Explore the vast range of titles available.

Purpose This study aims to describe a fixation technique for coronoid fractures using suture buttons, and to biomechanically evaluate this technique in comparison to screw fixation as a time-zero pilot study. Methods An O’Driscoll type 2 anteromedial coronoid facet (AMCF) fracture was simulated in 20 fresh-frozen human elbows. The specimens were randomized into two groups and fracture fixation was performed with either a suture button system or a 3.5 mm cannulated screw. Ultimate load-to-failure (N) was then tested for each specimen. Results The mean load-to-failure was 322.6 ± 75.9 N for suture button fixation and 314.2 ± 85.9 N for screw fixation. The differences were not statistically significant ( p  = 0.432). Additional fracturing of the coronoid fragment was observed in two specimens with screw fixation. Conclusion Promising biomechanical evaluations show that this fixation technique using suture buttons in the treatment of coronoid fractures provides equal construct stability as screw fixation. Further studies are required to fully validate this procedure.

Background The epidemiology and characteristics of shoulder dislocations in the context of epileptic seizures, as well as treatment recommendations, have so far been not described in detail in the literature. The aim of this retrospective study is to document the epidemiological characteristics and treatment options of shoulder instabilities occurring during epileptic seizures, as well as to quantify associated injuries. Methods As part of a retrospective analysis, 72 shoulders in 56 patients at our clinic were evaluated who sustained shoulder dislocation during an epileptic seizure. An analysis of the epidemiology and key characteristics was conducted. Sectional imaging including computer tomography scans and/or magnetic resonance imaging of all patients were independently analyzed at different time points by two raters (A.P. and H.G.) using OsiriX™ (Geneva, Switzerland) for glenoid defects as well as the Hill-Sachs lesion (HSL) and the reverse HSL (RHSL). When present, surgical treatment modalities were analyzed. Results The cohort had a mean age of 37 ± 16 years; 12 were female (21%) and 44 were male (79%). A total of 72 shoulder dislocations were identified: 60% anterior (43/72), 30% posterior (22/72), and 10% bidirectional (7/72); 51% were first-time dislocations (37/72) and 49% recurrent (35/72). Radiological imaging suitable for quantitative defect analysis was available for 47 shoulders, including 30 anterior and 17 posterior dislocations. The anterior glenoid defect size of patients with anterior dislocation averaged 11% (± 8%) and the mean posterior glenoid defect size of patients with posterior dislocation was 7% (± 6%). 16 of the 30 anterior dislocations and three of the 17 posterior shoulder dislocations were recurrent. Significant differences between first-time and recurrent dislocations were found in HSL width (13 mm vs. 15 mm; p = 0.008), HSL length (24 mm vs. 29 mm; p < 0.001), posterior glenoid defect size (5% vs. 13%; p = 0.04), and reverse HSL γ-angle (114° vs. 84°; p = 0.003). Fractures occurred in 46.4% of patients (26/56), all involving the proximal humerus, three patients also sustained a glenoid fracture. 62.5% of injuries were treated surgically (45/72). Surgical techniques included soft tissue stabilization (26.7%; 12/45), bony augmentation (24.4%; 11/45), arthroplasty (4.4%; 2/45), and humeral open reduction and internal fixation (44.4%; 20/45). Conclusion In patients with epilepsy, shoulder dislocations predominantly occur during generalized seizures, with anteroinferior dislocations being the most frequent, while posterior dislocations are significantly more prevalent compared to the general population. Recurrent dislocations were associated with significantly larger humeral and posterior glenoid defects, indicating progressive bone loss. Approximately half of all injuries involved proximal humerus fractures, with more than half requiring surgical intervention. Level of Evidence IV.

