Neurolysis of the ulnar nerve for neuropathy following total elbow replacement.

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.

Pain relief and functional results after resection arthroplasty of the shoulder.

We have examined the relief from pain and the functional outcome in 18 patients who underwent resection arthroplasty of the shoulder as a salvage operation between 1988 and 2002. The indications included failed shoulder replacement in 17, with infection in 13, and chronic septic arthritis in one. The mean follow-up was 8.3 years (2.5 to 16.6). Two intra-operative fractures of the humerus occurred, both of which healed. The level of pain was significantly decreased (t-test, p < 0.001) but five patients continued to have moderate to severe pain. The mean active elevation was 70 degrees (0 degrees to 150 degrees ) postoperatively and represented an improvement from 39 degrees (0 degrees to 140 degrees ) (t-test, p = 0.003), but internal and external rotation were hardly changed. The mean number of positive answers on the 12-question Simple Shoulder Test was 3.1 (0 to 12) but the shoulder was generally comfortable when the arm was positioned at rest by the side. The mean post-operative American Shoulder and Elbow Surgeon's score was 36 (8 to 73). Despite applying this procedure principally to failed shoulder replacements, the results were similar to those reported in the literature for patients after severe fracture-dislocation. Reduction of pain is possible in one half to two-thirds of patients. The outcome of this operation in providing relief from pain cannot be guaranteed, but the shoulder is usually comfortable at rest, albeit with profound functional limitations.

Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearance of the hamstring graft harvest site after harvesting the hamstring tendons to reconstruct a torn anterior cruciate ligament (ACL). TYPE OF STUDY: Case series. METHODS: We performed MRI on 21 patients who had previously undergone hamstring harvest and ACL reconstruction. Twenty of the patients (7 female and 13 male; mean age, 37 years; range, 16 to 84 years), all volunteers, were selected from a series of 45 ACL reconstructions performed by the senior author during a 20-month period. Another patient, a 32-year-old man, underwent ACL reconstruction elsewhere 32 months before. Both the semitendinosus and gracilis tendons were harvested in all cases. All MRIs were obtained on a 1.5-T magnet and were prospectively evaluated by 2 experienced musculoskeletal radiologists who were blinded to the time interval between graft harvest and MRI. RESULTS: Two weeks after graft harvest, MRI showed ill-defined intermediate signal on T1-weighted images and increased signal on T2-weighted images, consistent with fluid in the harvest site, with no discernable tendon. At 6 weeks, structures were seen at the level of the superior pole of the patella that had morphology and signal characteristics similar to native tendon. By 3 months, structures with normal morphology and signal characteristics were seen to the level of the joint line, and by 12 months, to the level of 1 to 3 cm above that of the tibial attachment. At 32 months, the tendons appeared on MRI to normalize to a level of 1 to 2 cm above their tibial attachment. CONCLUSION: Following hamstring tendon harvest, MRI demonstrates an apparent regeneration of tendons beginning proximally and extending distally over time.

Options in meniscal repair.

Meniscal repair is an important technique for the orthopaedic surgeon. As familiarity, equipment, and techniques improve, the interest in expanding the indications for application of meniscal repair also increases toward improving patient outcomes and long-term function. An overview of the indications, techniques, complications, and future direction of meniscal repair is presented in this article.

Correlation between Goldmann perimetry and maximal electroretinogram response in retinitis pigmentosa.

To evaluate the relationship between Goldmann perimetry and maximal electroretinographic responses in patients with retinitis pigmentosa, analyses were performed on 220 affected subjects and separately on two subgroups with autosomal dominant (n = 35) and autosomal recessive (n = 29) inheritance. Electroretinograms were recorded averaging 100 iterations elicited with a 20-lux/s, 0.5-Hz white flash ganzfeld stimulation. The peripheral isopters of the visual fields were delimited with I4e, IIIe and V4e targets, measured on conventional perimetry charts with a light pen and expressed in square centimeters. Unlike most previously published reports, this investigation showed a definite correlation (p = 0.0001) between maximal electroretinographic response amplitude and visual field areas. This correlation was more evident for I4e and IIIe isopters (r = 0.89 and 0.87, respectively) than for V4e isopter (r = 0.69). This phenomenon appears to be related to distortion occurring on standard isometric charts and to spatial summation effects in the peripheral field. Such correlations held for both the autosomal dominant and autosomal recessive subgroups. It appears that, if enough accuracy is provided, maximal electroretinographic responses and Goldmann visual fields are both good measures of the remaining functioning retina in nonsyndromic retinitis pigmentosa, irrespective of inheritance models and dystrophic patterns.