scholarly journals Histological and radiographic evaluation of three common tendon transfer techniques in an un-ossified bone porcine model: implications for early anterior tibialis tendon transfers in children with clubfeet

2021 ◽  
pp. 1-7
Author(s):  
Kyle Korth ◽  
Scott Bolam ◽  
Ellen Leiferman ◽  
Thomas Crenshaw ◽  
Michael Dray ◽  
...  
Keyword(s):  
Scoring System ◽  
Porcine Model ◽  
Suture Anchor ◽  
Bone Tunnel ◽  
Suture Techniques ◽  
Radiographic Evaluation ◽  
Suture Anchors ◽  
Level Of Evidence ◽  
Tendon Transfers ◽  
Fixation Techniques

Purpose To compare the histological healing and radiographic effects of tendons transferred to ossified or unossified bone using different tendon fixation techniques Methods Nine new-born piglets underwent bilateral tendon transfers to either the ossified boney calcaneal body or unossified apophysis. The tendons were fixed using metallic suture anchors, sutures alone or a bone tunnel. At six weeks of age, calcanei were harvested, radiologically imaged and then prepared for histology. A semi-quantitative aggregated scoring system with values ranging from 0 (poor) to 15 (excellent), was used to grade healing at the surgical enthesis and the apophyseal ossification was graded by five independent reviewers in triplicate using a modified (1 to 4) validated scoring system. Results Histologically, the cartilaginous transfers utilizing the tunnel and suture techniques also demonstrated the best average aggregated scores of entheses healing rivalling that measured in transfers using the classic bone tunnel technique (clinical benchmark), whereas suture anchor fixation demonstrated the worst healing in both the ossified and unossified samples. All three transfer techniques caused at least minor alterations in apophyseal ossification, with the most significant changes observed in the metallic suture anchor cohort. The tunnel and suture techniques demonstrated similar and more mild abnormalities in ossification. Conclusion Tendon transfers to unossified bone heal histologically as well as transfers classically performed through tunnels in bone. Suture fixation or tunnel techniques appear radiographically and histologically superior to suture anchors in our newborn porcine model. Level of evidence  

scholarly journals A retrospective comparative study on arthroscopic suture anchors repair and tendon debridement versus arthroscopic tendon debridement for treatment of recalcitrant lateral epicondylitis

2021 ◽  
Vol 12 ◽  
pp. 204062232110055
Author(s):  
Xu Li ◽  
Tong Zheng ◽  
Yue Li ◽  
Hailong Zhang ◽  
Yi Lu
Keyword(s):  
Scoring System ◽  
Suture Anchor ◽  
Tennis Elbow ◽  
Case Series ◽  
Lateral Epicondylitis ◽  
Level Of Evidence ◽  
System P ◽  
Retrospective Comparative Study ◽  
Repair Group

Aim: To compare the outcomes between the arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon alone and repairs to the ECRB tendon with suture anchor for the treatment of refractory lateral epicondylitis (LE). Methods: We retrospectively reviewed our patients who underwent arthroscopic surgical treatment for refractory LE by a single surgeon from January 2008 to June 2018 with a minimum follow-up of 12 months. The visual analog scale (VAS), the Mayo Elbow Performance Score (MEPS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, the Verhaar scoring system and the time of back to work were compared between two groups. Results: Both groups showed a significant postoperative improvement regarding the VAS, MEPS, DASH, PRTEE and the Verhaar scoring system ( p < 0.05). The repair group showed better results regarding the MEPS, DASH, PRTEE and Verhaar scoring system comparing with the debridement group, which were statically significant ( p < 0.05). There were no significant differences between the two groups regarding the VAS both at rest and activity at the final follow-up. There were no significant differences for the average time for return to work ( p = 0.229). There were 11 patients in the debridement group and six patients in the repair group, who completed the MRI evaluation at 6 months postoperatively. Conclusion: Compared with arthroscopic release and debridement of the ECRB tendon, arthroscopic suture anchor repairing of the origin of the ECRB tendon provides better outcomes when addressing the refractory LE. Level of Evidence: Case Series: Level IV

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

scholarly journals Survey to describe variability in early onset scoliosis cast practices

2018 ◽  
Vol 12 (4) ◽  
pp. 406-412 ◽  
Author(s):  
A. Grzywna ◽  
A. McClung ◽  
J. Sanders ◽  
P. Sturm ◽  
L. Karlin ◽  
...  
Keyword(s):  
Early Onset ◽  
Congenital Scoliosis ◽  
Patient Characteristics ◽  
Study Groups ◽  
Early Onset Scoliosis ◽  
Radiographic Evaluation ◽  
Level Of Evidence ◽  
Major Curve ◽  
Radiographic Measurements ◽  
Multicentre Research

Purpose To investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods A casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). Results A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. Conclusions Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible. Level of Evidence V, Expert opinion

The Influence of Trabecular Microstructure on Mechanical Properties and the Pullout Strength of Suture Anchors

2010 ◽  
Author(s):  
Mariya Poukalova ◽  
Christopher M. Yakacki ◽  
Robert E. Guldberg ◽  
Angela Lin ◽  
Ken Gall
Keyword(s):  
Mechanical Properties ◽  
Bone Mineral Density ◽  
Suture Anchor ◽  
Common Type ◽  
Tissue Fixation ◽  
Suture Anchors ◽  
Pullout Strength ◽  
Mineral Density ◽  
Trabecular Microstructure ◽  
Type Of Surgery

Suture anchors provide soft-tissue fixation, often tendons and ligaments, to bone. The most common type of surgery in which suture anchors are used is in rotator cuff repairs, where the anchor is implanted into the humerus to create a point of fixation for the supraspinatus.[1–2] Pullout strength, or the force necessary to pull the anchor from the bone, has been previously used as a metric to compare suture anchor performance. In investigating suture anchor performance, it has been suggested that pullout strength is positively correlated to bone mineral density (BMD).[2]

scholarly journals Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096631
Author(s):  
Luke D. Cicchinelli ◽  
Jurij Štalc ◽  
Martinus Richter ◽  
Stuart Miller
Keyword(s):  
Adverse Events ◽  
Prospective Trial ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Radiographic Evaluation ◽  
Fiber Reinforced ◽  
Level Of Evidence ◽  
Surgery Patient ◽  
Patient Reported

Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.

scholarly journals Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review

2018 ◽  
Vol 40 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Troy S. Watson ◽  
Jordan Panicco ◽  
Amit Parekh
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Senior Author ◽  
Bone Tunnel ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Tissue Handling ◽  
Tendon Interposition

The “anchovy” interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors’ experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

scholarly journals RADIOGRAPHIC EVALUATION OF THORACOLUMBAR STABILIZATION USING TWO DIFFERENT ORTHOSIS SYSTEMS

2018 ◽  
Vol 17 (4) ◽  
pp. 300-302
Author(s):  
Murilo Tavares Daher ◽  
Vinício Nunes Nascimento ◽  
Pedro Felisbino Jr ◽  
Nilo Carrijo Melo ◽  
Brenda Cristina Ribeiro Araújo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Thoracolumbar Junction ◽  
Radiographic Evaluation ◽  
Neutral Position ◽  
X Rays ◽  
Level Of Evidence ◽  
Institutional Review ◽  
Thoracolumbar Region ◽  
Boston Brace ◽  
Orthostatic Position

ABSTRACT Objective: To evaluate radiographically the stability of the thoracolumbar junction comparing the two types of thoracolumbosacral orthosis (TLSO) most used in our environment, the Jewett and the Boston braces. Methods: After approval by the institutional review board, nine participants were submitted to X-rays in the profile view, with the beam focused on T12, in the orthostatic position, maximal flexion without brace and maximal flexion with the Jewett and the Boston braces. The Cobb angle of the thoracolumbar junction (T10-L2) was measured and the values compared using the student T test (p <0.05). Results: The Boston brace promoted greater stabilization of the thoracolumbar junction during flexion of the trunk compared to the Jewett brace (p <0.05). In addition, there was no statistical difference in the Cobb angle of the thoracolumbar junction in the orthostatic (neutral) position and in flexion using the Boston brace. Conclusion: The Boston brace presented greater stabilization of the thoracolumbar region during flexion of the trunk compared to the Jewett brace. Level of Evidence II; Prospective comparative study.

scholarly journals Sublaminar polyester band fixation construct in the treatment of neuromuscular scoliosis

2019 ◽  
Vol 13 (4) ◽  
pp. 393-398
Author(s):  
S. Rosenfeld ◽  
S. Kenney ◽  
E. Rebich
Keyword(s):  
Blood Loss ◽  
Pedicle Screws ◽  
Posterior Spinal Fusion ◽  
Pelvic Obliquity ◽  
Neuromuscular Scoliosis ◽  
Level Of Evidence ◽  
Fixation Techniques ◽  
Clinical Records ◽  
Sublaminar Bands

Purpose Multiple fixation techniques exist for treating progressive neuromuscular scoliosis including pedicle screws, sublaminar bands/wires, hooks or a combination of instruments. Most sublaminar band constructs are supplemented with pedicle screws, hooks and/or sublaminar wires particularly at the top of the construct. There are no studies to date that describe an all/predominant sublaminar band construct. The purpose of this study was to investigate the outcomes of a sublaminar polyester band construct to treat neuromuscular scoliosis. Methods A retrospective review was conducted of 32 cases of neuromuscular scoliosis treated with posterior spinal fusion using a sublaminar band construct between 2013 and 2016 by a single surgeon at a single centre. Preoperative, immediate postoperative and two-year follow-up radiographs and clinical records were reviewed. Sagittal, coronal and pelvic obliquity correction was measured. Blood loss, length of surgery and complications were recorded. Results In all, 29 patients were included. Mean postoperative coronal plane correction was 57% (0% to 92%) and maintained at two-year follow-up. Mean sagittal balance was 2.3 cm (-2.5 to 6.4). Mean lumbar lordosis angle decreased by 7° (44° to 37°). Mean thoracic kyphosis angle increased by 9° (23° to 32°). Mean pelvic obliquity decreased by 50% (from 15° to 7°). There were four major complications (14%) and eight minor complications (21%). Mean blood loss was 1304 cc (250 cc to 2450 cc). Conclusion Sublaminar polyester band fixation constructs provide a viable option in correction of deformity in patients with neuromuscular scoliosis with comparable outcomes with what is reported with other constructs. Level of Evidence: V

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