Sequential Release and Muscle Slide of Irreparable Rotator Cuff Tears Results in Linear Gains in Tendon Mobility.

Purpose: The purposes of this study were to examine the technique of the supraspinatus and infraspinatus muscle slide for the treatment of rotator cuff tears and to quantify the amount of release and resultant tendon excursion at their insertion sites in cadavers. Methods: Twelve shoulders in 6 human cadavers were dissected. Their average age at time of death was 84 years. Though a large open posterior incision, artificial rotator cuff tears were created, if not already present. Standard arthroscopic release was completed. Muscle slide technique was then performed for the supraspinatus and infraspinatus muscles in quartiles, with tendon excursion measured at each interval. Results: The average muscle length from its most medial border to the tendinous insertion was 130 mm and 145.8 mm for the supraspinatus and infraspinatus, respectively. Progressive release of the muscle origin from lateral to medial in 25% increments corresponded to a 6.47-mm lateral shift of the tendon to a maximum of 25.8 mm before complete release of the supraspinatus muscle was achieved. For the infraspinatus, it was an average of 5.38 mm at each 25% interval to a maximum of 21.5 mm. The only restraint to mobility were the motor branches attached to the undersurface of each muscle belly. Conclusions: An additional 25.8 mm (supraspinatus) and 21.5 mm (infraspinatus) of tendon excursion was produced when 100% of the muscle was released from its underlying fossa. At that juncture, tendon excursion was limited by tension placed on each muscle's respective neurovascular supply. Furthermore, sequential release of each muscle resulted in a predictable and consistent gain in tendon mobility, with an average of 6.47 mm and 5.38 mm for each quartile of muscle release in the supraspinatus and infraspinatus from lateral to medial. Clinical Relevance: Tension at the repair site is a contributing factor to poor outcomes after arthroscopic rotator cuff repair of massive rotator cuff tears. This study quantifies the tendon mobility that may be gained following additional muscle slide techniques, and the addition of this technique may contribute to a tension-free repair.

Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate.

BACKGROUND: The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. METHODS: This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. RESULTS: Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° (P < .05) and the mean reduction of the HVA was 33° (P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points (P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. CONCLUSIONS: First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. LEVELS OF EVIDENCE: Level III.

ACL Reconstruction with Augmentation: a Scoping Review.

PURPOSE OF REVIEW: We reviewed the recent literature to identify and summarize new research surrounding anterior cruciate ligament reconstruction (ACLR) with augmentation in the form of additional soft tissue procedures or biologic augmentation. Specifically, we wanted to review the failure rates of these procedures in both the primary and revision settings. METHODS: The databases Embase, PubMed, and Medline were searched on August 13, 2018, for English-language studies that reported on the use of anterior cruciate ligament reconstruction (primary and revision) in conjunction with either soft tissue or biologic augmentation. The studies were systematically screened and data abstracted in duplicates. RECENT FINDINGS: Advancements in ACLR surgery, including soft tissue augmentation, may decrease primary and revision surgery failure rates for high-risk patients. The use of biological augmentation has shown histologic and radiographic improvements. These differences, however, have failed to be statistically significant and have not resulted in clinically significant improvements in outcome. The limited body of evidence has shown that the addition of soft tissue procedures may in fact lower the risk of graft re-rupture rates particularly in revision or in patients wishing to return to high-risk sports and activities. The use of biologic augmentation although promising in laboratory studies has yet to show any significant clinical results and therefore will require further studies to prove any efficacy.

Heterotopic Ossification in Hip Arthroscopy: an Updated Review.

PURPOSE OF REVIEW: Heterotopic ossification (HO) in hip arthroscopy is a common post-operative complication. This review was undertaken to provide an update (2014 present) on the current literature regarding HO in hip arthroscopy. RECENT FINDINGS: Risk factors for HO post-hip arthroscopy include male gender, mixed impingement, picture, and the size of CAM resection. HO prophylaxis with NSAIDs has been proven to decrease the rate of HO post-hip arthroscopy; however, there is inherent risk to long-standing NSAIDs therapy. HO post-hip arthroscopy is not uncommon as a radiological finding, but symptomatic HO post-hip arthroscopy requiring revision surgery is a rare event, at < 1%. The outcomes for revision surgery for HO excision have fair outcomes. The hip arthroscopist should stratify their patients based on known risk factors, and determine whether NSAIDs prophylaxis is warranted.

Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections. METHODS: We systematically searched MEDLINE, Embase and the Cochrane Library for randomized controlled trials (RCTs) published up to Aug. 15, 2014. We included all RCTs that compared postoperative antibiotic prophylaxis with postoperative placebo or no treatment in patients undergoing primary total hip or knee arthroplasty for osteoarthritis. We combined outcomes for surgical-site infection using a random-effects model and quantified heterogeneity using the χ2 test and the I2 statistic. We assessed the overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: We identified 4 RCTs (n = 4036) that met the inclusion criteria. Surgical-site infections occurred in 3.1% (63/2055) of patients in the prophylaxis group and 2.3% (45/1981) in the control group. Postoperative prophylaxis did not reduce the rate of surgical-site infections compared with placebo (risk difference 0.01, 95% confidence interval 0.00 to 0.02; I2 = 26%). This result was robust to sensitivity testing for losses to follow-up. According to the GRADE approach, the overall quality of evidence was very low. INTERPRETATION: The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself.