Aakash Chauhan

Flexor Tendon Repairs: Techniques, Eponyms, and Evidence

The evolution in surgical technique and suture technology has provided an abundance of options for flexor tendon repairs. Multiple biomechanical studies have attempted to identify the best surgical technique based on suture properties, technical modifications, and repair configurations. However, the burgeoning amount of research on flexor tendon repairs has made it difficult to follow, and no gold standard has been determined for the optimal repair algorithm. Therefore, it seems that repairs are usually chosen based on a combination of familiarity from training, popularity, and technical difficulty. We will discuss the advantages, disadvantages, and technical aspects of some of the most common core flexor tendon repairs in the literature. We will also highlight the nomenclature carried through the years, drawings of the repairs referred to by that nomenclature, and the data that support those repairs.

Extensor tendon injuries in athletes.

Extensor tendon injuries of the hand and wrist in high-level athletes can cause a delay in return to play and permanently affect their performance. Given the inherent demand for a speedy and complete recovery, orthopedic surgeons must have an understanding of how to best direct an athlete’s treatment for these injuries. The extensor anatomy is very intricate and a thorough understanding of the anatomy can help with both diagnosis and treatment. However, untreated or poorly managed injuries are at risk of leading to chronic deformities. We will discuss the diagnosis and management of the most common extensor tendon injuries and tendinopathies of the hand found in athletes: mallet fingers, swan-neck deformities, boutonniere deformities, central slip ruptures, sagittal band ruptures, intersection syndrome, extensor carpi ulnaris tendinitis, and extensor carpi ulnaris subluxation.

Presence of bacteria in failed anterior cruciate ligament reconstructions.

AbstractBackgroundNovel microbial detection technologies nhave revealed that chronic bacterial biofilms, which are recalcitrant to antibiotic treatment, are common in failed orthopedic procedures.QuestionsAre bacteria present on failed anterior cruciate ligament (ACL) reconstructions? Is there a difference in the presence or nature of bacteria in failed ACL reconstructions relative to a control set of healthy ACL’s?MethodsWe used a case–control study design, where we analyzed the bacterial composition of 10 failed ACL reconstructions and compared it to 10 native ACL’s harvested during total knee arthroplasty. The IBIS Universal Biosensor was used to determine the nature of bacteria on ACL specimens, and fluorescent in situ hybridization (FISH) was used to visualize bacteria in a subset of cases.ResultsBacteria are present in failed ACL reconstructions. Bacteria are present in ACL’s harvested during total knee arthroplasty, but the nature of the species differs significantly between experimental and control sets. Twelve genera were detected in the experimental set (in both allografts and autografts), and in four samples multiple species were detected. In contrast, the control group was characterized by presence of Propionibacterium acnes.ConclusionsWe demonstrate the presence of bacteria on failed ACLs surgeries, and open the door to investigate whether and how bacteria and the associated immune responses could possibly contribute to graft failure.Clinical relevanceIf microbial pathogens can be linked to failed grafts, it could provide: (1) markers for early diagnosis of abnormal healing in ACL surgeries, and (2) targets for early treatment to prevent additional reconstruction surgeries.

Patient-reported outcomes after acute carpal tunnel release in patients with distal radius open reduction internal fixation

BackgroundAcute carpal tunnel syndrome (CTS) is a complication that can develop after distal radius fractures. Our hypothesis tested whether patient-reported outcomes after acute carpal tunnel release (CTR) performed in combination with distal radius fracture open reduction internal fixation (ORIF) are worse than patient-reported outcomes with only elective CTR as measured by the symptom severity and functional status scales of the Boston carpal tunnel questionnaire (BCTQ).MethodsA retrospective assessment identified 26 patients treated with acute CTR at the same time as distal radius ORIF, no history of pre-existing CTS or CTR, no other injuries, and >12xa0months follow-up. Sixteen of these patients (Group A) could be contacted and answered the BCTQ. Group A was age- and sex-matched to control patients (Group B) treated with only elective CTR. A case–control study was performed comparing outcomes of both groups.ResultsThe average age of patients was 51u2009±u200915xa0years, with an average follow-up of Group A at 49u2009±u200921xa0months versus Group B at 55u2009±u200920xa0months. The mean symptom severity scale score for Group A was 1.4u2009±u20090.4 and for Group B was 1.4u2009±u20090.4. The mean functional status scale score for Group A was 1.4u2009±u20090.5 and for Group B was 1.3u2009±u20090.4. The mean total BCTQ score for Group A was 26.5u2009±u20097.5 and for Group B was 24.9u2009±u20097.5. There were no statistical or clinically significant differences between Group A and Group B for symptom severity, functional status, and total BCTQ scores.ConclusionsPatients with acute CTR performed at the same time with distal radius ORIF do as well in the long-term as those patients with only elective CTR as measured by the BCTQ. Patients should expect similar recovery of subjective nerve function from acute median nerve dysfunction when CTR is performed with distal radius ORIF as patients with only elective CTR.

Decellular Nerve Allografts.

Multiple treatment options are available for patients who have peripheral nerve injuries with a gap. Decellular nerve allografts are one option and provide an extracellular scaffold for neuronal cells to migrate for axonal regrowth. Immunosuppression is not needed because improved nerve processing technologies have rendered decellular nerve allografts nonimmunogenic. These allografts have also shown promising results in both animal and human studies as an alternative repair option.

Arthroscopically assisted elbow interposition arthroplasty without hinged external fixation: surgical technique and patient outcomes.

BACKGROUNDnTotal elbow arthroplasty is successful in older, lower demand patients but not in the younger, more active individual with severe elbow arthritis. Interposition arthroplasty is an alternative for younger patients who hope to minimize the degree to which arm use is restricted. Interposition arthroplasty traditionally involves release of all ligaments and capsule. As a result, the postoperative care included the use of a hinged external fixator of the elbow to apply distraction and to permit motion during the early phases of healing. We describe a novel surgical technique without a hinged external fixator that allows secure fixation of the interposition graft through arthroscopic assistance and maintains the integrity of the medial collateral ligament with only a takedown and repair of the lateral collateral ligament complex.nnnMETHODSnA retrospective chart review was performed to analyze 4 patients with an average age of 57 years who underwent surgery between 2007 and 2011. The patients were also contacted to assess elbow-specific American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder, and Hand scores.nnnRESULTSnThe average follow-up was 3.6 years (range, 2.5-6 years), and 1 patient was converted to a total elbow arthroplasty after 2.5 years because of persistent pain. The remaining 3 patients have done well with regard to pain control, stability, and functional use of the operative extremity. There were no postoperative complications.nnnDISCUSSIONnOn the basis of our small series of patients, an arthroscopically assisted elbow interposition arthroplasty without hinged external fixation can provide satisfactory medium-term outcomes as a salvage procedure for a difficult condition with limited options.

Use of extracorporeal membrane oxygenation support during an emergent decompression of a thoracic epidural abscess.

Study Design. Case report. Objective. To present the first reported case of using extracorporeal membrane oxygenation (ECMO) support in an emergent decompression and evacuation of a thoracic epidural abscess. Summary of Background Data. Thoracic epidural abscesses with neurological deficits require surgical evaluation and intervention in most cases. We report a case of a 35-year-old patient with an acute onset of paraplegia diagnosed with a thoracic epidural abscess. The patient was emergently taken to the operating room and was unable to tolerate prone positioning secondary to cardiopulmonary collapse. ECMO was initiated for cardiopulmonary support to complete the case. Methods. Retrospective chart review of patient case. Results. The patient was stabilized with ECMO support and tolerated a T4–T8 laminectomy and decompression. The source of the patients abscess was hematogenous and at 6 months of clinical follow-up, the patient has no motor or sensory function of his bilateral lower extremities. Conclusion. The use of ECMO support in adult spinal surgery has not been previously reported in the literature. Therefore we describe the first reported use of ECMO to maintain cardiopulmonary support in a patient unable to tolerate prone positioning during spine surgery. ECMO support can be a viable option in adult patients who need emergent spinal surgery but are unable to tolerate prone positioning secondary to cardiopulmonary complications. Level of Evidence: N/A

An Algorithm for Diagnosing and Treating Primary and Recurrent Patellar Instability

Major anatomic risk factors for recurrent patellar instability include trochlear dysplasia, patella alta, a lateralized tibial tuberosity, and medial patellofemoral ligament insufficiency.Acute first-time patellar dislocation may be treated nonoperatively in the absence of osteochondral injury.Recurrent patellar instability often requires medial patellofemoral ligament reconstruction, with osseous procedures reserved for patients with substantial underlying anatomic abnormalities.Surgical treatment of patellar instability is complex and should be individualized to address the needs of each patient.

Recurrent Cubital Tunnel Syndrome: A Critical Analysis Review

&NA; ≫ Most patients (>90%) will have continued or recurrent symptoms after primary cubital tunnel release. Those patients with severe preoperative findings are at a higher risk of failure. ≫ Failed primary surgery may be due to diagnostic, technical, or biologic factors. ≫ Revision surgical interventions can provide relief, but there is no consensus on what is the optimal technique. ≫ The options for revision surgery include simple neurolysis, neurolysis with subcutaneous transposition, and neurolysis with submuscular transposition. Autogenous (vein) and non‐autogenous nerve wraps may be placed around the nerve to prevent cicatrix reformation.

Posterior Shoulder Instability in Athletes

Posterior instability represents up to 10% of all cases of shoulder instability1. In athletes, posterior instability can result from a single traumatic injury, repetitive microtrauma, or, rarely, atraumatic instability. The demands on the athlete’s shoulder, especially in contact or overhead throwing sports, can be dramatic, and, as a result, the managing orthopaedic surgeon must understand the complexities of such an injury complex. Participation in contact sports may result in an increased risk for the development of traumatic posterior instability. In overhead athletes, posterior instability can result from repetitive microtrauma sustained from an early age, which can be further exacerbated with the increase in year-round play.nn### Static StabilizersnnThe static stabilizers of the glenohumeral joint include the glenoid and the humeral head, the capsulolabral complex, the articular surface, and the glenohumeral ligaments. Anatomic alterations of the retroversion of the osseous and chondrolabral portions of the glenoid have been shown to be associated with posterior shoulder instability2. Cadaveric studies of …