6 Plantar plate repair – a single centre, single procedure case series

2021 ◽  
Vol 55 (16) ◽  
pp. 942-942
Author(s):  
M Bernardotto ◽  
S Hodder ◽  
R Thomas ◽  
E Barlow-Kearsley
Keyword(s):  
Functional Outcome ◽  
Clinical Outcomes ◽  
Case Series ◽  
Joint Stability ◽  
Single Centre ◽  
Single Procedure ◽  
Plantar Plate ◽  
Operative Outcomes ◽  
Outcome Scores ◽  
Score Range

AimThe plantar plate (PP) is an important structure that maintains stability of the metatarsophalangeal joints1 and is commonly injured in athletes such as sprinters and ballet dancers. However, clinical outcomes following plantar plate repair are limited due to the lack of studies and the heterogeneity of surgical procedures.2 This retrospective case series reviews the pre- and post-operative outcomes of a single-procedure PP repair series.MethodsPatients who underwent PP repair using the Arthrex Complete Plantar Plate Repair System (CPR™) were identified in a single academic hospital centre. Pre- and post-operative outcomes were compared using clinical notes, radiological evaluation and the national podiatry surgery clinical outcomes database (PASCOM-10). Parameters measured included PP rupture grading, congruence, alignment, joint stability and Manchester-Oxford Foot Questionnaire (MOXFQ) scores.ResultsA total of 20 patients with confirmed PP rupture underwent CPR™ procedure with a team comprising 4 surgeons. Post-operative congruence correction was achieved in 95% of patients, whereas average alignment score (range 0–4) improved from 2.7 to 0.5 and joint stability score (range 0–4) from 2.6 to 0.25. MOXFQ functional outcome scores were available for 65% of patients, showing a 42%, 53% and 42% improvement for weightbearing (W/S), pain and social interaction (SI) domains respectively.ConclusionsThis is the first single-centre, single procedure PP repair case series. Objective radiological and clinical measures showed good improvement in the majority of patients. Functional outcome scores were more heterogeneous and limited by incomplete data collection. Our results appear replicable with no difference between surgeons performing the same procedure.ReferencesNery C, Coughlin M, Baumfeld D, Raduan F, Mann TS, Catena F. How to classify plantar plate injuries: parameters from history and physical examination. Rev Bras Ortop 2015; 50(6):720–728.Elmajee M, Shen Z, A’Court J, Pillai A. A Systematic Review of Plantar Plate Repair in the Management of Lesser Metatarsophalangeal Joint Instability. The Journal of Foot & Ankle Surgery 2017; 56(6):1244–1248.

Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

2018 ◽  
Vol 46 (11) ◽  
pp. 2700-2706 ◽  
Author(s):  
Lukas Willinger ◽  
Lucca Lacheta ◽  
Knut Beitzel ◽  
Stefan Buchmann ◽  
Klaus Woertler ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Shoulder Function ◽  
Dash Score ◽  
Outcome Scores ◽  
Retear Rate

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

2020 ◽  
pp. 107110072096249
Author(s):  
Craig C. Akoh ◽  
Amanda Fletcher ◽  
Akhil Sharma ◽  
Selene G. Parekh
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Case Series ◽  
Postoperative Outcome ◽  
Foot And Ankle ◽  
Achilles Tendon Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

scholarly journals Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090372 ◽  
Author(s):  
Travis J. Dekker ◽  
Matthew D. Crawford ◽  
Nicholas N. DePhillipo ◽  
Mitchell I. Kennedy ◽  
W. Jeffrey Grantham ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Case Reports ◽  
Case Series ◽  
High Rate ◽  
Patient Satisfaction Score ◽  
Presenting Symptoms ◽  
Patient Reported ◽  
Outcome Scores

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time. Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with a minimum of 21-month follow-up after isolated fabellectomy for fabella syndrome were reviewed retrospectively. Clinical outcome scores of the following domains were collected: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm knee survey, along with a simple numeric patient satisfaction score (range, 1-10; 10 = “very satisfied”). Statistical analysis was performed using paired t tests for all clinical outcome data. Results: A total of 11 isolated fabella excisions were included in 10 patients with isolated lateral-sided knee pain in the setting of fabella syndrome (8 males, 2 females), with a mean age of 36.9 years (range, 23-58 years) and a mean follow-up of 2.4 years (range, 21-47 months). A total of 8 patients (80%) were able to return to full desired activities, including sports. Only 5 of 11 (45%) excisions had concomitant lateral femoral condyle cartilage pathology. There were significant improvements across multiple WOMAC domains, and the WOMAC total score improved from 28.5 ± 17.6 preoperatively to 11.6 ± 10.2 postoperatively ( P < .05). Lysholm scores significantly improved from 66.6 ± 23.1 preoperatively to 80.2 ± 13.9 postoperatively ( P = .044). Overall patient-reported satisfaction was 8.8 ± 1.6. Conclusion: Fabella excision in the setting of fabella syndrome demonstrated improvements in clinical outcome scores, high rate of returning to preinjury level of activities, and low risk of complications or need for additional surgical procedures.

