Cable-Augmented, Quad Ligament Tenodesis Scapholunate Reconstruction.

Maintaining reduction of the scapholunate interval after reconstruction can be difficult. The authors performed scapholunate reconstruction using tensionable suture anchors in 8 patients. The anchors provide a fixed cable that both fixes the graft, and reduces the scapholunate diastasis and maintains reduction. The flexor carpi radialis tendon graft stabilizes not only the volar scaphotrapezial ligament, and dorsal scapholunate ligament, but also the dorsal intercarpal and dorsal radiocarpal ligament. The Berger flap is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. The mean pain score improved from 5.8 to 2.1. Mean extension was 56° (91% of contralateral side), flexion 44° (70% of contralateral side), and grip strength was 41kg (95% of the contralateral side). The mean scapholunate angle was 71°, radiolunate angle 16° and scapholunate interval 3.0 mm. The cable augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages but long term follow up is required.

Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study.

BACKGROUND: Lateral tibial plateau fractures that are located posterolaterally are difficult to reduce through an anterolateral surgical approach because of the lack of direct visualisation of the fracture. This study compared the results of unicondylar posterolateral tibial plateau fractures in two patient cohorts: one treated through a posterolateral direct approach and the other through an anterolateral indirect approach. PATIENTS AND METHODS: All nine patients admitted to our hospital, a tertiary care, urban, public hospital in Australia, from 2007 to 2010 with unicondylar posterolateral tibial plateau fractures were treated through a direct posterolateral transfibular approach and prospectively studied. All eight patients admitted from 2004 to 2007 with unicondylar posterolateral tibial plateau fractures were treated through an indirect anterolateral approach and retrospectively reviewed. Fracture reduction and maintenance of reduction were assessed radiographically over 2 years. Knee function was assessed clinically and using the Lysholm score. RESULTS: Fractures managed through a direct posterolateral transfibular approach were reduced with no measurable articular step on standard radiography and had no loss of reduction over time. By contrast, fractures treated through an indirect anterolateral approach had a median postoperative articular step of 5.5mm (interquartile range=4.5). These displacements worsened over time in six of the eight patients. At 2 years, patients treated through a direct approach had significantly better Lysholm scores than those treated through an indirect approach. CONCLUSION: This study suggests that a direct posterolateral transfibular approach to unicondylar posterolateral tibial plateau fractures results in improved reduction, stabilisation and functional outcomes at early follow-up compared to an indirect anterolateral approach.

Cable-augmented, quad ligament tenodesis scapholunate reconstruction: rationale, surgical technique, and preliminary results.

Eight patients underwent scapholunate reconstruction using tensionable suture anchors. Adapted from a modified Brunelli technique, the anchors provide a fixed cable that reduces the scapholunate diastasis and maintains reduction during the healing phase. The flexor carpi radialis tendon graft is advanced through the scaphoid and stabilizes the volar scaphotrapezial ligament, dorsal scapholunate ligament, dorsal intercarpal ligament, and dorsal radiocarpal ligament. The ligament-sparing approach is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. Good clinical results were obtained. Measured on a visual analog scale (0 to 10), the average pain score improved from 5.8 to 2.1, average patient satisfaction was 7.6, average extension was 56 degrees (91% of contralateral side), flexion was 44 degrees (70% of contralateral side), and grip was strength 41 kg (95% of contralateral side). Radiographic parameters were less favorable. The average scapholunate angle was 71 degrees, radiolunate angle 16 degrees, and scapholunate interval 3.0 mm. The cable-augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages over previously published techniques, but long-term follow-up is required.

Repair of the acutely unstable elbow: use of tensionable anchors.

Acute ruptures of the medial or lateral collateral ligaments of the elbow associated with elbow dislocations have traditionally been repaired back to their respective epicondyles using suture anchors or transosseous sutures. Tensioning of those ligaments using conventional techniques had been difficult because of the need to maintain tension while tying and securing sequential knots. Tensionable anchors are a new generation of anchors that have been used for rotator cuff repair, but can be employed for the repair of collateral ligaments and capsular tears. It allows fine control and sequential tensioning of the ligament repair, and on-table assessment of stability before locking the anchor. We present a modified surgical technique for the repair of collateral ligaments repair using tensionable anchors in acute elbow dislocations or fracture dislocations.

The effect of hip position on the length of trochanteric muscles: potential implications for early postoperative management of hip arthroplasty.

We investigated the effect several lower limb positions have on muscles that are detached to perform hip arthroplasty through posterior and lateral approaches. We used string models and computer navigation to measure the length changes in these muscles throughout hip movements in the anatomical planes and while simulating several sitting and lying postures. Piriformis and the obturators were shortened by sitting and lying postures when the femur was externally rotated and abducted; the clinical implication being that such postures have the potential to best protect their repair after a posterior approach. The anterior part of gluteus medius was lengthened with femoral external rotation. This lengthening was prevented, and therefore, theoretically, the gluteus medius repair protected after a lateral approach, by neutral or internal femoral rotation.