A Novel Technique Utilizing a Vastus Lateralis Anchor in Treatment of Chronic Patellar Dislocation After Total Knee Arthroplasty.

Extensor mechanism complications involving the patella frequently result in total knee arthroplasty (TKA) failure. Postoperative patellar dislocation may be caused by soft tissue imbalance, improper sizing, and position of the prosthesis. This report describes a case of revision TKA requiring several rounds of soft tissue releases in an effort to treat the patient's chronic patellar dislocation. In the process, a novel surgical approach was developed for the surgical management of refractory chronic patellar dislocations. Postoperative follow-up at 1, 2, 6, 12, and 24 months indicated no complaints of patellar subluxation or dislocation. Plain films also demonstrated no effusion, fracture, or patellar dislocation on sunrise, anteroposterior, and lateral views. This novel anatomic repositioning of the vastus lateralis around the quadriceps tendon converted a pathologic lateralizing force into a medial stabilizer. On follow-up evaluations, successful patellar tracking without dislocation has been demonstrated. (Journal of Surgical Orthopaedic Advances.

Role of nonoperative treatment of subacromial impingement.

Subacromial impingement syndrome (SIS) occurs when the rotator cuff is compressed by the overlying acromion during shoulder flexion resulting in shoulder pain. The objective of this study was to demonstrate significant relief of symptoms and improved function from physical therapy over long-term follow-up. Eighty-one patients were followed. Patients had subjective and strength assessments at the initial physical therapy visit and 2-year follow-up. Statistical analysis was done using paired t tests for binomial data and Shapiro-Wilk test for the variable data. At 2 years, the Penn shoulder score (81) statistically significantly improved from the initial score (59) for 20 subjects (p = .002). The DASH score improved from 25 to 15 (p = .005). Average external rotation strength deficits compared with the contralateral side improved from 20% to 7% (p = .009). Physical therapy for SIS alleviates symptoms and improves function according to patient-based surveys and strength measurements over a 2-year period.

Pseudoarthrosis in a hypertrophic nonunion of the humerus: a case report.

Nonunion of humerus fractures is an extensively reviewed topic in orthopedic literature. The current case describes the successful outcome of a hypertrophic nonunion in a patient who chose not to undergo any intervention when the nonunion was identified and the treatment options were discussed with him. Hence this case report is a good example of the transition of the medical world to the concept of patient-centered decision making having a successful outcome.

Biceps tendinitis in chronic rotator cuff tears: a histologic perspective.

Patients with chronic rotator cuff tears frequently have anterior shoulder pain attributed to the long head of the biceps brachii (LHBB) tendon. In this study, tenodesis or tenotomy samples and cadaveric controls were assessed by use of immunohistochemical and histologic methods to quantify inflammation, vascularity, and neuronal plasticity. Patients had moderate pain and positive results on at least 1 clinical test of shoulder function. The number of axons in the distal LHBB was significantly less in patients with biceps tendinitis. Calcitonin gene-related peptide and substance P immunostaining was predominantly within nerve roots and blood vessels. A moderate correlation (R = 0.5) was identified between LHBB vascularity and pain scores. On the basis of these results, we conclude that, in the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity.