Assessments of activities of daily living after arthroscopic SLAP repair with knot-tying versus knotless suture anchors.

PURPOSE: The clinical influence of knot-tying or knotless anchor systems for the arthroscopic repair of SLAP lesions (superior labrum lesion from anterior to posterior) remain unclear. MATERIALS AND METHODS: In a retrospective cohort analysis, 61 of 78 (78.2%) patients with isolated symptomatic SLAP II lesions were examined with a minimum of 24 months after arthroscopic SLAP repair compared to a control group: 28 patients with knot-tying anchors (group I, G1; 28.95 ± 9.48 years, 23 male/5 female), 33 with knotless anchors (group II, G2; 31 ± 10.09 years, 26 male/7 female) and 140 healthy volunteers (group III, G3; 30.9 ± 8.9 years, 109 male/31 female). The clinical assessment included an examination and estimated parameters of ADL (activities of daily living), the CS (Constant score), ASES (American Shoulder and Elbow score), DASH (disability of arm-shoulder hand) and the RS (Rowe score). RESULTS: The ROM analysis recorded no significant differences for the external rotation in 0° abduction (G1 63.75° ± 15.55° versus = vs G2 65.30° ± 18.15°; pERG1 vs G2 = 0.72). The clinical outcomes revealed significantly decreased pain status in G1 for the O'brien test and in G2 for the Palm-up test, whereas Yergason test showed similar pain levels (pO'brien = 0.03; ppalm up = 0.02; pyergason > 0.5). The pulley associated rotator cuff tests revealed a significantly inferior force status in G2 compared to G1 (plift-off = 0.005, pJobe = 0.02) whereas the further rotator cuff assessments were equal. In general, the intervention group showed increased pain level and functional deficits compared to the G3. The score analysis detected no significant differences with PCSG1 vs G2, PASESG1 vs G2, PDASHG1 vs G2 and PRSG1 vs G2 all > 0.05 and significant impairments compared to G3 in all scores pG1/G2 vs G3 < 0.05 (CSG1 = 88.28 ± 14.42, CSG2=92.73 ± 9.24, CSG3 = 96.2 ± 4.96; ASESG1 = 81.10 ± 21.69, ASESG2 = 85.35 ± 17.12, ASESG3 = 94.95 ± 10.39,; DASHG1= 35.75 ± 13.44, DASHG2 = 36.03 ± 17.55, DASHG3 = 27.13 ± 6.52; RSG1 = 90.71 ± 9.88, RSG2 = 88.33 ± 11.22, RSG3= 92.96 ± 11.27). CONCLUSIONS: The clinical assessment revealed for both anchor systems similar outcomes but showed general underestimated impairments after the SLAP repair surgery compared to the healthy control. The clinical status only marginally differed between both techniques, wherefore the present assessment of ADL allowed no recommendation of one of these two specific surgery technique for SLAP repair.

Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization.

PURPOSE: The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration. METHODS: Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 months; FU2 = 12 months). The structural MRI assessments were performed at FU0 (injured ACJ) and at FU2 bilateral (radiologic control group) and assessed separately the ligament thickness and length at defined regions for the conoid, trapezoid and the superior AC ligament. RESULTS: Thirty-seven patients were assessed after 6.5 months and after 16.0 months. The 16-month MRI analysis revealed for all patients continuous ligament healing for the CC-complex and the superior AC ligament with in the average hypertrophic consolidation compared to the control side. Separate conoid and trapezoid strands (double-strand configuration) were detected in 27 of 37 (73%) patients, and a single-strand configuration was detected in 10 of 37 (27%) patients; both configurations showed similar CCD data. The ligament healing was not influenced by the point of surgery, age at surgery and heterotopic ossification. The clinical outcome was increased (FU0-FU2): Rowe, 47.7-97.0 pts.; TAFT, 3.9-10.6 pts.; NAS pain, 8.9-1.4 pts. (all P < 0.05). CONCLUSION: The arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation showed 16 months after surgery sufficient consolidations of the AC and double-CC ligament complex in 73%. LEVEL OF EVIDENCE: III, Case series.

Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes.

INTRODUCTION: Arthroscopic repair is one option for the surgical treatment of type II superior labrum tears from anterior to posterior (SLAP) lesions in athletes' shoulders. MATERIALS AND METHODS: Sixty-one of 78 (78.2%) athletes were retrospectively examined after isolated arthroscopic SLAP repair (group 1/G1: 28x knot-tying anchors; group 2/G2: 33 knotless anchors; follow-up 24 months) and compared to two specific, separate matched volunteer athlete control groups (group 3/G3: 28 athletes matched to G1; group 4/G4: 33 athletes matched to G2). The assessment of G1-4 included numerical analogue scales (NASs: 1-15 scales) and the Athletic Shoulder Outcome Scoring System (ASOSS) score, and the Shoulder Sport Activity Score (SSAS). The preinjury status (FU-1), the status before surgery (FU0), and at follow-up (FU1) were assessed. RESULTS: High external rotation at abduction (hER) was significantly worse in G1 than G2 (FU1: G1, 86.6° ± 7.7° versus = vs G2, 91.1° ± 10.7°; p = 0.03). The ASOSS and SSAS revealed significant impairment in G1-2 compared to G3-4 (ASOSS FU1: 83.9 ± 19.9 G1 vs 94.6 ± 7.7 G3; p = 0.002 and 80.3 ± 17.7 G2 vs 91.8 ± 9.1 G4; p = 0.002; SSAS 5.9 ± 2.7 G1 vs 6.9 ± 1.8 G3; p = 0.02 and 6.3 ± 2.5 G2 vs 7.4 ± 1.4 G4; p = 0.06), with 17-20% loss on ASOSS and 23-25% deficits on SSAS. The NAS analysis detected for pain (4 ± 3.5 vs 3.2 ± 2.6), satisfaction (2 ± 0.8 vs 1.8 ± 0.9), reduction of function (4.6 ± 3.9 vs 3.9 ± 3.8) and proficiency (9.6 ± 4.7 vs 10.9 ± 3.9) similar impairments in G1-2 (p > 0.05) and better results in G3 and G4 (all p < 0.001). CONCLUSIONS: After SLAP repair, athletes showed underestimated impairment of shoulder sport resumption and proficiency with high rates of shoulder sports cessation. The present data favor the knotless fixation technique, because this fixation technique allowed bilaterally equivalent ranges of motions. The uninjured shoulder athletes also showed functional deficits with significant shoulder sport impairments, which must be considered in outcome analysis and for the rehabilitation program. LEVEL OF EVIDENCE: III, retrospective cohort study.

[Posterior cruciate ligament injuries]. / Verletzungen des hinteren Kreuzbands.

Posterior cruciate ligament (PCL) injuries are still often overlooked and treatment of a ruptured PCL is inherently different in comparison to anterior cruciate ligaments (ACL). Conservative treatment is the first-line therapy for acute isolated PCL injuries leading to good clinical and biomechanical results. Injuries to the PCL combined with rupture of other stabilizing ligaments, such as the collateral ligaments or the posterolateral corner of the knee joint are treated surgically. The same is true for high grade chronic PCL insufficiency. Meticulous classification of PCL injuries taking all stabilizing factors of the knee joint as well as the time from injury into account are essential for successful treatment of PCL injuries.

A pocket-sized hand held ultrasound system for intraoperative transthoracic echocardiography by anaesthesiologists: A feasibility study.

