Jerome G. Enad

Electrothermal capsulorrhaphy in glenohumeral instability without bankart tear

PURPOSE The purpose of this study is to review the clinical results of electrothermal capsulorrhaphy (ETC) performed on 23 patients for the treatment of glenohumeral instability at an minimum follow-up of 2 years. TYPE OF STUDY Retrospective case series. METHODS Twenty-six patients with symptomatic unidirectional or multidirectional glenohumeral instability without Bankart tear were treated with ETC using a radiofrequency probe. No labral repairs were performed. A standard postoperative rehabilitation protocol was followed. Patients were evaluated with respect to motion, direction of instability, need for repeat surgery, return to overhand sports, and symptoms of pain and instability using various scores. RESULTS Twenty-three patients were available for follow-up evaluation at an average of 30 months. The overall average ASES and Rowe scores were 84.2 and 79.3, respectively. Recurrent instability requiring an open stabilization procedure occurred in 4 patients (17%), 2 with anterior and 2 with multidirectional instability. Seven of 14 overhead athletes (50%) reported inability to return to their previous level. According to Rowe scores, overall results were 11 excellent, 5 good, 4 fair, and 3 poor. No postoperative nerve complications occurred. CONCLUSIONS The ETC procedure was safely performed to treat glenohumeral instability without Bankart lesions. The recurrence rate is similar to that for other arthroscopic procedures but higher than for open surgery. In the absence of Bankart tear, patients with multidirectional instability and overhand athletes may require something other than an isolated ETC procedure to address instability. Long-term results of ETC are needed to better define its surgical indications.

Patellar Tendon Repair: Postoperative Treatment

OBJECTIVE To compare results of patellar tendon repair after early and delayed postoperative mobilization. DESIGN Two separate treatment groups, comparing 2 treatment alternatives at different time periods (before-after trial). PARTICIPANTS Postoperative rehabilitation of 10 men who underwent patellar tendon repair. INTERVENTION Delayed mobilization group: weight-bearing in a cast and isometric lower-extremity exercises for 6 weeks; active flexion and extension exercises thereafter. Early mobilization group: weight-bearing in an extension brace, isometric lower-extremity exercises, prone active knee flexion, and passive knee extension for 6 weeks; active flexion and extension exercises thereafter. Sixteen-month minimum follow-up. RESULTS Clinical (physical) findings were: 2 excellent, 1 good, 2 fair in the delayed-mobilization group; 1 excellent, 3 good, 1 fair in early-mobilization group. Functional (pain and activity level) findings were: 2 good, 2 fair, 1 poor in the delayed-mobilization group; 3 good, 1 fair, 1 poor in the early-mobilization group. CONCLUSIONS Clinical and functional results were similar for both treatment groups. Further study is required to determine any significant long-term differences between rehabilitation methods.

Position of Brachial Artery with Changing Elbow Flexion: Implications for Arthroscopy (SS-49)

Introduction Arthroscopy of the anterior compartment of the elbow may be performed at various flexion angles depending on the procedure. Since the brachial artery courses near the anterior surface of the distal humerus and proximal ulna, it is important to recognize how the vascular anatomy is related to elbow position in order to minimize risk of arterial injury. The purpose of this study was to determine how close the brachial artery was located to the distal humerus and proximal ulna with varying elbow flexion. Methods Eleven fresh-frozen cadaveric elbows were obtained and superficial muscular dissection was performed to identify the brachial artery proximal and anterior to its crossing the elbow. Barium was injected through the lumen of the artery and lateral images of the elbow in the sagittal plane were obtained with a fluoroscan at 5 different elbow flexion angles (0, 30, 60, 90, and 110 degrees). Digital software was used for 2 measurements: 1) the closest distance of the brachial artery from the anterior surface of the distal humerus (at the coronoid fossa), and 2) the closest distance of the brachial artery from the anterior surface of the ulna (15 mm distal to the tip of the coronoid). One-way ANOVA for repeated measures was used to compare the mean distances for each flexion group within each measurement group. A coronal image in full extension was also obtained to examine the medial-lateral course of the brachial artery as it passed the coronoid and fossa. Results The mean distances of the brachial artery from the distal humerus for each flexion angle were 12.2 mm, 17.7 mm, 21.2 mm, 21.7 mm, and 21.2 mm at 0, 30, 60, 90, and 110 degrees, respectively. The mean distance away from the distal humerus significantly increased with increasing flexion up to 60 degrees (p Conclusion The results of this study suggest that the brachial artery is located further away from the distal humerus (at the coronoid fossa) and proximal ulna (at the coronoid) with increasing elbow flexion and slightly laterally in the coronal plane. These anatomic landmarks can be used as references during elbow positioning at arthroscopy in order to reduce the risk of brachial artery injury.

Postoperatieve behandeling van patellapeesrupturen

Patellar tendon repair: postoperative treatment [Archives of Physical Medicine & Rehabilitation 2000;81:786-8]