suboptimal outcomes. The authors aim to illustrate the variability in bilobed flap execution and provide guidelines in preoperative design to improve consistency. Methods: A geometrically-based approach was used to characterize the inconsistency of bilobed repair technique. The pre-operative design images from fifteen scholarly articles were analyzed via a series of measurements and computations to quantify the angle of rotation and dimensions for the primary and secondary lobes. The “Error Quotient” was a calculated ratio that objectively measured the extent to which a bilobed design deviated from Zitelli’s specifications. Results: There was a noticeable variability in the design of both the primary and secondary lobes. Bilobed designs with smaller angles of rotation, particularly of the first lobe, were associated with higher Error Quotients and greater amounts of deviation from Zitelli’s design. Designs with the smallest Error Quotients had a primary lobe rotation that approached 45°. Conclusion: Consistency of application of the bilobed flap should be established to allow for optimal results, particularly with emphasis on design of the primary lobe. This can be accomplished by including a disposable protractor and marker in their sterile kit to measure a 45° rotation.

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A technique for repairing rotator cuff transtendinous tears with a remnant attached to the footprint

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02449-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hyung-Suk Choi ◽

Byung-Ill Lee ◽

Jae-Hyung Kim ◽

Hyung-Ki Cho ◽

Gi-Won Seo

Keyword(s):

Rotator Cuff ◽

Surgical Technique ◽

Subchondral Bone ◽

Suture Anchor ◽

Surgical Repair ◽

Tendon Healing ◽

Repair Technique

Abstract Background Some unusual rotator cuff (RC) tears are located in more proximal tendinous portions, with substantial remnant tissue attached to the footprint. The two options for surgical repair are sacrificing or preserving the remnant tissue. We introduce a surgical repair technique that preserves as much of the remnant footprint as possible. Surgical technique A double-loaded suture anchor is inserted into the subchondral bone at the medial portion of the RC footprint; the lateral remnant tissue is preserved. Each strand is shuttled and repassed through the medial portion of the tendon in a mattress fashion using a suture hook device. Then, multiple no. 1 PDS sutures are passed through the medial and lateral stumps and left untied. Strands from the suture anchor are first tied in a double mattress fashion. Then, the repair is completed by tying the remaining no. 1 PDS sutures. Conclusions We propose a remnant-preserving RC repair technique for transtendinous RC tears with sufficient tissue remaining within the RC footprint. This technique appears advantageous in terms of re-establishing an environment that promotes tendon healing after repair.

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The Use of the Comma Sign and Tissue for Recognition, Reduction, and Stability During Arthroscopic Repair of Combined Anterosuperior Cuff Tears

Video Journal of Sports Medicine ◽

10.1177/26350254211011183 ◽

2021 ◽

Vol 1 (4) ◽

pp. 263502542110111

Author(s):

Jocelyn Corbaz ◽

William G. Blakeney ◽

George Athwal ◽

Stefan Bauer

Keyword(s):

Major Complication ◽

Muscle Quality ◽

Rotator Interval ◽

Double Row ◽

Arterial Blood ◽

Goutallier Classification ◽

Ligamentous Structure ◽

Loop Technique ◽

Cerebral Saturation ◽

Comma Sign

Background: The comma sign is a useful marker for combined retracted supraspinatus and subscapularis tears. It was first described by the group of Burkhart as a “composite ligamentous structure” of the rotator interval attached to the retracted subscapularis. However, Neyton and coworkers suggested that the ruptured superior part of subscapularis is pulled upward by supraspinatus retraction. This video illustrates the value of “comma” recognition for reduction and repair stability. We feel that the comma tissue can be a composition of rotator interval ligaments with or without superior subscapularis contribution depending on an associated cleavage tear. Indications: Patients with retracted anterosuperior tears, unless muscle quality is poor (Goutallier classification ≥3). Understanding of the comma tissue is difficult but of crucial importance to assess complex anterosuperior cuff tears for reduction and repair with stability by maintaining and integrating this comma link into the repair construct. Technique Description: Arthroscopic setup includes beach chair position, armholder, cerebral saturation monitoring (target mean arterial blood pressure of about 70 mm Hg). Previously described circumferential portals were used for a repair with a double row construct (4 medial anchors: 2.5 for subscapularis; 1.5 for supraspinatus) and 2 lateral anchors. The superior boarder of subscapularis as well as the retracted capsular layer of supraspinatus was reduced and fixed using a lasso loop technique. Key stages are (1) tendon manipulation with 2 traction sutures; (2) tendon release; (3) comma reduction; (4) footprint preparation (burr, microfracture); (5) retrograde suture passing; (6) knot tying, knotless lateral row; and (7) a close surgeon to physiotherapist rehabilitation link (6 weeks passive to 90°, no resistance training for 3-6 months). Results: Senior author’s (S.B.) series: 32 anterosuperior tears over 4 years (mean age: 62 years, 48-73 years), minimum follow-up 1 year showed good results (mean SSV: 85% [preop. 35%], range: 40%-95%; mean Constant: 82 [preop. 30], range: 40-90). One major complication (cutibacterium infection; brick layer; workers compensation; invalidity demand; Constant/Subjective Shoulder Value both 40) and minor temporary stiffness at 3 months (8 patients; 22%). Conclusion: Adequate reduction and comma integration into a solid repair construct, as well as responsible rehabilitation surveillance, deliver successful results after technically intricate anterosuperior repairs.

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Residual Stresses in Overlapping Friction Taper Stud Welds

Materials Science Forum ◽

10.4028/www.scientific.net/msf.652.111 ◽

2010 ◽

Vol 652 ◽

pp. 111-115 ◽

Cited By ~ 3

Author(s):

D.G. Hattingh ◽

Axel Steuwer ◽

M. Neil James ◽

I.N. Wedderburn

Keyword(s):

Solid State ◽

Neutron Diffraction ◽

Residual Stresses ◽

Creep Damage ◽

Local Damage ◽

Planar Defects ◽

Repair Technique ◽

Damage Repair ◽

Stud Welding ◽

Residual Strains

This paper presents microstructural, hardness and residual strain information for solid-state welds in creep-resistant Cr-Mo steel, made using the new local damage repair technique offered by friction taper stud welding (FTSW). The technique is suitable for making single welds to repair, for example, localised creep damage but can also be extended to deal with planar defects through the use of overlapping welds. Neutron diffraction was used to measure residual strains at a number of positions along a series of 5 overlapping FTS welds.

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