Objectives: Acromioclavicular joint (ACJ) injuries can lead to severe pain and reduced shoulder function. Anatomic coracoclavicular reconstruction (ACCR) using a free tendon graft has demonstrated favorable biomechanical properties and good short- to mid-term outcomes, but data on long-term outcomes are scarce. The purpose of the present study was to evaluate the long-term clinical and functional outcomes after ACCR, with a focus on return to sport and revision surgery. Methods: Patients who underwent ACCR using a free tendon allograft for the treatment of ACJ injuries type III or V between November 2006 and April 2011 by a single surgeon with a minimum 10-year follow-up were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES) Score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE) and patient satisfaction (1-10 scale with “10” indicating maximum satisfaction), rates of return to sport and further surgery, specifically revision ACJ stabilization, were evaluated minimum 10 years follow-up. Survivorship was defined as not undergoing revision ACJ stabilization. Pain (via Visual Analog Scale [VAS]) was additionally assessed preoperatively and at final follow-up. Patients who underwent further surgery were excluded from analysis. Results: Fourteen patients were evaluated after 13.0 (interquartile range, 12.0-15.0) years. Four patients (28.6%) underwent further surgery (2x revision ACJ stabilization, 2x exostosis removal) and were excluded from further analysis (survivorship: 85.7%). In the remaining patients, shoulder function was excellent at follow-up (ASES Score: 100 [96.6-100], QuickDASH: 0 [0-5.1]), SANE: 99.0 [91.5-99.0]). Pain levels decreased significantly from preoperative measurements to follow-up (VAS for pain: 2.0 [1.0-3.0] to 0 [0-0.5], p = 0.016). Satisfaction at follow-up was high (10 [5.0-10]). The majority of patients returned to their sports equal to or above (44.4%, n = 4) or slightly below (22.2%, n = 2) their preoperative level. One patient reported hypersensitivity and anterior shoulder pain postoperatively, but reported low pain levels at follow-up. No other complications occurred. Conclusions: Anatomic coracoclavicular reconstruction using a free tendon graft for the treatment of ACJ injuries type III or V resulted in excellent shoulder function, low pain levels and high patient satisfaction at long-term follow-up. The rate of revision ACJ stabilization was 14.3%.

Objectives: High tibial osteotomies (HTO) and distal femoral osteotomies (DFO) may be used for a variety of knee pathologies including unicompartmental cartilage disorders and ligamentous instability. A novel instrumentation system for osteotomies utilizing three-dimensional patient-specific instrumentation (3D-PSI) cutting guides has been recently described, however there is limited reporting on the clinical outcomes and accuracy of this system. The purpose of this study was to evaluate the clinical outcomes and accuracy of correction of a 3D-PSI osteotomy system for HTO’s and DFO’s. It was hypothesized that patients would have significant improvements in patient-reported outcome (PRO) scores and that at least 90% of patients would have coronal alignment within 10% of the planned correction. Methods: A prospectively maintained database of patients who underwent opening wedge (oW) or closing wedge (cW) HTO or DFO utilizing a 3D-PSI system (Fine Osteotomy, Bodycad, Canada) from October 2020 to January 2022 was reviewed.Preoperatively and postoperatively, PROs were collected, including the International Knee Documentation Committee Subjective Knee Form (IKDC), San Francisco 12 physical component score and mental component scores (SF-12 PCS and MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) including the stiffness (WOMAC-stiff), pain (WOMAC-pain), physical function (WOMAC-PF) and total (WOMAC-total) scores, the Lysholm score, Tegner activity scale, and subjective satisfaction (1-10 scale, with 10 indicating maximum satisfaction). A paired t-test was used to evaluate for differences in PRO’s from pre- to postoperatively. To assess coronal and mechanical alignment, mechanical medial tibial width ratio (mMTWr), defined as the distance from the medial aspect of the tibia to the point on the tibia where the mechanical axis intersects the tibial plateau divided by the entire width of the tibial plateau, was measured on standing whole-leg radiographs (Figure 1). Radiographic measurements were performed by two blinded independent raters. Intra-class correlation coefficients (ICC) were calculated to determine inter-observer reliability for radiographic measurements between raters and reliability between the raters and the Bodycad software’s pre-operative measurements. To analyze correction accuracy, the differences between the planned final mMTWR based on the preoperative plan and actual measured mMTWr (Figure 2) as well as the percentage of patients within 10% of the planned mMTWR were calculated. This 10% threshold was based on prior studies and corresponds to approximately 2 degrees of tibiofemoral angle. Results: Complete data sets were obtained for 23 cases (16 oW-HTO, 4 oW-DFO, 2 cW-DFO, 1 combined cW-HTO + oW-DFO) at mean follow-up of 2.6 years. Demographics for the cohort are shown in Table 1. Using a Bonferroni-corrected P value (p<0.006), there were significant improvements from pre- to post-operatively in IKDC, Lysholm, WOMAC-pain, WOMAC-stiffness, WOMAC-physical function, and WOMAC-total scores (Table 2). The ICC’s for pre- and post-operative mMTWR measurements were 0.996 and 0.982, respectively, indicating near perfect agreement. The ICC between the raters pre-operative measurements of mMTWr on whole-leg standing radiographs and the Bodycad measurements of mMTWr based on the 3D CT was 0.985. 89% of patients were within 10% of the planned final mMTWR, and the median difference between the planned and actual correction was  3.7% (95% CI, 2.8 – 8.4). Excluding patients who underwent removal of hardware, 22% (5/23) of patients had at least one related reoperation. Survivorship, defined as patients who did not undergo revision osteotomy or arthroplasty, was 21/23 knees (91%). Conclusions: This study found that patients who underwent corrective HTO or DFO using PSI had significant improvements in PRO’s, and there was good accuracy, 89%, of coronal correction. These findings demonstrate that osteotomy utilizing 3D-PSI can lead to clinically meaningful improvements in patient function with high accuracy of planned correction. While the median difference of 3.7% between the planned and actual correction is less than 1 degree, the presence of outliers emphasizes the importance of meticulous surgical technique and abiding by osteotomy principles even when utilizing 3D PSI. This study adds to a growing body of literature that corrective osteotomies can significantly improve patients’ quality of life and knee function in the treatment of chondral and meniscal pathologies and provides early data on the accuracy and outcomes of a newly released 3D PSI osteotomy system for HTO’s and DFO’s.

Background: Psychological readiness is an essential determinant of safe return to sport (RTS) after injury, yet it is often underrepresented in assessments of patients with elbow instability. The Elbow Instability–Return to Sport after Injury (EI-RSI) scale is a questionnaire designed to evaluate psychological readiness in athletes after lateral ulnar collateral ligament (LUCL) reconstruction for posterolateral rotatory instability of the elbow. Purpose: To develop and validate the EI-RSI scale. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The EI-RSI was developed from the anterior cruciate ligament return-to-sport index (ACL-RSI) and the shoulder instability return-to-sport index (SI-RSI) with input from 10 patients with LUCL reconstruction (10 elbow joints), then tested in a retrospective cohort (2015-2021). Validity was assessed by correlating with the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Elbow Evaluation (PREE). Reliability was assessed using test-retest analysis. RTS was measured via a questionnaire assessing participation (yes/no), return to preinjury level, and time to return. Statistical analyses included the Mann-Whitney U test and the Cronbach alpha. Results: A total of 47 patients (47 elbow joints; mean age, 40.7 ± 13 years; 22 men) were analyzed, with a median follow-up of 77 months (interquartile range [IQR], 36-110). The EI-RSI demonstrated good construct validity, showing a moderate positive correlation with MEPS (r = 0.472; P < .001) and moderate negative correlations with the PREE total (r = −0.572; P < .001), PREE pain (r = −0.610; P < .001), and PREE function (r = −0.595; P < .001) scores. Test-retest reliability was excellent (Spearman rho = 0.965; P < .001; ICCsingle = 0.965 [95% CI, 0.935-0.981]; ICCaverage = 0.982 [95% CI, 0.966-0.991]). Internal consistency was high (Cronbach α = 0.982). Patients who returned to sport exhibited significantly higher EI-RSI scores (median, 91.3 [IQR, 83.2-94.6]) compared with those who did not (median, 77.5 [IQR, 52.5-91.7]; P = .017). No floor or ceiling effects were observed. Conclusion: Our study demonstrated that the EI-RSI is a valid and reliable instrument for evaluating psychological readiness to RTS after LUCL reconstruction for posterolateral rotatory elbow instability. Its clinical implementation may facilitate informed RTS decisions and identify patients who could benefit from psychological support before safely resuming athletic activity.

Background There exists a paucity of data on the relationship between psychological factors and return to sport in patients who undergo surgery for complex patellofemoral instability (PFI). The purpose of this study was to investigate the influence of psychological factors on the return to the preoperative level of sports and knee function in patients with complex PFI who were treated with distal femoral osteotomy (DFO). Methods Patients who underwent DFO for recurrent PFI associated with increased femoral antetorsion and/or valgus malalignment were included. Psychological readiness to resume sporting activities was assessed at a minimum of 12 months postoperatively using the PFI-Return to Sport after Injury (PFI-RSI) scale. A receiver operating curve (ROC) analysis was performed for the PFI-RSI scale and its ability to discriminate between patients who returned to the preoperative level of sport and those who did not. Spearman’s rank-order correlation was used to test for correlations between the PFI-RSI scale and patient-reported outcome measures (PROM), including Banff Patella Instability Instrument 2.0 (BPII 2.0), Kujala score, Tegner Activity Scale (TAS) and Visual Analog Scale (VAS) for pain. Results Sixty-five patients (70.8% female) were included at a median of 61.0 months (40.0-78.5 months) postoperatively. Patients who returned to their preoperative level of sports scored significantly higher on the PFI-RSI scale than patients who did not (75.8 [64.4–84.2] vs. 40.8 [23.4–60.9], p  < 0.001). Reaching a threshold value of 55 on the PFI-RSI scale could predict whether or not patients returned to the preoperative level of sport with a sensitivity of 90.9% and a specificity of 70.6% (area under the curve = 0.834; Youden index = 0.615). The PFI-RSI scale showed moderate to strong correlations with PROM. Conclusion Psychological readiness to resume sporting activities correlated with knee function and was significantly higher in patients who achieved the preoperative level of sport than in patients who did not.

Background: Elbow injuries are common among strength athletes, particularly distal biceps tendon ruptures. These injuries can significantly affect athletes’ performance and require effective treatment strategies to ensure optimal recovery and return to sport. Purpose/Hypothesis: The purpose of this retrospective cohort study was to evaluate the patient-reported outcomes, return-to-sport rate, and postoperative strength of competitive strength athletes who underwent distal biceps tendon repair. It was hypothesized that patients would show excellent patient-reported outcomes on validated questionnaires and exhibit high rates of return to sport as well as high subjective strength levels. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed for cases of distal biceps tendon repair in athletes competing in strength sports, such as weightlifting and powerlifting, between August 2003 and July 2020. The preoperative and postoperative sporting activity, mechanism of injury, and complications were assessed. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Additionally, the athletes were asked to rate their elbow strength as a percentage compared with their uninjured side. Results: A total of 183 patients were included (88% follow-up rate), with a mean follow-up of 69.6 ± 61.0 months. Among them, 168 underwent primary repair, while 15 underwent revision procedures, of which 7 involved allograft augmentation. All athletes were able to return to sport, and 73% of patients achieved full subjective strength of their affected arm. The median MEPS score was 100 (interquartile range, 100-100), and the median SANE score was 100 (interquartile range, 95-100). Multivariate linear regression analysis showed that an increased time between injury and surgery was associated with a decrease in the MEPS score (standard error [SE] = 0.002; t = −2.113; P = .036) and self-assessed strength (SE = 0.053; t = −3.183; P = .002). Graft usage was associated with a nonsignificant decrease in the SANE score (SE = 1.538; t = −1.791; P = .075). There were 28 complications (15%) that occurred, including 5 tendon retears (3%) and 1 intraoperative brachial artery injury (1%). Conclusion: Distal biceps tendon repair in competitive strength athletes resulted in a high return-to-sport rate and excellent recovery. However, delayed surgery negatively affected outcomes, and 27% of patients experienced persistent subjective strength deficits. Future research is needed to further optimize treatment strategies for athletes.

Objectives: Due to the expanding indications and increasing number of arthroscopic hip surgeries performed each year, there has been a subsequent increase in the number of revision hip arthroscopies. Cam over-resection can lead to the loss of the hip suction seal, resulting in instability and pain. After failure of non-operative treatment, hip remplissage can be utilized to fill the defect and restore the hip suction seal. There remains limited data in the literature regarding patient outcomes following hip remplissage. The purpose of this study was to evaluate minimum 2- and 5 -year patient-reported outcomes after arthroscopic hip remplissage with an iliotibial band (ITB) allograft for cam over-resection. Methods: Patients who underwent arthroscopic ITB hip remplissage from 2015 to 2022 were included in the study. Pre- and at short- (minimum 2 years) as well as at mid-term (minimum 5 years) follow-up, postoperative patient-reported outcomes, including the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport), were compared. Results: Forty-six patients (sex: 57% female, age at the time of surgery: 36±11 years) were included at short-term follow-up (median 2.3 years (range, 2.0-7.0 years; 86% follow-up) (Table 1).  Eleven of these patients (sex: 81.8% female, age at surgery: 42±10 years) were additionally followed up at mid-term (median 5.6 years [range, 5.0-7.2 years]). At short-term follow-up, SF-12 PCS, WOMAC pain, WOMAC function, WOMAC total, mHHS, HOS-ADL and HOS-Sport all statistically significantly improved post-operatively (Figure 1, Table 2). SF-12 MCS (P=0.06) and WOMAC stiffness (p=0.661) scores did not statistically significantly improve at short-term follow-up compared to preoperative scores. Four patients went on to revision hip arthroscopy (8.7%) and 2 patients converted to total hip arthroplasty (4.3%). In the mid-term follow-up analysis, similar patient-reported outcomes were identified. There was a significant improvement in all patient reported outcomes with the exception of SF-12 MCS (p=0.07) and WOMAC stiffness (p=0.34) (Table 3). No additional patients required revision hip arthroscopy and the two previously mentioned patients that converted to total hip arthroplasty were included in this cohort. Conclusions: Arthroscopic hip remplissage using an ITB allograft improves patient reported outcomes at short-term follow-up. Subgroup analysis at mid-term follow-up demonstrated that the clinical improvements are maintained without any additional conversions to total hip arthroplasty or need for revision hip arthroscopy. Remplissage is a reasonable and successful treatment for cam over-resection. Surgeons must remain diligent and careful to avoid cam over-resection in the primary and revision setting.

Objectives: Patient-specific instrumentation (PSI) based on three-dimensional (3D) computed tomography imaging (CT) is increasingly being used for corrective high tibial osteotomies (HTO’s) and distal femoral osteotomies (DFO’s). These PSI cutting guides are based off of measurements on a 3D CT, however plain radiographs are typically used during the pre-operative evaluation to determine the need for an osteotomy, and it is unclear how well measurements on plain radiographs correlate to those performed on 3D CT. The purpose of this study was to evaluate the correlation between measurements of coronal alignment and posterior tibial slope (PTS) on plain radiographs and measurements by semi-automated PSI software on 3D CT. It was hypothesized that coronal and posterior tibial slope measurements on plain radiographs would significantly correlate with measurements on 3D CT by PSI software. Methods: Patients who underwent hip to ankle CT as part of the pre-operative workup prior to a opening wedge (oW) or closing wedge (cW) HTO or DFO from October 2020 to November 2023 were reviewed. Mechanical medial tibial width ratio (mMTWr, Figure 1) and medial PTS (Figure 2) were evaluated pre-operatively by two independent raters, orthopaedic sports medicine fellows, on standing whole-leg radiographs and a lateral radiograph of the knee, respectively. Lateral radiographs were excluded if they were malrotated, defined as greater than 5 mm distance between the posterior aspect of the medial and lateral femoral condyles. The mMTWr and PTS using the full length tibial anatomic axis were measured on 3D CT utilizing semi-automated commercial PSI software (Bodycad, Quebec, Canada) without any surgeon involvement (Figure 3). Intra-class correlation coefficients were calculated to determine the inter-rater reliability between raters and between the raters and the PSI software for each measurement. Pearson’s correlation coefficient and an independent t-test were respectively used to analyze for a correlation and difference between the raters’ and PSI software’s measurements. Significance was set at p<0.05. Results: Complete data sets were obtained for 91 cases (43 oW-HTO, 17 cW-HTO, 24 oW-DFO, 4 cW-DFO, 1 rotational HTO, 1 combined cW-HTO and oW-DFO, 1 combined cW-HTO and cW-DFO). 11 patients were excluded from PTS measurements due to malrotated lateral knee radiographs. Demographics for the cohort are shown in Table 1. The ICC between raters for pre-operative mMTWr measurements was 0.99. The ICC between the raters’ measurements of mMTWr on whole-leg standing radiographs and the PSI measurements of mMTWr based on the 3D CT was 0.99, and these two measurements were significantly correlated (r=0.99, p<0.001). There was no difference between the raters’ (40.8% ± 23.5) and the PSI measurement of mMTWr (41.3% ± 22.1, p>0.05). The ICC’s between raters for pre-operative PTS measurements was 0.82. The ICC between the raters’ measurements of PTS on standard lateral knee radiographs and PSI measurements of medial PTS based on the 3D CT was 0.63, and these two measurements were significantly correlated (r=0.72, p<0.001). There was a significant difference between the raters’ measurements (10.4° ± 3.4) and the PSI measurements of PTS (12.0° ± 3.2, p<0.001). Conclusions: This study found that coronal measurements performed on standard whole-leg radiographs and by semi-automated PSI software on 3D CT and standing whole-leg radiographs are highly correlated with near perfect agreement between modalities. PTS measurements had moderate correlation between plain radiographs and 3D CT, and PTS on lateral knee radiographs was, on average, 1.6° less than 3D CT, which utilizes the full-length tibia. Although the absolute value of slope is different between modalities, these data are important as they confirm that PTS on plain radiographs is a moderately reproducible measurement which correlates highly with 3D CT. Altogether, these data confirm that measurements on standing whole-leg and lateral knee radiographs are reproducible and accurate for evaluating coronal alignment and PTS pre-operatively.

Background: The patient-specific instrumentation (PSI) used during corrective high tibial osteotomies and distal femoral osteotomies is based on 3-dimensional computed tomography (3D CT). Plain radiographs are typically used preoperatively to determine the need for an osteotomy; however, it is unclear how well measurements on plain radiographs correlate with 3D CT. Purpose/Hypothesis: The purpose of this study was to evaluate the correlation between coronal and sagittal alignment measurements on plain radiographs and 3D CT. It was hypothesized that there would be high agreement in the measurement of the mechanical medial tibial width ratio (mMTWr) and the medial posterior tibial slope (PTS) between both modalities. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients who underwent hip-to-ankle CT as part of the preoperative workup before a corrective osteotomy from October 2020 to November 2023 were reviewed. Coronal (mMTWr) and sagittal alignment (medial PTS) were evaluated preoperatively by 2 raters on standing whole-leg radiographs and a lateral radiograph of the knee, respectively, and by semi-automated PSI software on 3D CT. Intraclass correlation coefficients (ICC) were calculated to assess interrater reliability for each measurement and to evaluate agreement between raters and the PSI software. Results: Complete data sets were obtained for 91 cases. The ICC between raters for preoperative mMTWR was 0.99. The ICC between the raters’ measurements and the PSI software measurements of mMTWr was 0.99. The ICC between raters for preoperative PTS was 0.82. The ICC between the raters’ measurements and the PSI software's PTS measurements was 0.63. Conclusion: This study found that coronal measurements performed on whole-leg radiographs and 3D CT were highly correlated, with near-perfect agreement, and that medial PTS measurements showed moderate agreement between modalities. These data suggest that measurements on plain radiographs are reproducible and accurate for evaluating coronal alignment and PTS preoperatively. Surgeons can confidently use plain radiographs to assess whether or not a patient is a candidate for a knee osteotomy.