Anatomic Variation of Submental Artery: A Case of Submental Artery Coursing Through a Developmental Defect of Mylohyoid Muscle.

Knowledge about variations in mylohyoid muscle and submental artery is essential for maxillofacial surgeons, as these structures are commonly encountered in maxillofacial ablative and reconstructive surgery. While cadaveric and radiologic studies on mylohyoid variations have been documented in the literature, we report an intraoperative variation observed in relation to mylohyoid muscle and submental artery.

Five Year Follow up of Retrospective Cohort Comparing Structural and Functional Outcome of Arthroscopic Single-row ersus Double-row Suture Bridge Repair of Large Posterosuperior Rotator Cuff Tear in Patients Less than or Equal to 70 Years.

BACKGROUND: High re-tear rates after repairing large-sized posterosuperior rotator cuff tears remain a significant concern which may affect the clinical outcome. The most optimal type of repair (single versus double-row suture bridge) suited for large size tear remains debatable. METHODS: In a retrospective cohort study with a minimum of five years follow up, the structural and functional outcome of 103 patients with large size cuff tear repaired with single row (SR) or double row suture bridge (DRSB) were evaluated. The structural outcome was assessed with ultrasonography whereas functional outcome was evaluated with Constant Murley (CM) and American shoulder elbow score (ASES). RESULTS: There were 55 patients in the SR group and 48 patients in the DRSB group with a mean follow-up of 74.2 months (range, 60-96 months). While comparing the structural integrity in two groups, we found significantly lower re-tear rates in the DRSB group as compared to the SR group (10.4% vs. 32.7%; P=0.006). Also, there were more focal defects in the SR group (25.4%) than the DRSB group (8.3%). Overall, there was no significant difference in CM and ASES scores when the SR group was compared to DRSB. However, subgroup analysis between those with intact and retorn tendon revealed significant difference (P=0.0001) in the clinical scores. CONCLUSION: At a minimum of five years follow-up, the DRSB repair of large posterosuperior cuff tear resulted in superior structural healing over SR repair. Nevertheless, overall there was no significant functional difference between both the techniques. However, the functional outcome of the healed tendon subgroup was superior to retear tendon subgroup.

Correlation of Flexor Pollicis Longus Tendon Status by Ultrasonography with Plate Position on Radiographs Following Volar Plate Fixation of Distal Radius Fractures with Pronator Quadratus Repair.

BACKGROUND: Purpose was to correlate flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs following volar locked compression plate fixation (LCP) in patients who have undergone pronator quadratus (PQ) repair for distal radius fractures. METHODS: Status of flexor pollicis longus tendon was analyzed by ultrasonography in patients who underwent volar locked compression plating with pronator quadratus repair at a minimum of one year follow up. Soong's criteria was used to assess the plate position and then correlated the ultrasonography findings of flexor pollicis longus. RESULTS: There were 33 patients included in our study, of which 15 belonged to Soong's grade zero, 10 were grade one and eight were grade two. Flexor pollicis longus attrition was noted in all cases with grade two plating. CONCLUSION: Pronator quadratus repair may not prevent attritional changes in higher grades of Soong's, hence follow up may be required in these patients to identify attritional changes and early implant removal to prevent complications.

Does application of abduction brace after arthroscopic rotator cuff repair improve blood flow around posterosuperior rotator cuff and repair site, affecting pain levels and clinical and structural outcomes? A pilot randomized controlled trial.

BACKGROUND: As per some cadaveric studies, blood flow in posterosuperior rotator cuff tendons improves in the abducted shoulder position compared with the neutral position. In a clinical post-rotator cuff repair scenario, the impact of abduction on altered blood flow in and around the posterosuperior rotator cuff tendons is unknown in terms of clinical outcomes and structural healing. MATERIALS AND METHODS: This study included 42 eligible patients aged between 40 and 70 years with clinically diagnosed and radiologically confirmed rotator cuff tears undergoing arthroscopic rotator cuff repair. Patients were randomly allocated to undergo application of either an abduction brace (group 1) or an arm pouch (group 2). On postoperative day 1, power Doppler scanning was performed on the index shoulder in adduction and 30° of abduction in each patient; the allocated treatment (abduction brace or arm pouch) was then applied. Power Doppler scanning was repeated at 6 weeks in the immobilization position assigned to the patient (abduction or adduction). The vascular flow in 6 regions was noted as per the criteria of Fealy et al. A visual analog scale score was assessed preoperatively and at 1, 3, 6, 12, and 56 weeks postoperatively. Clinical assessment was performed with the Constant-Murley score at 1 year, and structural healing of the cuff was assessed using ultrasonography at 3 and 12 months. RESULT: On the first postoperative day, blood flow was significantly higher in all 6 areas of the shoulder in group 1 than in group 2. The mean total vascular score was significantly higher in group 1 than in group 2 on postoperative day 1 (P = .0001) and remained so at 6 weeks (P = .0001). However, significantly higher vascular flow was noted only in the peribursal region at 6 weeks in group 1 (P = .04). No significant difference in the visual analog scale score was noted between the 2 groups at any given point of follow-up. Furthermore, no clinical and structural healing differences were noted between the 2 groups at final follow-up. CONCLUSION: Higher blood flow in and around the posterosuperior rotator cuff owing to an abducted shoulder position with an abduction brace in the first 6 weeks postoperatively fails to offer any advantage in terms of lower pain levels, better clinical scores, or superior cuff healing.

A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion.

BACKGROUND: Lone Bankart repair is associated with high rates of recurrence, especially in off-track Hill-Sachs (HS) lesion. The objective of the study was to assess the impact of remplissage in off-track HS lesion influencing the rate of redislocation and range of motion (ROM) of the shoulder. MATERIAL AND METHOD: We retrospectively reviewed 136 patients for arthroscopic Bankart repair without remplissage (group 1, n = 77) or with remplissage (group 2, n =59) for recurrent anterior dislocation of the shoulder with glenoid bone loss of <25%. Further subgroups of on- and off-track HS lesion were based on computed tomographic assessment. At a minimum follow-up of 2 years; patients were evaluated for functional scores (Rowe, Constant-Murley, Western Ontario Shoulder Instability Index), redislocations, and ROM. RESULTS: At a mean follow-up of 54 and 44 months in group 1 and 2, respectively, there was no difference in postoperative functional scores. There were significantly more dislocations in patients with Bankart repair with off-track lesion than in patients with Bankart repair with on-track lesion (P = .02). There were significantly fewer redislocations in patients with off-track lesion who underwent Bankart repair and remplissage than in those who did not undergo remplissage (P = .0007). Compared with group 1 patients, those in group 2 revealed a statistically significant loss of ROM. CONCLUSIONS: Although a nonremplissaged off-track HS lesion remains an important risk factor for recurrent instability, remplissage also results in significant loss of shoulder ROM compared with those who do not undergo remplissage.

Clinical and Structural Outcomes after Arthroscopic Repair of Medium- to Massive-Sized Delaminated and Nondelaminated Rotator Cuff Tears.

INTRODUCTION: Current evidence is controversial about the outcomes after the repair of the delaminated versus nondelaminated rotator cuff tears. The objective of this study was to evaluate the factors affecting delamination of the cuff and clinical and structural outcomes after en masse arthroscopic repair of delaminated versus nondelaminated cuff of varying sizes. MATERIALS AND METHODS: A total of 233 patients with full-thickness posterosuperior cuff tears were divided in two groups: Group 1: Delaminated tears (n = 131) and Group 2: Nondelaminated tears (n = 102) of medium, large, and massive sizes. Both groups were evaluated by clinical scores (Constant-Murley [CM], American shoulder and elbow score [ASES]) and ultrasonography (USG), at a minimum followup of 2 years. RESULTS: The mean followup was 45.47 months. There was a weak but statistically significant linear correlation (P = 0.02) between the increasing size of tear and delamination, whereas increasing age and duration of symptoms did not correlate with increasing tendency of delamination. Final followup USG analysis revealed that there was no significant difference (P = 0.55) between healing rates of Group 1 and Group 2. Further taking various tear sizes into account, USG revealed no significant difference between the healing rates of two groups. The mean overall final postoperative CM and ASES scores of two groups did not show any significant difference (CM; P = 0.36, ASES; P = 0.4). However, the clinical outcome was significantly better in the completely healed group as compared to partially healed or retear group. CONCLUSIONS: A weak linear correlation between delamination and increasing size of the tear was noted. Although overall structural and clinical outcome is no different between two groups, the clinical outcomes of completely healed tear are better than partially healed ones. LEVEL OF EVIDENCE: Level III, Retrospective comparative.