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Journal of Periodontal & Implant Science Apr 2024The aims of this study were 1) to investigate the effects of a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix (VCMX) on soft-tissue...
Soft-tissue volume augmentation using a connective tissue graft and a volume-stable collagen matrix with polydeoxyribonucleotide for immediate implant placement: a pilot study in a dog model.
PURPOSE
The aims of this study were 1) to investigate the effects of a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix (VCMX) on soft-tissue volume gain in the immediate implant placement protocol, and 2) to determine whether polydeoxyribonucleotide (PDRN) can enhance the effects of a VCMX.
METHODS
Dental implants were placed in 4 mongrel dogs immediately after extracting the distal roots of their third and fourth mandibular premolars. The gap between the implant and the buccal bone plate was filled with synthetic bone substitute particles. The following soft-tissue augmentation modalities were applied buccally: 1) control (no augmentation), 2) SCTG, 3) VCMX, and 4) VCMX/PDRN. After 4 months, histomorphometric analysis was performed. Tissue changes were evaluated using superimposed standard tessellation language (STL) files.
RESULTS
Wound dehiscence was found in more than half of the test groups, but secondary wound healing was successfully achieved in all groups. Histomorphometrically, tissue thickness was favored in group SCTG at or above the implant platform level (IP), and group SCTG and the groups with VCMX presented similar tissue thickness below the IP. However, the differences in such thickness among the groups were minor. The keratinized tissue height was greater in group VCMX/PDRN than in groups SCTG and VCMX. Superimposing the STL files revealed a decrease in soft-tissue volume in all groups.
CONCLUSIONS
Wound dehiscence after soft-tissue volume augmentation might be detrimental to obtaining the expected outcomes. PDRN appears not to have a positive effect on the soft-tissue volume gain.
PubMed: 38725426
DOI: 10.5051/jpis.2400240012 -
The Archives of Bone and Joint Surgery 2024Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine...
Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine whether isolated anatomic medial patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed configuration and fixed on the patella and the femur with suture anchors and interference screws, respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstruction can restore patellar stability in adolescents.
PubMed: 38716173
DOI: 10.22038/ABJS.2024.75154.3476 -
JSES International May 2024Arthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable...
BACKGROUND
Arthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable posterior-superior rotator cuff tears. The purpose of this study was to investigate whether favorable clinical outcomes after SCR for irreparable rotator cuff tears would be obtained in patients aged more than 70 years.
METHODS
A total of 173 consecutive shoulders in 162 patients who underwent arthroscopic SCR using autografts of fascia lata for irreparable rotator cuff tears were allocated to 3 groups according to patient age at the time of surgery: Group 1, <55 years old (11 shoulders); Group 2, 55-70 years old (85 shoulders); and Group 3, > 70 years old (77 shoulders). American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores, active shoulder range of motion, and visual analog scale were evaluated before surgery and at the final follow-up. Postoperative complications, including graft tears in magnetic resonance imaging and donor-site morbidity, were assessed.
RESULTS
The mean follow-up was 3 years and 9 months. Both American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores and active range of motion (elevation, external rotation, and internal rotation) increased significantly after arthroscopic SCR in all 3 groups ( < .001), and visual analog scale decreased significantly. All 3 groups had low graft tear (6%-10%) and donor site morbidity (0%-1%) rates, with no significant difference among the groups.
CONCLUSION
Arthroscopic SCR can lead to functional improvement and pain relief with a low rate of complications regardless of patient age.
PubMed: 38707584
DOI: 10.1016/j.jseint.2024.01.012 -
JSES International May 2024Although the ulnar collateral ligament reconstruction procedure has been increasing in popularity annually owing to its stable postoperative outcomes, the number of...
BACKGROUND
Although the ulnar collateral ligament reconstruction procedure has been increasing in popularity annually owing to its stable postoperative outcomes, the number of revision surgeries following ulnar collateral ligament reconstruction has increased. The success of the initial reconstruction surgery and further improvement in the return-to-play rates of the initial surgery are crucial. In this study, we report on ulnar collateral ligament reconstruction using the twisting technique, which aims to enhance the strength of the graft (palmaris longus tendon) to improve return-to-play rates.
