Technique for All-Inside Repair of Bucket-Handle Meniscus Tears.

Bucket-handle meniscal tears (BHMT) remain a challenge to treat due to their complex pathology and technical difficulty. Subtotal meniscectomy has shown to improve symptoms early but leads to accelerated osteoarthritis in the affected compartment and poor long-term outcomes. BHMT repair and meniscal preservation is the preferred option. This can be performed with inside-out, all-inside, or hybrid meniscus repair techniques. All-inside meniscus repair avoids the need for additional safety incisions, trained assistants for suture passing, and reduce concerns of soft-tissue and neurovascular complications. In this Technical Note, we detail our all-inside technique for BHMT technique and share tips for a successful repair.

Perioperative Factors Influencing Postoperative Satisfaction After Lateral Access Surgery for Degenerative Lumbar Spondylolisthesis.

BACKGROUND: Lateral access surgery (LAS) for lumbar degenerative spondylolisthesis is a minimally invasive lumbar fusion technique which has been gaining increasing popularity in the recent years. This study aims to identify perioperative factors that influence postoperative satisfaction after LAS for lumbar degenerative spondylolisthesis. METHODS: From August 2010 to November 2014, 52 patients with lumbar degenerative conditions (16 male: 36 female, mean age 64.0 ± 8.7 years) were prospectively recruited and underwent LAS by a single surgeon. All patients were assessed preoperatively and 2 years postoperatively with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, Short-Form 36 (SF-36) scores, North American Spine Society score for neurogenic symptoms, patient satisfaction, and expectation fulfillment. Cobb angles, global lumbar lordosis, disc heights, adjacent disc heights, fusion, and subsidence were rates assessed. Multiple linear regression performed with satisfaction as dependent variable to identify predictive independent variables. RESULTS: Lower preoperative SF-36 general health scores (P = .03), higher NPRS leg pain scores (P = .04), and longer surgical duration (P = .02) were significant predictors of lower satisfaction (P < .05). NPRS back and leg pain decreased by 80.3 and 83.0%, respectively. Oswestry Disability Index and North American Spine Society score for neurogenic symptoms improved by 76.2 and 75.9%, respectively. Ninety percent of patients reported excellent/good satisfaction. Significant correction and maintenance of Cobb and global lumbar lordosis angles were achieved. There was significant increase in disc heights postoperatively (P = .05) and no significant difference in adjacent disc heights at 2 years (P > .05). Ninety-eight percent of patients achieved Bridwell Fusion Grade 1, and 5.8% had Marchi Grade 3 subsidence. CONCLUSIONS: Lower preoperative SF-36 general health, higher NPRS leg pain, and longer surgical duration are predictors of lower satisfaction in patients undergoing LAS for lumbar degenerative spondylolisthesis. LEVEL OF EVIDENCE: III. CLINICAL RELEVANCE: Identifying preoperative predictors for postoperative clinical outcome can assist clinicians in patient education prior to operation.

A new technique of arthroscopic subscapularis repair with 2-year clinical outcomes in an Asian population.

BACKGROUND: Tears of the subscapularis are not as common as the other rotator cuff muscles and hence not as many arthroscopic repair techniques have been previously described in the literature. The purpose of this study is to evaluate the clinical outcomes in patients undergoing arthroscopic subscapularis repairs (with and without repairs of the other cuff muscles) using a technique devised by the senior author of this study. METHODS: A retrospective study of 40 consecutive patients who underwent arthroscopic subscapularis repair at a single centre, by a single surgeon from 2009 to 2014. All patients were assessed preoperatively and post-operatively at 3, 6, 12 and 24 months. The Visual Analogue Scale (VAS), Constant-Murley Shoulder Score (CMSS), University of California at Los Angeles (UCLA) Shoulder Score and Oxford Shoulder Score (OSS) were recorded and used. RESULTS: At 24 months follow-up, the VAS for pain improved from 6 (±2) points preoperation to 0 (±1) points. The CMSS improved from 41 (±18) points preoperation to 71 (±15). The relative CMSS improved from 55 (±24%) preoperation to 96 (±22%; % of the uninjured side). The ULCA Shoulder Score improved from 15 (±5) points preoperation to 30 (±4). The OSS improved from 28 (±12) points preoperation to 45 (±5). p < 0.001 for all outcomes measured. CONCLUSION: Overall clinical outcomes are favourable at 2 years post-operatively. The described technique is an effective method for arthroscopic subscapularis repair in the Asian population.