scholarly journals Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series

2020 ◽  
Vol 52 (5) ◽  
pp. 373-376
Author(s):  
Francesca Simioli ◽  
Anna Annunziata ◽  
Gerardo Langella ◽  
Giorgio E. Polistina ◽  
Maria Martino ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Clinical Outcomes ◽  
Case Series ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Single Centre

Comparison of Clinical and Radiographic Outcomes of Vertical Simple Stitch Versus Modified Mason-Allen Stitch in Arthroscopic Bankart Repairs: A Prospective Randomized Controlled Study

2018 ◽  
Vol 47 (2) ◽  
pp. 398-407 ◽  
Author(s):  
Jin-Young Park ◽  
Seok Won Chung ◽  
Jong Soo Lee ◽  
Kyung-Soo Oh ◽  
Jae-Hyung Lee
Keyword(s):  
Computed Tomography ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Bankart Repair ◽  
Controlled Study ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Outcome Scores ◽  
Retear Rate

Background: In spite of the probable advantages of Bankart repair with modified Mason-Allen technique, there has been no study to evaluate the clinical outcomes of the modified Mason-Allen technique for Bankart repair. Purpose: To prospectively compare the anatomic and clinical outcomes between the vertical simple stitch and the modified Mason-Allen stitch with respect to the labral height, retear rate, redislocation/apprehension, and various functional outcome scores. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients who underwent arthroscopic Bankart repair with double-loaded suture anchors were randomly allocated to 1 of 2 groups: the vertical simple stitch method (SS; n = 45) or the Bankart repair using modified Mason-Allen technique (BRUMA; n = 41). All patients underwent computed tomography arthrography at 6 months postoperatively and various functional outcome measurements at least 2 years postoperatively. The labral height and width at the 3-, 4-, and 5-o’clock positions were measured preoperatively and at 6 months after surgery on axial computed tomography arthrography; the redislocation/apprehension rate, the retear rate, and various functional outcome scores were evaluated at each follow-up visit. Results: Postoperative labral height and width were significantly increased at all locations (all P < .001) in both groups, but they were not statistically different between groups (all P > .05). Two patients in the SS group (4.4%) and 2 in the BRUMA group (4.9%) experienced redislocation after surgery, and 4 patients in the SS group (8.9%) and 2 in the BRUMA group (4.9%) group showed apprehension after surgery. Additionally, 5 patients in the SS group (11.1%) and 2 in the BRUMA group (4.9%) showed retear at 6 months ( P = .239). There were no differences in any functional outcome scores (all P > .05). Conclusion: There was no difference in the radiologic outcomes at 6 months and the clinical outcomes assessed at least 2 years after surgery between the groups.

scholarly journals Excisional Debridement for Chronic Achilles Insertional Tendinosis: Technique and Case Series

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Tara E. Gaston ◽  
Hope Skibicki ◽  
Megan C. Chapter ◽  
Quincy Cheesman ◽  
Joseph N. Daniel
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Case Series ◽  
Standard Of Care ◽  
Pain Scores ◽  
Wound Breakdown ◽  
Novel Approach ◽  
Superficial Skin ◽  
Outcome Scores

Category: Sports; Ankle Introduction/Purpose: Operative treatment of chronic Achilles insertional tendinosis (AIT) involves tendon debridement, removal of the retrocalcaneal bursitis, and excision of the calcaneal exostosis, often followed by repair of the Achilles tendon and deep tendon transfer. The literature describes a variety of techniques without a single standard of care. The purpose of this study is to describe a novel approach for the treatment of chronic AIT and report clinical outcomes and complications of this technique. Methods: A retrospective review was performed of 57 patients with chronic AIT who were treated with the proposed surgical technique by a single surgeon from January 2015 through January 2019. Patient demographics, pain scores, functional outcome scores, and complications were reviewed. A telephone survey was also utilized to assess patient satisfaction. Following the breakdown of the data, comparisons of the preoperative scores were compared to the postoperative outcomes using Mann- Whitney U testing. Results: Preoperative VAS pain scores and VR-12 Physical scores were significantly improved at two year follow up. Additionally, patients described the outcome of their surgery as, ‘very good.’ Complications were also few and minimal. Three (5.3%) patients experienced superficial skin breakdown requiring return to the operating room and three (5.3%) developed postoperative cellulitis which responded to local care and oral antibiotics. There were no ruptures or record of recurrence of disease or pain. Conclusion: The technique described in this paper utilizes an excisional debridement of the central portion of the Achilles tendon in the shape of an apex superior triangle and therefore, does not require detachment of the tendon from its insertion on the calcaneus (Image 1). Functional outcome scores and pain significantly improved at two years follow up. Postoperative complications were similar to those previously reported with superficial wound breakdown being the most common. In conclusion, the authors encourage the use of this reliable, reproducible, and effective technique for the treatment of patients with chronic AIT.

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