METHODS
We investigated the return-to-play rate and period in 60 cases (2016-2021) that underwent ulnar collateral ligament reconstruction using the twisting technique and 211 cases (2007-2019) that did not use the twisting technique. The twisting technique involved inserting the graft through the bone tunnel and then twisting the doubled tendon.
RESULTS
According to the Conway-Jobe scale, the twisting technique group had 98.3% excellent, 1.7% good, 0% fair, and 0% poor results, with a mean return-to-play period of 9.8 months. The non-twisting technique group had 86.7% excellent, 9.0% good, 1.9% fair, and 2.4% poor results, with a mean return-to-play period of 11.4 months. The two groups showed significant differences in return-to-play rate ( = .020) and period ( = .022).
CONCLUSION
The clinical results of the twisting technique showed that the return-to-play rate of the twisting technique group was higher after than before the procedure, and the return-to-play period was shortened by more than 1 month. The twisting technique may improve the results of ulnar collateral ligament reconstruction surgery.
PubMed: 38707581
DOI: 10.1016/j.jseint.2023.12.003 -
Arthroscopy, Sports Medicine, and... Apr 2024To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years. (Review)
Review
PURPOSE
To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years.
METHODS
This was a secondary analysis from a prior systematic review of the MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases on studies evaluating clinical outcomes in ACLR patients ≥40 years. Studies were included based on the following criteria: English-language studies reporting on postoperative complications and/or ACLR failure rates in patients ≥40 years. Case reports, technical notes, studies with duplicate reporting of patient cohorts, or studies using publicly available registry data were excluded. ACLR failure definitions, failure rates, graft rupture rates, revision ACLR and non-ACLR revision rates, and complication rates were recorded.
RESULTS
Twenty-one studies were included following full-text review. Autografts were used in 89.0% of cases. Definitions for ACLR failure varied, ranging from (1) revision ACLR, (2) graft rupture, (3) clinical examination of increased knee laxity, and (4) postoperative arthrofibrosis requiring an additional surgery. The median ACLR failure rate was 5.0% (range, 0%-12.1%) among the 9 studies reporting this outcome, with only 4 of the studies providing explicit definitions of failure. The median ACLR revision surgery, graft rupture, and non-ACLR revision surgery rates were 0% (range, 0%-7.7%), 2.7% (range, 0%-9.1%), and 7.2% (range 0%-34.4%), respectively. Commonly reported complications included pain (range, 0%-14.0%), stiffness (range, 0%-12.7%), hematoma (range, 2.5%-8.8%), neurovascular (range, 0%-41.7%), and undefined (range, 0%-13.8%).
CONCLUSIONS
ACLR in patients over 40 years old shows low failure rates.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II-IV studies.
PubMed: 38706974
DOI: 10.1016/j.asmr.2024.100899 -
Arthroscopy, Sports Medicine, and... Apr 2024To determine the effectiveness of preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area (CSA) of the semitendinosus tendon in predicting...
PURPOSE
To determine the effectiveness of preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area (CSA) of the semitendinosus tendon in predicting the intraoperative quadrupled semitendinosus graft diameter of a posteriorly harvested hamstring autograft for anterior cruciate ligament (ACL) reconstruction.
METHODS
A retrospective review of patients who underwent ACL reconstruction with autograft using a posterior hamstring harvest was performed. Patient demographics and operative reports were reviewed, and measurements of the CSA of the semitendinosus on MRI were performed. Multiple linear regression was used to analyze the predictors for graft diameter. A value < .05 was considered statistically significant. Interrater and intrarater reliability were calculated.