BACKGROUND: The intraoperative application of focused transthoracic echocardiography (TTE) is often considered to be restricted. Echocardiography with pocket-sized hand held ultrasound systems has been shown to be feasible in various settings. OBJECTIVE: The aim of this study was to investigate the feasibility of the intraoperative application of pocket-sized echocardiography and the comparison of its imaging quality and diagnostic reliability and variability with a standard ultrasound system. METHODS: After written informed consent, TTE was performed on 40 anaesthetised general, vascular, visceral, thoracic surgical and orthopaedic patients according to the FATE protocol: first, with a pocket-sized and second, with a high-end ultrasound system randomly by two anaesthetists. Imaging quality of four basic and three additional FATE views was rated on an established scale from 1 (impossible) to 5 (perfect). Successful TTE was defined, if one basic FATE views would be rated as grade 4 or 5 or alternatively two views as grade 3. Pathologic findings by both ultrasound devices were documented and imaging quality and pathologic findings were compared. RESULTS: All 40 patients presented acceptable imaging quality, resulting in a success rate of 1.0 (97.5%-CI 0.91-1, p= 0.015). The individual imaging ratings of each view were significantly lower with the pocket-sized system, but still showed acceptable imaging quality. With the high-end device more pathologic findings were detected (107 vs. 87), but none of the relevant or severe pathologies were overseen with the hand-held device. CONCLUSION: The application of a pocket-sized echocardiography device for focused intraoperative TTE is feasible and can appropriate be used for the initial evaluation of relevant pathologies in the operating theatre.

Complications and failure of MPFL reconstruction with free tendon grafts in cases of patellofemoral instability.

BACKGROUND: Reconstruction of the medial patellofemoral ligament (MPFL) using free tendon grafts has become a widespread treatment option for patellofemoral instability. As the numbers of cases gradually grow, so do the reports of possible peri- and postoperative complications following this procedure. OBJECTIVE: The present review summarizes all known complications of MPFL reconstruction with regard to postoperative outcome and seeks to highlight possible pitfalls that may occur during treatment. CONCLUSIONS: MPFL reconstruction generally has to be regarded as a safe procedure today due to low patellar re-dislocation rates. Complication rates however are not trivial owing to the complexity of the underlying pathology. Complications can arise from graft fixation or femoral tunnel placement. Postoperative flexion deficits and medial knee pain have been described as predominant complaints. Anatomical preconditions as the grade of trochlear dysplasia, axis or torsion of the lower extremity have to be considered in search of causes for possible graft failure as well as in the thorough preoperative planning of the procedure.

[Measurement on printed paper strips or on the ultrasound device with computer assistance - which technique is more accurate in paediatric hip ultrasound?]. / Ausmessung auf Papier oder computergestützt am Ultraschallgerät - Welches Verfahren ist genauer in der Sonografie der Säuglingshüfte?

AIM: Two different measurement techniques of ultrasonograms of the infant hip were evaluated with respect to reproducibility of the Graf classification and variation of α- and ß-angles. MATERIAL AND METHODS: In a cross-sectional, blinded study, the hips of 207 consecutive newborn babies (101 male; 106 female) were sonographically screened at an average of 2.64 days after birth. Each hip was measured twice by three investigators with different levels of experience - a paediatric orthopaedic surgeon, a senior surgeon and a trained medical student. A mobile ultrasound system (SONOLINE G60S®, Siemens, Erlangen, Germany), equipped with a 7.5 MHz linear transducer, was used. Both hip joints were measured twice by all three investigators. The measurement was performed 6-8 weeks later in a blinded manner. The sonograms were initially printed out on high-quality paper strips and measured by pencil, ruler and goniometer. Finally, each investigator evaluated the same sonograms computer-assisted, using the trackball and dashboard of the ultrasound system. RESULTS: Concerning intraobserver reliability, we observed a significant reduction of variation both for α- and ß-angles in favour of the classic measurement on printed strips (p < 0.05). The interobserver calculation also detected a trend for higher angle variation when the angles were measured electronically. The reproducibility of Graf classification was not influenced by the kind of measurement technique. The outcome was not affected by investigator's level of experience (p > 0.05). CONCLUSIONS: This study demonstrated considerable advantages for the classic measurement of paediatric hip ultrasonograms with pencil and goniometer on printed paper strips compared to computer-aided measurement concerning variation of α- and ß-angles.