Posterior Root Tears of the Lateral Meniscus Only Affect Tibiofemoral Contact Forces when the Meniscofemoral Ligament Is Involved: A Cadaveric Study.

Purpose: The objective of this study was to examine the impact of progressive radial tears in the lateral meniscal root on the lateral compartment contact forces and joint surface area through a range of motion of knee and evaluate the role of the meniscofemoral ligament (MFL) in preventing adverse tibiofemoral joint forces. Methods: Ten fresh frozen cadaveric knees were tested using 6 experimental conditions (0% lateral meniscal posterior root tear, 25% tear, 50% tear, 75% tear, 100% tear, 100% tear and resection of MFL) at five flexion angles (0°, 30°, 45°, 60°, and 90°) under 100-1,000-N axial load. Contact joint pressure and lateral compartment surface area were measured using Tekscan sensors. Statistical analysis, including descriptive, ANOVA, and post hoc Tukey analysis, was performed. Results: Progressive radial tears of the lateral meniscal root were not associated with an increase in tibiofemoral contact pressure or decrease in lateral compartment surface area. Complete lateral root tear and resection of MFL were associated with increased joint contact pressure (P < .001) at knee flexion angles of 30, 45, 60, and 90° and decreased lateral compartment surface (P < .001) at all knee flexion angles area compared to complete lateral meniscectomy alone. Conclusion: Isolated complete tears of lateral meniscus root and progressive radial tears of the lateral meniscus posterior root were not associated with any change to tibiofemoral contact forces. However, additional resection of the MFL increased contact pressure and decreased lateral compartment surface area.

Can Postoperative Radiographs Accurately Identify Screw Misplacements?

STUDY DESIGN: Retrospective case series. OBJECTIVE: The objective of this study was to determine the safety of postoperative radiographs to assess screw placement. SUMMARY OF BACKGROUND DATA: Previously defined criteria are frequently employed to determine pedicle screw placement on intraoperative supine radiographs. Postoperatively, radiographs are typically used as a precursor to identify screws of concern, and a computed tomographic (CT) is typically ordered to confirm screw safety. METHODS: First, available postoperative PA and lateral radiographs were reviewed by 6 independently blinded observers. Screw misplacement was assessed using previously defined criteria. A musculoskeletal radiologist assessed all CT scans for screw placement. Pedicle screw position was classified either as acceptable or misplaced. Misplacements were subclassified as medial, lateral, or anterior. RESULTS: One hundred four patients with scoliosis or kyphosis underwent posterior spinal fusion and had postoperative CT scan available were included. In total, 2,034 thoracic and lumbar screws were evaluated. On CT scan, 1,772 screws were found to be acceptable, 142 were laterally misplaced, 30 medially, and 90 anteriorly. Of the 30 medially placed screws, 80% to 87% screws were believed to be in positions other than medial, with a median of 73% (63% to 92%) of these screws presumed to be in normal position. Similarly, of the 142 screws placed laterally, 49% to 81% screws were identified in positions other than lateral, with a median of 77% (59% to 96%) of these screws felt to be in normal position. Of the 90 anteriorly misplaced screws, 16% to 87% screws were identified in positions other than anterior, with 72% (20% to 98%) identified as normal. The criteria produced a median 52% sensitivity, 70% specificity, and 68% accuracy across the 6 observers. CONCLUSION: Radiograph is a poor diagnostic modality for observing screw position. LEVEL OF EVIDENCE: Level IV.

Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures: A comparative study.

BACKGROUND: With changing trends in treatment of displaced midshaft clavicle fractures (DMCF), plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). However, prospective randomized studies comparing the two methods of fixation are lacking. We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of DMCF. MATERIALS AND METHODS: 80 unilateral displaced midclavicular fractures operated between October 2010 and May 2013 were included in study. This prospective comparative study was approved by the local ethical committee. Followups were at 2(nd) and 6(th) weeks and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Primary outcome was measured by the Constant score, union rate and difference in clavicular length after fracture union. Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications. RESULTS: During analysis, we had 37 patients in the plate group and 34 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union, lesser operative time, lesser blood loss, easier implant removal and fewer complications were noted in the TEN group. CONCLUSION: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder.

BACKGROUND: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature. MATERIALS AND METHODS: Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. RESULTS: All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients. CONCLUSION: Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder.