Comparison of single versus double coracoclavicular loop stabilization technique for the management of unstable distal clavicular fractures: a randomized controlled trial.

PURPOSE: The coracoclavicular (CC) loop stabilization technique is proposed for unstable distal clavicular fractures. This study aims to compare single and double CC loop stabilizations and evaluate differences in functional and radiographic outcomes between them. METHODS: We conducted a prospective randomized controlled trial involving 46 patients who sustained unstable distal clavicular fractures between April 2017 and 2019. The participants were randomly assigned to one of two groups: the single CC loop stabilization group (n = 23) or the double CC loop stabilization group (n = 23). We assessed their Constant score, American Shoulder and Elbow Surgeons score (ASES), and pain level. Additionally, we recorded data on time to union, CC distance, and any complications. RESULTS: The single CC loop group demonstrated a shorter operative time and significantly higher Constant score than the double CC loop group at 1 month (77.32 ± 5.65 vs. 71.91 ± 8.33; p = 0.016) and 3 months (86.17 ± 4.05 vs. 81.13 ± 6.34; p = 0.009) postoperatively. However, there was no differences in the ASES score, time to union or CC distance restoration between two groups. Implant irritation was observed in the double CC loop group (26.1%), but there were no cases requiring revision surgery. CONCLUSIONS: Both single and double CC loop stabilization demonstrated favorable outcomes, including a high union rate and minimal complications. Single CC loop stabilization showed slightly better early functional outcomes, reduced implant-related irritation, and shorter operative times.

Efficacy of high-volume vs very low volume corticosteroid subacromial injection in subacromial impingement syndrome: a randomized controlled trial.

Subacromial corticosteroid injections (SCI) treat shoulder pain from subacromial impingement syndrome (SIS). However, a high-volume corticosteroid injection (HVCI) increases the incidence of local and general complications from lidocaine. This study aimed to compare the results of functional and clinical outcomes between the very low-volume corticosteroid injection (VLVCI) and HVCI including to WORC (Western Ontario Rotator Cuff Index), VAS (Visual Analog Scale), DASH (The disabilities of the arm, shoulder, and hand) and ROM (Range of Motion). A total of 64 patients presenting with SIS were evaluated in two SCI volume in a randomization-controlled trial study. The VAS for pain pre-injection and post-injection at 15 min, was from 5.34 ± 2.44 at before injection to 2.44 ± 1.58 at post injection 15 min in the HVCI group (P < 0.001) and from 5.19 ± 2.33 to 2.84 ± 1.49 in VLVCI group (P < 0.001). Not significant differences at mean difference VAS post-injection 15 min VAS (P = 0.324) and Percentage difference VAS pre-injection and post-injection (P = 0.24). All follow-up timing, there were no significant differences in WORC, DASH and ROM between two groups (P > 0.05). The results revealed the VLVCI is non-inferior to HVCI both of functional outcomes and VAS.

Suture Bridge Transosseous Quadriceps Tendon Repair for Spontaneous Quadriceps Tendon Rupture in Patients With End-Stage Renal Disease.

End-stage renal disease with spontaneous quadriceps tendon rupture (QTR) is a specific condition that differs from classic QTR. The tissue quality of the quadriceps tendon (QT), the rupture site, the mechanism of injury, and the pathophysiology of the rupture mechanism all have an effect on conventional QT repair procedures, with a higher likelihood of rerupture or failed repair construction. We believe that our technique provides repair-site stability, strong repair construction, increased contact surface healing, and a reduced chance of rerupture after QT repair. Furthermore, in most patients who have end-stage renal disease with QTR, misdiagnosis and/or underestimation occurs, resulting in proximal retraction of the QT and poor results; however, this technique can be performed with alternative procedures such as augmentation or QT lengthening. The suture bridge transosseous QT repair technique relies on biomechanics knowledge for better stability. Suture bridge repair concept can achieve better healing of all layers of the QT until returning to normal activity with no disability and an improved quality of life.

Arthroscopic Triple-Loaded Soft Anchor Technique in Medial Meniscal Root Repair: A Systematic, Step-by-Step Approach.

The results of meniscal root repair (MRR) have shown that this repair is the best treatment option in the presence of an acute situation with no degenerative changes. The meniscal root could be restored, in addition to the meniscus's hoop stress function, which is a key component in preventing osteoarthritis progression in the future. Several MRR techniques have been developed, and both improved biomechanics and a lower incidence of failure repair are correlated with suture anchor techniques. Suture anchor techniques also have many ways in which they can be adapted until the disadvantages are eliminated, such as the risk of a major neurovascular problem in the posterior compartment and the difficulty of preparing the base of the meniscal footprint because visualization in the medial compartment of the knee is limited. My MRR technique can improve knee function and allow a return to normal activities without the development of osteoarthritis by relying on the concepts of biomechanics and the regeneration process.

Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique.

Medial meniscus root repair is often combined with correction of knee varus alignment by performing an opening wedge high tibial osteotomy (HTO) in patients with varus knee malalignment, particularly in those with suspected long-term medial meniscus root tear (MRT). Before planning a corrective alignment treatment, radiographic imaging of the knee alignment is recommended to assess a medial joint space and the tibiofemoral axis. Because HTO can reduce pressure on the repair site, new alignment may promote healing in the attachment of the MR repair. When HTO is used with meniscus root repair (MRR), the tunnel convergence remains a major concern. We describe an arthroscopic technique for treating chronic MRT with knee malalignment using the technique of arthroscopic posterior MRR with HTO. This approach was used to enhance anatomic healing of the meniscus root, decrease the load to the medial knee compartment to achieve MRR, and stop progressive osteoarthritis of the medial knee compartment.

Arthroscopic-Assisted Coracoclavicular Stabilization With Anchorless Transosseous Double-Row Acromioclavicular Ligament Complex Repair: The Acute Acromioclavicular Joint Dislocation.

The current concept procedures in the acute acromioclavicular joint dislocation should be divided into 2 types of structure restoration: those that provide coracoclavicular stabilization, which affects the primary healing of the coracoclavicular ligaments by vertically stabilizing the clavicle and coracoid in their anatomical positions, and those that attempt to repair the superior acromioclavicular ligament complex, which controls both horizontal and rotational stabilization. The acute acromioclavicular joint dislocation clinical outcome will be achieved if you perform both procedures. It's difficult to stabilize the acromioclavicular joint in both vertical and horizontal planes, and most current techniques aren't always effective. In this Technical Note, we discuss an arthroscopic-assisted technique that reconstructs the coracoclavicular and acromioclavicular ligaments under image intensifier guidance to achieve bidirectional (vertical and horizontal) and rotational stability.

3-in-1 Hybrid Suture Bridge Technique in Posterosuperior Rotator Cuff Tear.

Our technique repaired the posterosuperior rotator cuff tear in the full-thickness type. The key successful of the arthroscopic full-thickness rotator cuff repair has several suture techniques. First, it will distribute a tensile force throughout the entire tendon. Second, it will improve tendon healing by getting it closer to the medial anatomical footprint. Third, the suture bridge compression technique has been used to compress all layers of the repaired tendon against the bone with the total contact area. Fourth, it reduces the risk of cut through the rotator cuff and the rate of rotator cuff retear with a tension free repair. We used three suture limbs in one hole to reduce rotator cuff damage and the rate of retear and also only tie three medial row knots. The reasons are to compress anatomically the medial footprint. The configuration suture pattern consists of suture bridges that distribute pressure-tension over a larger contact surface area on the tendon-bone interface, allowing for robust tendon-bone stabilization, better tendon-bone healing, and less retear after repair.

The role of shoulder arthroplasty after chronic brucellosis of glenohumeral joint septic arthritis. A case report and literature reviews.

INTRODUCTION: The main socioeconomic area in Thailand has been the agricultural endemic area, where brucellosis infection, one of the bacterial infectious diseases has been an overlooked diagnose. PRESENTATION OF CASE: A 50-year-old Thai woman was admitted to the hospital with pain and limited motion in her left shoulder. These symptoms have been prolonging with progressive clinical for two years. The physical examination revealed stiffness in all directions. The glenohumeral joint appeared to be narrowing on radiographic evaluation. The multiple loculate mass and septic glenohumeral joint arthritis were seen by magnetic resonance imaging (MRI). Furthermore, the Brucellosis investigation specificity was Brucella IgM/IgG positive. This patient was treated with a combination of surgery and oral antimicrobial medication. We decided to perform a total shoulder arthroplasty because the patient was still in pain and stiff from secondary arthritis. DISCUSSION: As a result of the late treatment for osteoarticular involvement, secondary osteoarthritis develops until leading to significant cartilage loss. Therefore, even medical treatment and surgical debridement, the patient still suffers from secondary osteoarthritis, which causes pain and limited activity. The arthroplasty treatment method plays a role in the treatment of function following secondary osteoarthritis infection. CONCLUSION: The role of arthroplasty was selected in the treatment of brucellosis osteoarticular involvement, which is an uncommon and difficult to identify condition that can lead to maltreatment. So that this case report offers the treatment option if the patient was not responsible for the medical and surgical debridement therapy with secondary osteoarthritis at the glenohumeral joint, even though the brucellosis infection condition had completely resolved.

The differences of the acromiohumeral interval between supine and upright radiographs of the shoulder.

The acromiohumeral interval (AHI) is a measurement used to determine the superior migration of the humeral head in rotator cuff (RC) tear patients. The purpose of this study was to compare the AHI of; supine, upright shoulder radiographs, and magnetic resonance imaging (MRI) of the shoulder. The 86 shoulders were divided into 3 groups that included; (1) non-full thickness tear (50%), (2) full thickness (FT) tear ≤3 cm (33.7%), and (3) FT tear > 3 cm (16.3%). The mean difference of AHI noted was significantly lower in the supine radiographs and MRIs than with the upright (1.34-1.37 mm, 1.62-1.87 mm, respectively). Upright AHI ≤ 7.0 mm had 27.9% sensitivity and 100% specificity in diagnosing FT tears with 64% accuracy (p < 0.001). The supine AHI ≤ 6.5 mm had 32.6% sensitivity, 100.0% specificity, and 66.3% accuracy (p < 0.01). The results revealed the AHI in supine radiographs were significantly lower than upright shoulder radiographs. For AHI ≤ 7 mm in upright shoulder radiographs, this remains as an appropriate diagnostic test for ruling in shoulders with full thickness rotator cuff tears. This value was not relevant for use as the cut point in the supine radiographs and MRIs.

Current concepts on meniscal repairs.

The specific meniscus injury pattern were divided into many patterns. Nowadays, the meniscus root injury, radial tear meniscus, bucket handle tear meniscus and Ramp lesion were particularly focused on many way to manage and still controversial a lot of issues. Meniscus root tears (MRTs) and Ramp lesion are the most ignored, or misdiagnosed causes of chronic knee pain. Most patients delayed seeking treatment, consequently resulting in cartilage loss, and leading to the condition progressing to osteoarthritis knee. This has resulted in the rate of MR and Ramp repair increase significantly. The bucket handle meniscus tear trend to strong saving the anatomical meniscus and avoid to menisectomy. This article, on the other hand, will reveal you how to save and secure a nearly native meniscus fixation. In case of the radial meniscus, the partial meniscectomy is still used to treat this type of injury today, but it does not prevent degenerative changes from occurring, which can lead to unfavorable outcomes. Meniscal repair is a popular procedure for treating radial tears as an alternative to surgery. However, this pattern of meniscus tear can be difficult to repair and has a high failure rate, the arthroscopic meniscus repair techniques are published.