Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up.

Introduction: Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Methods: Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. Results: 16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Conclusion: Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.

A randomized clinical trial of glenohumeral joint steroid injection versus suprascapular nerve block in patients with frozen shoulder: a protocol for the Therapeutic Injections For Frozen Shoulder (TIFFS) study.

Frozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients' symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB. The Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive physiotherapy as normal for frozen shoulder. The primary analysis will compare the Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include OSS at six and 12 months, range of shoulder movement at three months, and Numeric Pain Rating Scale, abbreviated Disabilities of Arm, Shoulder and Hand score, and EuroQol five-level five-dimension health index at three months, six months, and one year after injection. A minimum of 40 patients will be recruited to obtain 80% power to detect a minimally important difference of ten points on the OSS between the groups at three months after injection. The study is registered under ClinicalTrials.gov with the identifier NCT04965376. The results of this trial will demonstrate if there is a difference in shoulder pain and function after GHJ injection or SSNB in patients with frozen shoulder. This will help provide effective treatment to patients with frozen shoulder.

Rate of Insufficient Ipsilateral Hamstring Graft Harvesting in Primary Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) reconstruction, using an ipsilateral hamstring graft, may necessitate an alternative graft source if the obtained graft is insufficient with regards to length or diameter. The study aims to determine the rate of insufficient ipsilateral hamstring graft harvesting in primary ACL reconstruction. Retrospective review of 50 consecutive primary ACL reconstructions performed by a single surgeon in the United Kingdom. In 3 of 50 cases, there was insufficient ipsilateral hamstring graft harvesting and a contralateral hamstring graft was used. In two cases, this was due to premature division of the ipsilateral hamstring tendons (3/100 harvested tendons). In one case, an adequate length of semitendinosus was obtained, but its central portion was too thin. Retrospective review of preoperative magnetic resonance imaging identified the thin part of the tendon in the latter case. Insufficient ipsilateral hamstring graft harvesting is a recognized, yet unusual intraoperative complication in primary ACL reconstruction. Presurgical planning as to how to manage such complications is essential.

Distal biceps tendon ruptures - the relation of radiological retraction and chronicity to the ability of tendon reattachment and long-term functional outcomes.

AIMS: To assess whether the degree of radiological retraction and chronicity of distal biceps tendon ruptures are related to the ability to reattach the tendon and long-term functional outcomes. METHODS: Analysis of consecutive patients undergoing surgery for distal biceps tendon ruptures by a single surgeon. Measurements regarding the site and degree of tendon retraction in relation to anatomical landmarks following rupture were correlated with intraoperative findings. Postoperative functional outcomes were assessed in cases with >12 months follow-up. RESULTS: 24 cases of distal biceps tendon ruptures treated surgically were identified. Mean tendon retraction was 6.0 cm (range 1.2-9.5) from the radial tuberosity. 22 cases were reattached successfully. 2 required ligament augmentation/bridging using a synthetic ligament. In 2 cases the tendon could not be reattached due to poor quality of the tendon stump. Ability to reattach the tendon was unrelated to degree of radiological retraction or chronicity of rupture. Degree of retraction was not related to rupture chronicity. All reattachments healed with no re-rupture at follow-up with no substantial motion loss. In 17 cases >12months follow-up the DASH and OES were not related to retraction or chronicity of rupture. CONCLUSIONS: Radiological retraction and chronicity are not related to the ability to reattach distal biceps tendon ruptures or their clinical outcomes, hence should not discourage surgical exploration and attempted reattachment. Substantial tendon retractions can occur acutely and reattachment in considerable flexion did not produce any significant motion loss. Some cases will need augmentation or gap bridging and augmentation devices need to be available at surgery. LEVEL OF EVIDENCE: Level IV Retrospective Study Defined.

Same day discharge following inter-scalene block administration for arthroscopic shoulder surgery: implementing a change in practice.

Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.