Transfer of the Coracoid and Conjoined Tendon for Failed, Unstable, Short Clavicle Following Excessive Outer Clavicle Resection

Background: The overall objective of this study was to investigate whether a reverse shoulder arthroplasty could provide adequate stability to a shoulder even with extreme soft tissue loss. The specific objectives of this study were: to determine if just the deltoid, conjoined tendon, and triceps are sufficient soft tissues to allow a Reverse Shoulder Arthroplasty (RSA) to provide shoulder stability and to determine the influence of load direction, rotation, shoulder position, and polyethylene thickness on RSA stability in this soft-tissue deficient model. Methods: This study utilized six cadaveric shoulders that had all soft tissue removed, with the exception of the deltoid, conjoint tendon, and long head of triceps. A reverse shoulder arthroplasty was then performed (Delta III, DePuy Inc., Warsaw, IN) and an increasing dislocation force was applied perpendicular to the humeral socket centerline until dislocation occurred, or a maximum load of 100 N was reached. This was repeated to measure the effect of four factors: load direction, arm position, polyethylene thickness, and arm rotation on force to dislocation. Results: For load direction, there was an increase in force to dislocate an inferior load direction (p=0.01). There was a lower not dislocated percentage and lower survival for a posterior load direction (p=0.02). For arm position, there was a decrease in force for dislocation and lower survival for both abduction and extension arm positions. There was a higher not dislocated percentage for a flexion arm position (p=0.01). For arm rotation, there was a lower not dislocated percentage and lower survival for an external rotation arm position (p=0.03). There was no statistically significant influence of polyethylene thickness (p=0.26). Conclusion: The deltoid, conjoined tendon, and triceps are sufficient to stabilize an RSA. Load direction, arm position, and arm rotation were all shown to significantly affect stability. Finally, polyethylene thickness may not affect overall RSA stability in this soft-tissue deficient model. Level of Evidence: Basic science study, Biomechanical study.

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Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i6.2711 ◽

2021 ◽

Vol 5 (6) ◽

pp. 61-66

Author(s):

Guanbao Li ◽

Pinquan Li ◽

Wei Zhou ◽

Qiuan Chen ◽

Peng Ma ◽

...

Keyword(s):

Tendon Repair ◽

Direct Anterior Approach ◽

Joint Capsule ◽

Musculoskeletal Ultrasound ◽

Significant Difference ◽

Group A ◽

Harris Score ◽

Group B ◽

Conjoined Tendon

Objective: To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty (DAA-THA), and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair. Methods: A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected; the patients were divided into two groups, an observation group, group A (n = 30), and a control group, group B (n = 30), according to different intraoperative methods. There was no significant difference in gender, age, and diagnosis between the two groups. Direct anterior approach was used for both the groups. For group A, the joint capsule and conjoined tendon (superior gemellus, obturator internus, and inferior gemellus) were repaired in situ, whereas for group B, only the joint capsule was repaired in situ, while the conjoined tendon was not repaired. The healing of the tendon was observed. Results: (1) in terms of diagnosis, after conjoined tendon repair, 26 cases in group A showed good tendon continuity, good tension, and a small amount of effusion echo around, three cases showed partial interruption of tendon echo, low echo, or no echo inside with insufficient structural clarity, and a case showed complete interruption; in group B, all 30 cases had continuous interruption, poor tension, tendon retraction, and thickening; the healing rate of group A’s conjoined tendon repair was 96.67%; (2) in terms of prognostic assessment, one month after the surgery, the Harris score of group A was significantly higher than that of group B (P < 0.05); however, there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery (P > 0.05); the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B (P < 0.05). Conclusion: Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA; it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension, enhance its muscle strength, significantly improve early joint stability and joint function, as well as facilitate the rapid recovery of patients.

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