Ultrasound-guided fasciotomy for chronic exertional forearm compartment syndrome: a cadaveric feasibility study.

OBJECTIVES: Chronic exertional forearm compartment syndrome is observed in patients who engage in physical activity requiring repetitive isometric muscular effort of the wrist during prolonged grasping. Open fasciotomy was considered as the gold-standard treatment, for its ability to release all compartments. However, its invasiveness means that high-level athletes have to abstain from competition for a long period of time. For this reason, minimally invasive techniques have been developed, to allow faster recovery. The objective of this cadaveric study was to evaluate the feasibility and reproducibility of ultrasound-guided palmar fasciotomy in the treatment of chronic exertional forearm compartment syndrome. METHODS: Surgery consisted in ultrasound-guided palmar fasciotomy of the superficial anterior compartment, using a single minimally invasive approach. Twenty forearms were then dissected by an independent operator, (1) to check complete fasciotomy and (2) to screen for iatrogenic lesions on the tendons, veins and superficial sensory branches. RESULTS: Sixteen fasciotomies were total and 4 partial: i.e., a release rate of 80%. The superficial sensory branches were intact, and notably the branches of the medial cutaneous nerve of the forearm. Mean surgery time was 9 min, progressively decreasing with the repetition of the ultrasound-guided procedure. CONCLUSIONS: Ultrasound-guided fasciotomy in the management of chronic exertional forearm compartment syndrome appears to be a simple, effective, safe and reproducible technique.

Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair.

BACKGROUND: Few data are available about the impact of operative time on outcome of rotator cuff repair. AIM: The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. METHODS: Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1 year. The significance threshold was set at p = 0.05. RESULTS: A total of 219 Patients, with a mean age of 54.6 years (range 40-70 years), were included. Mean operative time 44.9 min (range 14-140 min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1 year: increasing operative time by 1 min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1 year (p = 0.2577), tendon healing at 1 year (p = 0.295) or onset of complications during follow-up (p = 0.193). DISCUSSION: The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60 min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. LEVEL OF EVIDENCE: Level III: Retrospective Cohort Design. Therapeutic Study.

History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair.

BACKGROUND: A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. AIM OF STUDY AND HYPOTHESIS: The primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. MATERIALS AND METHODS: The study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). RESULTS: The Constant score was lower preoperatively in patients with history of MAD (-4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). DISCUSSION/CONCLUSION: Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. LEVEL OF EVIDENCE: III; retrospective case-control study.