Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes.

PURPOSE: To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR. METHODS: Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed. RESULTS: There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years' postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group. CONCLUSIONS: This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears. LEVEL OF EVIDENCE: Level III, retrospective case study.

Extensile Exposures in Revision and Complex Primary Total Knee Arthroplasty: A Review of Anatomy, Biomechanics, and Techniques.

Developing adequate exposure when performing a revision total knee arthroplasty is critical to an efficient and safe intraoperative course. Proper planning and knowledge of the relevant anatomy are important when dissecting scar tissue associated with previous trauma or surgery and navigating bone loss. We present a review of the different total knee arthroplasty extensile exposure techniques that have been described in the literature. Specific exposures discussed include the femoral peel, banana peel, medial epicondylar osteotomy, quadriceps snip, tibial tubercle osteotomy, wandering resident, and the V-Y quadricepsplasty with patella turndown. Furthermore, we review the histological healing potential, biomechanical principles that drive post-operative expectations, post-operative rehabilitation protocols, and reported functional outcomes of each technique.

Effects of Hypercarbia on Lower Extremity Primary Total Joint Replacement Infections.

INTRODUCTION: Prosthetic joint infection (PJI) is a serious complication after total joint replacement (TJR). Adequate wound oxygenation is critical for wound healing and infection prevention. As carbon dioxide (CO2) is exchanged for oxygen (O2) in the lungs, serum bicarbonate (HCO3 -) may be used as a marker for predicting relative serum O2 levels, and therefore, healing potential. No currently published literature explores the relationship between serum bicarbonate levels and PJI in TJR patients. METHODS: We performed this retrospective review of lower extremity TJR patients to determine whether the risk of PJI and wound complications within one year was correlated with hypercarbia, which was defined as a preoperative serum bicarbonate level >30 mEq/L. RESULTS: Out of 1,690 TJR procedures, 1.6% (N=27) had a PJI or superficial wound infection within one year postoperatively. The average preoperative serum bicarbonate was 26.9 (SD 2.6) among patients without PJI and 27.2 (SD 2.1) among patients with PJI (p=0.46). Hypercarbia was present in 9.2% of non-PJI patients and in 7.4% of PJI patients. The relative risk of PJI and wound complications did not differ for patients with vs without hypercarbia (RR = 0.79, 95% CI = 0.19-3.31, p=0.75). CONCLUSION: The results of this study provide preliminary evidence that preoperative hypercarbia may not be correlated with an increase in the risk of PJI or wound complications. However, due to the rarity of both PJI and hypercarbia, a larger patient population is needed to ensure adequate power to detect clinically meaningful effect sizes.

Overuse Injury to Proximal Phalanx in Throwing Athlete (Little Leaguer's Finger): A Case Report.

ABSTRACT: The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.

Rotational Ankle Fracture Dislocation With Associated Lisfranc Fracture.

While ankle fractures most often result from a rotational injury, Lisfranc injuries are more commonly associated with an axial load on a plantarflexed foot. Due to differing mechanisms of injury, rotational ankle fractures with Lisfranc injuries are uncommon and rarely discussed in the literature. Here we present a case of a rotational ankle fracture-dislocation with a concomitant Lisfranc injury. The Lisfranc injury, which was ultimately treated nonoperatively, was discovered seven weeks after operative fixation of the ankle fracture. At the last follow-up nine months after the initial injury, the patient had mild midfoot soreness with activity but no evidence of deformity or arch collapse. Although no deformity was observed in our patient, missed Lisfranc injuries may result in significant functional deficits indicating the importance of recognizing the possibility of a dual injury.