RESULTS
280 patients were included. Patient height ( < .0001), and CSA of the semitendinosus ( < .0001) were significant predictors. Patients shorter than 63 inches had an average graft diameter of 7.89 mm compared to 8.69 mm for patients above 63 in ( < .001). The formula for the model is as follows: Graft diameter (mm) = 2.74 + .067·Height (in) + .00009 · Weight (lbs) + .0018 · Age (years) +.12·Gender (1 if M, 0 if F) 8.56 · CSA (cm). The for the model (0.5620), was greater than models using only height ( = .4092) or only CSA Semitendinosus ( = .3932). None of the interaction terms between covariates (e.g., height, weight, age, gender) were significant. Age ( =.6400), weight ( = .9970), and gender ( = .6700) were not significant predictors. Both intraclass (ICC = 0.864, 95% CI=[0.791, 0.912]) and interclass correlation (ICC=0.827, 95% CI=[0.715, 0.894]) showed good reliability.
CONCLUSION
CSA semitendinosus tendon and patient height independently perform similarly as predictors of graft diameter. When used together, CSA and height accurately predict the graft diameter. In particular, for patients under 63 in tall who demonstrated an average graft diameter below the minimum 8 mm, as suggested by the literature, this may be a useful tool for preoperative planning of patients intending to undergo ACL reconstruction with posterior hamstring harvest.
LEVEL OF EVIDENCE
Level III, diagnostic: retrospective cohort study.
PubMed: 38706973
DOI: 10.1016/j.asmr.2023.100844 -
Arthroscopy : the Journal of... May 2024Anterior shoulder instability is common. Cases of mild glenoid bone loss are typically addressed with conventional arthroscopic Bankart repair procedures, whereas more...
Editorial Commentary: Arthroscopic Subscapular Sling Procedure for Anterior Glenohumeral Instability Has Limitations: Dynamic Anterior Stabilization Using Long Head of the Biceps Tendon May Represent a More Favorable Alternative.
Anterior shoulder instability is common. Cases of mild glenoid bone loss are typically addressed with conventional arthroscopic Bankart repair procedures, whereas more critical glenoid bone loss often necessitates more invasive, bone-blocking procedures. Recently, for cases that fall between the need for arthroscopic repair and open procedures, surgeons have developed methods for using soft tissue grafts to create a "sling" effect and augment glenoid labral repair. The subscapular sling procedure aims to restore stability by introducing a semitendinosus autograft into the glenohumeral joint to reconstruct the torn labrum; the graft is wrapped around the subscapularis to create a suspensory sling. Limitations include harvest site morbidity; increased surgical time; subscapularis split, which can compromise the tendon integrity, resulting in loss of internal rotation; and a persistently positive apprehension test. Finally, the technique is complex, and similar alternatives with fewer limitations may include a dynamic anterior stabilization technique using the long head of the biceps tendon, which creates a stabilizing sling effect without graft harvest from the leg and has positive reported outcomes.
PubMed: 38705545
DOI: 10.1016/j.arthro.2024.04.017 -
JBJS Case Connector Apr 2024A 19-year-old woman sustained an open ankle fracture with complete destruction of the left medial malleolus and significant soft-tissue loss. After temporizing external...
CASE
A 19-year-old woman sustained an open ankle fracture with complete destruction of the left medial malleolus and significant soft-tissue loss. After temporizing external fixation and coverage with a rotational posterior tibial artery perforator flap, the medial malleolus was reconstructed with an autologous iliac crest bone graft and direct repair of the deltoid ligament. The patient achieved excellent improvement in functional outcomes at 21 months with adequate restoration of ankle motion.
CONCLUSION
This case shows reconstruction of the medial malleolus with autologous iliac crest bone graft after traumatic loss can be a viable treatment option for young patients.
Topics: Humans; Female; Ilium; Young Adult; Ankle Fractures; Autografts; Bone Transplantation; Fractures, Open; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 38704855
DOI: 10.2106/JBJS.CC.22.00559 -
Arthroscopy : the Journal of... Apr 2024To investigate the effects of ramp lesion (RL) and its repair on knee instability in patients with anterior cruciate ligament (ACL) injury by quantitatively assessing...
