The authors describe a novel suture fixation technique that combines a doubled suture with a sliding knot. The knot can be tied in both open and arthroscopic surgery to fix torn tendons/ligaments and fractured/osteotomized bones. The advantages of the doubled-suture Nice knot include strength, adjustability, simplicity, and versatility. This technique, which has proven useful in the authors' practice for the past 10 years, has replaced metallic wires and cables for bone fixation. The doubled-suture Nice knot can also be tied over a double-button and has been used for ankle syndesmosis, acromioclavicular joint separation repair, and coracoid bone block fixation. [Orthopedics. 2017; 40(2):e382-e386.].
Large joint arthrofibrosis and scarring, involving the shoulder, elbow, hip, and knee, can result in the loss of function and immobility. The pathway of joint contracture formation is still being elucidated and is due to aberrations in collagen synthesis and misorientation of collagen fibrils. Novel antibodies are being developed to prevent arthrofibrosis, and current treatment methods for arthrofibrosis include medical, physical, and surgical treatments. This article describes the biology of joint contracture formation, along with current and future pharmacologic, biologic, and medical interventions.
Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occur infrequently, few studies have documented surgical techniques and outcomes. Surgical strategies include arthroscopic débridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.
The aim of this study was to evaluate the impact of instrumented gait analysis on the walking performance of children with cerebral palsy at The Children's Hospital, Denver. The study population consisted of 2 groups of 10 children; an experimental group (X) and a recommendation matched control group (C). All subjects had 2 instrumented gait analyses at least 1 year apart. Group X was composed of patients who abided by the gait analysis recommendations and completed all surgical interventions. Group C included patients who chose not to follow surgical recommendations from the initial gait analysis but instead pursued alternative nonsurgical treatments. Sagittal and coronal plane kinematic outcomes for each surgical procedure were obtained from comparing sequential instrumented gait analyses, and analyzed using logistic regression. Group X was found to experience a significantly higher percentage of positive outcomes (44%) than Group C (26%). The calculated odds ratio using the Wald test indicated that patients who complied with gait analysis surgical recommendations were 3.68 times more likely to experience a positive outcome than recommendation matched patients who chose not to follow gait analysis recommendations.
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