Kenneth Cutbush

Scapholunate Ligament Reconstruction

Background Scapholunate reconstruction poses a challenge to orthopedic surgeons. Materials and Methods Prospective cohort. Description of Technique Our technique for scapholunate (SL) reconstruction involves ligament reconstruction utilizing a portion of the flexor carpi radialis tendon rerouted via transosseous tunnels across the scaphoid, lunate, and triquetrum (scapholunotriquetral tenodesis). The tendon graft is secured with interference screw fixation into the triquetrum. The philosophy of this new technique is to reduce subluxation and maintain the relationship between scaphoid and lunate by placing a graft through the center of the SL articulation. This graft is then tensioned by passing it centrally through the lunate and triquetrum and secured using an interference screw in the triquetrum. Secondary stabilizers, including the dorsal intercarpal ligament, are then augmented by passing the graft back to the scaphoid, crossing from the triquetrum over the proximal capitate. This further reinforces the translational relationship between the scaphoid and the triquetrum and, therefore, augments stability of the SL articulation. Results We have utilized this technique successfully in over 40 patients since 2009. We report on a prospective consecutive series of 11 patients with over 12 months follow-up (range 12 to 24 months) demonstrating good early radiological and clinical outcomes. Conclusions In developing this technique, we aimed to take the best features of previously described techniques and address the perceived shortcomings of each. We believe there are several benefits of our technique. Moreover, few other techniques address as many of the aspects of chronic SL instability as our technique does.

Early experience with the trimed fragment-specific fracture fixation system in intraarticular distal radius fractures

This paper reports the results of fixation of intraarticular fractures of the distal radius using the TriMed fragment-specific fixation system by surgeons early in their experience with the system. A consecutive series of 22 AO types C2 and C3 fractures in 21 patients were internally fixed with the system. Restoration of articular congruity to less than 2 mm was possible in 20 fractures. At a minimum of 6 months follow-up, mean volar and radial inclination were 8° and 25°, respectively, with no loss of reduction. The patients had a mean of 50° flexion, 63° extension and a pronation–supination arc of 149°. The mean subjective Patient Rated Wrist Score was 20. Our complication rate was comparable to other published series despite long operating times. Therefore, we commend the system as a powerful tool to treat these difficult fractures but acknowledge the significant learning curve.

All-Arthroscopic Latissimus Dorsi Transfer

Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function.

Capitellar fractures-is open reduction and internal fixation necessary?

Objective: The purpose of this retrospective study was to evaluate the medium-term to longer-term results of type 1 displaced capitellar fractures treated with closed reduction. Design: Retrospective case series. Patients: Eight consecutive cases (7 adults; 1 child) with type 1 capitellar fractures. Intervention: Closed reduction of type 1 capitellar fractures and 4 weeks of postreduction immobilization. Outcome Measures: Complications (including radiographic), Disabilities of the Arm, Shoulder, and Hand Score, and active elbow range of motion. Results: Average follow-up was 41.6 months (range, 18–77 months). All 8 fractures were united. The patients obtained near full return of the range of motion when compared with the uninjured contralateral side. Mean average Disabilities of the Arm, Shoulder, and Hand Score scores were 4.36 (SD, 2.68; Range, 0–9). No complications were observed. Conclusions: This study demonstrated that type 1 capitellar fractures can be treated successfully with closed reduction and cast immobilization. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

All-Arthroscopic Technique for Reconstruction of Acute Acromioclavicular Joint Dislocations

Acromioclavicular joint dislocations are a common injury particularly among contact sports players. There has been an increasing trend toward arthroscopic management of these injuries. To date, these reconstructions have primarily addressed superoinferior instability by reconstructing the coracoclavicular ligaments. We describe an all-arthroscopic technique for reconstruction of the coracoclavicular ligaments using Arthrex ABS TightRopes (Arthrex, Naples, FL), with additional stabilization of the superior acromioclavicular joint capsule using an anchor-based suture bridge to address anteroposterior instability.

Arthroscopic latarjet stabilization of the shoulder with capsulolabral repair

The arthroscopic Latarjet procedure is an evolving treatment for anterior shoulder instability in patients with significant glenoid bone loss, or failed soft-tissue repair. The original description of the arthroscopic Latarjet procedure includes resection of the anterior capsule to simplify passage of the transferred coracoid through the subscapularis split. We describe a technical modification of the arthroscopic Latarjet procedure that includes repair of the anterior capsule at the conclusion of the operation.