A cyclic testing comparison of FasT-Fix and RapidLoc devices in human cadaveric meniscus.

INTRODUCTION: Cyclic testing may provide a more valid depiction of how arthroscopic meniscal repairs will withstand the forces of activities of daily living (ADLs) and therapeutic exercises early post-surgery than single cycle load to failure testing. This study compared the meniscal fixation provided by vertically or horizontally placed FasT-Fix devices to horizontally placed RapidLoc devices under submaximal cyclic test conditions. MATERIALS AND METHODS: Eighteen human cadaveric menisci were divided into three groups of six specimens. A scalpel was used to create a 2 cm lesion at 3 mm from the outer edge of the posterior third of each specimen. Merselene tape loops were placed around each side of the lesion and the tears were repaired using two vertical FasT-Fix, two horizontal FasT-Fix, or two RapidLoc devices. Cyclic testing (5-50 N at 1 Hz for 500 cycles) was performed on a servo hydraulic device. One-way ANOVA and Scheffe post-hoc tests were used to evaluate group differences (P < 0.05). RESULTS: The vertical FasT-Fix group had less displacement over the initial ten loading cycles compared to the RapidLoc group (P = 0.004), but did not differ from the horizontal FasT-Fix group (P = 0.07). At 50, 100, 200, 300, 400, and 500 cycles, the vertical FasT-Fix group had less displacement than the horizontal FasT-Fix or RapidLoc groups (P < or = 0.004). At each interval the vertical FasT-Fix group had greater relative stiffness than the other groups (P < or = 0.009). CONCLUSIONS: The vertical FasT-Fix group had comparatively less displacement (primarily repair site gapping) and greater relative stiffness.

Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction.

INTRODUCTION: Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( > or = 5 cm(2)) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements. PATIENTS AND METHODS: Of 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have co-morbidities that negatively impacted their ability to perform intense exercise underwent a comprehensive clinical examination of involved and uninvolved side shoulder and elbow active range of motion and strength (both isometric instrumented manual muscle testing and concentric isokinetic measurements). RESULTS: At 2 years following surgery, pre-operative UCLA Shoulder Scores improved from 10.6 +/- 3 to 27.4 +/- 5 and pre-operative ASES Function Scores improved from 20.1 +/- 10 to 43.2 +/- 5. However, isometric involved side shoulder abductor torque was decreased by 28.2% with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6% at 60 degrees/s and by 53.8% at 120 degrees/s with isokinetic testing. Isometric involved side elbow extensor torque was decreased by 39% with instrumented manual muscle testing, and concentric elbow extensor torque was decreased by 17.7% and 19.2% at 60 and 120 degrees/s, respectively, with isokinetic testing. Including three additional patients who were contacted via telephone, the majority of patients (21 of 22, 95.4%) were satisfied with their improved shoulder function and reduced pain. CONCLUSIONS: Despite reduced pain and improved shoulder function, residual involved side shoulder abductor; shoulder external rotator and elbow extensor strength deficits were evident at 2 years following surgery. This suggests the need for more focused rehabilitation, particularly for involved side elbow extensor strengthening to further improve patient function and minimize disability.

Tibial fixation comparison of semitendinosus-bone composite allografts fixed with bioabsorbable screws and bone-patella tendon-bone grafts fixed with titanium screws.

