Hussein A. Elkousy

Arthroscopic Biceps Tenodesis Using the Percutaneous, Intra-articular Trans-tendon Technique: Preliminary Results

The percutaneous intra-articular trans-tendon procedure relieved pain, increased or maintained strength and function, and did not cause a cosmetic deformity in this small consecutive series of patients.

Immediate and early complications of the open Latarjet procedure: a retrospective review of a large consecutive case series

BACKGROUNDnImmediate and early postoperative complications of the Latarjet procedure are not well documented in the literature. The purpose of this study was to report the procedure-related complications of our large consecutive case series of 3 surgeons at a single high-volume center.nnnMETHODSnWe conducted a retrospective chart review of 416 Latarjet procedures performed on 400 patients (16 patients had bilateral procedures) who underwent surgery by the 3 senior authors from October 2002 to July 2015. Immediate and early complications included hardware problems, infection, and neurologic injury. In addition, the patients age and history of prior instability surgery were noted and evaluated as risk factors for complication.nnnRESULTSnThe overall complication rate was 5.0% (21 complications in 19 procedures). Thirteen neurologic injuries (3.1%) occurred to the axillary (7), musculocutaneous (4), and suprascapular (2) nerves, including 2 patients with multiple nerves affected. All but 2 patients had complete resolution of symptoms at time of last follow-up. Six infections (1.4%) developed, including 3 superficial infections treated with oral antibiotics and 3 deep infections requiring irrigation and débridement with intravenous antibiotics. Two early hardware-related complications (0.05%) were also noted. Increased age was associated with a higher complication rate. History of prior surgery was not associated with increased complications in our series.nnnCONCLUSIONSnThis study highlights the procedural complications of the Latarjet procedure. Neurologic injury was the most common complication in our series, with complete or near-complete recovery in 11 of 13 patients.

Retrospective Comparison of Freehand and Ultrasound-guided Shoulder Steroid Injections

The objective of this study was to assess the clinical benefits and financial feasibility of using ultrasound for steroid injections of the shoulder. A retrospective chart review and telephone survey of patients in a clinical shoulder practice were performed. ICD-9 codes and CPT codes identified patients who received shoulder injections without (2006) and with (2007) ultrasound guidance during 2 consecutive years. Results were assessed by patient assessment of relief and duration of that relief via telephone survey or from chart review. Financial data was assessed by reviewing the patients accounts. One hundred fifty-seven injections were given in 2006 and 159 in 2007. In 2006, 126 unique patients were injected compared to 99 unique patients in 2007 (P<.001). Clinical data was collected on 272 patients (86.1%). Ultrasound had no significant effect on the amount of pain relief following injection (P=.468). One hundred thirty-six patients (50.0%) reported significant pain relief, 72 (26.5%) reported moderate, 39 (14.3%) reported mild, and 25 (9.2%) reported no pain relief following injection. During both years, 92.4% of patients had subacromial injections with no significant difference in injection sites (subacromial vs glenohumeral) between the 2 years (P=.252). Neither the injection site (subacromial or glenohumeral, P=.152) nor diagnosis (P=.540) had a significant effect on pain relief. Financial collections from injections increased as expected due to the use of ultrasound.Ultrasound guidance did not change the efficacy of steroid injections, the number of injections, or the type of injections. Steroid injections are useful for managing pain in several shoulder conditions and ultrasound guidance may not be necessary.

Broadening the indications for meniscal repair

The management of meniscal tears is still evolving. As recently as 20 years ago, many meniscal tears were treated with complete excision. With the growing appreciation for meniscal function, management has progressed to partial meniscectomy, meniscal repair, and meniscal transplant to preserve as much of the meniscus as possible. The decision to perform a meniscal repair depends on the patience and technical expertise of the surgeon and on certain properties of the tear itself. Many surgeons are now performing meniscal repairs on tears of defined patterns and locations in a subset of patients; however, many tears are still treated with partial excision. This article explores the current indications for meniscal repairs and how some surgeons are broadening these indications.

Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy

BACKGROUNDnThe purpose of this study was to evaluate outcomes in patients with rotator cuff tear arthropathy after staged bilateral reverse shoulder arthroplasties (RSAs) and to compare them with an age-, gender-, and diagnosis-matched control group with a unilateral RSA.nnnMETHODSnWe identified 11 patients with bilateral RSAs for rotator cuff tear arthropathy with a minimum of 2-year follow-up in a prospective shoulder arthroplasty registry. The bilateral group was matched to a control group of 19 patients with a unilateral RSA. Shoulder function scores, mobility, patient satisfaction, and activities of daily living were assessed preoperatively and at final follow-up.nnnRESULTSnThere was no statistical difference between the first RSA or second RSA and the control group regarding age, gender, or follow-up. No group differences were noted preoperatively for shoulder function scores or mobility (P > .10). All groups significantly improved on all shoulder function scores (Constant score, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index, Single Assessment Numeric Evaluation score) and mobility at final follow-up (all P < .01). There were no significant differences in shoulder function scores or mobility between the first and second RSA in the bilateral group or between either shoulder in the bilateral group and the unilateral group (all P > .10). Patient satisfaction improved and patients were successfully able to perform many important activities of daily living after bilateral RSAs.nnnCONCLUSIONSnPatients with bilateral rotator cuff tear arthropathy can be advised that staged bilateral RSAs can be successful when indicated. Improvements in shoulder function scores, patient satisfaction, and mobility are possible for both the first RSA and the second RSA.

ACL/PCL reconstruction: the role of double-bundle PCL reconstruction

Abstract Our approach to combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries depends on the timing of the injury and concomitant ligament and bony pathology. In the acute setting (within 3 weeks), we prefer to perform single-bundle ACL and PCL reconstruction because we have seen consistently good results. However, chronic combined injuries do not fare as well because single-bundle PCL reconstruction in these injuries has not consistently corrected posterior laxity. Because of this clinical data, we now utilize a double-bundle PCL technique for knees with chronic, combined ligament deficiency with instability. This particular patient population has significant anterior, posterior, and, in many cases, posterior lateral laxity. Once the decision has been made to proceed with this procedure, attention to the technical details is critical to achieving good results. In this article, we will outline important general and specific technical details that will facilitate the procedure and optimize the clinical outcome.

Ligament deficiency with mal alignment

In caring for active middle aged patients with a knee ligament deficiency, orthopedic surgeons must consider several variables not present in younger patients. Besides the specific ligament deficiency, practitioners must also consider alignment, or mal alignment, and degenerative changes of the knee. These factors may exacerbate the symptoms of ligament deficiency or they may impact the therapeutic intervention. Diagnostic tools include a detailed history, thorough physical examination, and imaging modalities. Several operative options are available depending on the specific pattern of pathology. These options include ligament reconstruction, osteotomies, or meniscus transplantation in various combinations. In this article, ligament injuries in middle aged athletic patients in which alignment plays a role are reviewed, and diagnostic and therapeutic options for their management are offered. Also, emphasized are the more common anterior cruciate ligament deficiency with varus mal alignment and the less common posterior cruciate ligament deficiency with medial compartment arthrosis.