Anterior Cruciate Ligament-Injured Knees With Meniscal Ramp Lesions Manifest Greater Anteroposterior and Rotatory Instability Compared With Isolated Anterior Cruciate Ligament-Injured Knees.
PURPOSE
To investigate the effects of ramp lesion (RL) and its repair on knee instability in patients with anterior cruciate ligament (ACL) injury by quantitatively assessing anteroposterior and rotational knee instability before and after ACL reconstruction.
METHODS
All primary double-bundle ACL reconstructions using hamstring autografts between 2016 and 2021 were evaluated retrospectively. Patients with RLs without other meniscal injuries were included in group R, whereas those with isolated ACL injuries constituted group C. RL was repaired using all-inside devices in all patients in group R. Knee instability, including the amount of anterior tibial translation (ATT), and the acceleration and external rotational angular velocity of the knee joint (ERAV) during the pivot-shift test were assessed at the time of surgery. The pivot-shift test grade was recorded.
RESULTS
A total of 73 patients were included in this study. Preoperatively, group R (n = 23) had significantly greater pivot-shift grades (P = .039), ATT (6.0 mm, group R; 4.5 mm, group C, P < .001), acceleration (6.8, 2.8; P = .037), and ERAV (3.9, 2.8; P = .001) than group C (n = 50). Intraoperatively, ATT (-1.0 mm, -1.0 mm; P < .001), acceleration (1.2, 1.1; P < .001), and ERAV (1.4, 1.2; P < .001) were significantly decreased compared with the preoperative values in both groups. No significant differences in these values were observed between groups R and C.
CONCLUSIONS
ACL-injured knees accompanied by RLs exhibited significantly greater anteroposterior and rotatory instability than knees with isolated ACL injuries; increased knee instability can be effectively addressed by performing RL repair in conjunction with ACL reconstruction. The quantitative assessments employed-specifically measuring ATT, acceleration, and ERAV during the pivot-shift test-have allowed us to delineate these aspects of knee instability with greater precision.
LEVEL OF EVIDENCE
Level Ⅲ, retrospective comparative study.
PubMed: 38697327
DOI: 10.1016/j.arthro.2024.04.009 -
Journal of Orthopaedics Sep 2024To assess the difference in perceived readiness to return to sport (RTS) within the first year postoperative period between individuals undergoing anterior cruciate...
PURPOSE
To assess the difference in perceived readiness to return to sport (RTS) within the first year postoperative period between individuals undergoing anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) autografts or allografts.
METHODS
This was a prospective cohort study of patients undergoing primary ACL reconstruction done either with BTB autograft or allograft from 2010 to 2018. Skeletally mature patients aged 14 to 25 were eligible for inclusion. Patients completed the Marx Activity Rating Scale (MARS) questionnaire postoperatively evaluating perceived ability to perform various activities to compare subjective ability to RTS. Those patients who were outside outlined cohort age, failed to complete a single post-operative survey, underwent revision procedures, or underwent simultaneous or staged additional ligament surgery were excluded.
RESULTS
Fifty-nine patients (20.1 ± 3.19 years, 57.6 % Male) were included in the study. Sixteen patients underwent ACL reconstruction with allograft (19.8 ± 3.43 years) while 43 patients received autograft (20.2 ± 3.13). At 3 months autograft recipients reported higher perceived ability to cut ( = .003). At 6-months, allograft recipients reported higher perceived ability to run ( = .033), cut ( = .048), and decelerate ( = .008) as well as a higher overall perceived ability to RTS ( = .032). At all other times, there was no significant difference between cohorts' subjective readiness to perform activities.
CONCLUSION
The results of this study indicate that at times within the first year of recovery following ACL reconstruction, patients who receive allografts and autografts may have significantly different perceived ability to perform activities or RTS. However, while present at various times throughout the first year of recovery, any difference in perceived ability to perform activities or in overall RTS is no longer present at 12 months.
LEVEL OF EVIDENCE
Level II, Prospective cohort study.
PubMed: 38694957
DOI: 10.1016/j.jor.2024.04.010