Tibial fixation remains the weak link of ACL reconstruction over the first 8-12 weeks postoperatively. This study compared the biomechanical properties of tibial fixation for a bone-patellar tendon-bone (BPTB) graft and a novel semitendinosus-bone composite (SBC) allograft with mixed cortical-cancellous bone dowels at each end. Seven paired, fresh frozen cadaveric knees (20-45 years) were stripped of all soft tissue attachments and randomly assigned to receive either the BPTB graft or SBC allograft. Grafts were placed into tibial tunnels via a standard protocol and secured with either a 10 mmx28 mm bioabsorbable (SBC) or titanium (BPTB) screw. Grafts were cycled ten times in a servo hydraulic device from 10-50 N prior to pull to failure testing at a rate of 20 mm/min with the force vector aligned with the tibial tunnel ("worst case scenario"). Wilcoxon Signed Rank Tests were used to evaluate biomechanical differences between graft types ( p<0.05). Tibial bone mineral density and interference screw insertion torque were statistically equivalent between graft types. The mode of failure for all constructs was direct screw and graft construct pullout from the tibial tunnel. Significant differences were not observed between graft types for maximum load at failure strength (BPTB=620.8+/-209 N vs. SBC=601.2+/-140 N, p=0.74) or stiffness (BPTB=69.8 N/mm+/-29 N/mm vs SBC=47.1+/-31.6 N/mm, p=0.24). The SBC allograft yielded significantly more displacement prior to failure than the BPTB graft (15.1+/-4.9 mm vs 9.2+/-1.3 mm, p=0.04). Increased construct displacement appeared to be due to fixation failure, with some evidence of graft tissue tearing around the sutures: Bioabsorbable screw (10 x 28 mm) fixation of the SBC allograft produced unacceptable displacement levels during testing. Further study is recommended using a titanium interference screw or a longer bioabsorbable screw for SBC graft fixation under cyclic loading conditions.

Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study.

The outcomes of 18 patients (11 females, 7 males; age, 40.4+/-11 years) at 2 years after ACL reconstruction with cryopreserved tibialis anterior allografts using a double bundle technique are presented. Most subjects (72%) described themselves as being moderately active before surgery. After providing written informed consent, subjects completed the 2000 IKDC Knee Form, underwent arthrometric knee measurements, and performed one-leg hop and isokinetic quadriceps and hamstring torque tests (60 degrees /s). Ninety-four percent (17/18) of the subjects had normal or near-normal grades for manual knee ligament tests. Knee arthrometry measurements revealed a mean 1.1-mm involved side increase at 134 N (8.9+/-2 mm vs 7.8+/-3 mm) and a 2-mm involved side increase during manual maximum testing (11.3+/-2 mm vs 9.3+/-3 mm). Group means revealed active knee flexion (136+/-8 degrees vs 139+/-6 degrees ) and knee hyper-extension (3+/-2 degrees vs 5+/-2 degrees ), which were slightly reduced at the involved knee. One-leg hop testing revealed a 15% mean deficit at the involved side (0.81+/-0.3 m vs 0.95+/-0.3 m). Isokinetic testing revealed an 11% mean deficit at the involved side (143.4+/-60 Nm vs 161.8+/-54 Nm) for the quadriceps and 7% greater strength at the involved side (105.9+/-35 Nm vs 98.8+/-35 Nm) for the hamstrings. Side-to-side comparisons revealed that many patients displayed less than normal quadriceps femoris torque (72%, 13/18), hamstring torque (28%, 5/18) and hop test (28%, 5/18) performance. Moderate positive correlations existed between involved side quadriceps ( r=0.80) and hamstring ( r=0.83) torque/bodyweight and hop test performance. Scores were 77.6+/-21 (range 28.7-100) and 78.1+/-16 (range 41.7-100) for the 2000 IKDC Subjective Knee Evaluation and Health Assessment forms. Most subjects (83%, 15/18) rated their current function at >or=91% of pre-injury levels and all subjects continued to participate at their pre-injury perceived activity level. At 2 years after ACL reconstruction with tibialis anterior allografts, this subject group displayed satisfactory functional outcomes. Tibialis anterior allograft use provides an effective ACL reconstruction alternative, particularly for older individuals who want to continue recreational sports.

Outcomes of carpal tunnel release in diabetic and non-diabetic patients.

OBJECTIVE: To investigate the postoperative prognosis of carpal tunnel syndrome (CTS) in diabetic patients compared with non-diabetic patients. MATERIAL AND METHODS: The outcomes of 22 diabetic patients were compared with those of 25 non-diabetic patients undergoing surgery by the open release method for CTS. Analysis of electrodiagnostic findings and assessment of global symptom score were performed preoperatively and 1 month and 1 year postoperatively. RESULTS: A significant improvement in all the parameters occurred in both groups after the surgical decompression. However, a less significant improvement in these parameters was observed in the diabetic group than in the non-diabetic group (all of them P < 0.001). CONCLUSION: These findings suggest that CTS in diabetic patients does not only stem from external anatomic factors, but is also dependent on internal factors such as metabolic and vascular causes and that its treatment should include the correction of these factors.