Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi-CC7 transfer, on total root avulsion brachial plexus injuries (BPI). Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi-CC7 transfer for hand function, while group 2 (n = 20) received total-CC7 transfer. Additional neurotization included spinal accessory, phrenic, and intercostal nerve transfer for shoulder and elbow function. The results were evaluated with an average of 6 years follow-up. Results: Group 1 had fewer donor site complications (15%) than group 2 (45%); group 2 had significantly better hand M3 and M4 motor function (65%) than group 1 (30%; P = 0.02). There was no difference in sensory recovery. Significantly, better shoulder function was obtained by simultaneous neurotization on both suprascapular and axillary nerves. Conclusions: Total-CC7 transfer had better hand recovery but more donor complications than hemi-CC7. Neurotization on both supra-scapular and axillary nerves improved shoulder recovery. © 2013 The Authors. Microsurgery published by Wiley Periodicals, Inc. Microsurgery 34:91–101, 2014.

Upper arm type BPI patients have a good motor recovery after double nerve transfer. The different outcomes between C5-C6 and C5-C7 BPI patients appeared in muscles responding to hand grip, wrist extension, and sagittal movements in shoulder and elbow joints.

BackgroundThe unilateral approach for bilateral decompression was developed as an alternative to laminectomy. Unilateral laminotomy has been rated technically considerably more demanding and associated with more perioperative complications than bilateral laminotomy. Several studies have indicated that bilateral laminotomy are associated with a substantial benefit in most outcome parameters and thus constituted a promising treatment alternative. However, no complete kinematic data and relative biomechanical analysis for evaluating spinal instability treated with unilateral and bilateral laminotomy are available. Therefore, the purpose of this study was to compare the stability of various decompression methods.MethodsTen porcine lumbar spines were biomechanically evaluated regarding their strain and range of motion, and the results were compared following unilateral or bilateral laminotomies and laminectomy. The experimental protocol included flexion and extension in the following procedures: intact, unilateral or bilateral laminotomies (L2–L5), and full laminectomy (L2–L5). The spinal segment kinematics was captured using a motion tracking system, and the strain was measured using a strain gauge.ResultsNo significant differences were observed during flexion and extension between the unilateral and bilateral laminotomies, whereas laminectomy yielded statistically significant findings. Regarding strain, significant differences were observed between the laminectomy and other groups. These results suggest that laminotomy entails higher spinal stability than laminectomy, with no significant differences between bilateral and unilateral laminotomies.ConclusionsThe laminectomy group exhibited more instability, including the index of the range of motion and strain. However, bilateral laminotomy seems to have led to stability similar to that of unilateral laminotomy according to our short-term follow-up. In addition, performing bilateral laminotomies is easier for surgeons than adopting a unilateral approach for bilateral decompression. The results provide recommendations for surgeons regarding final decision making. Future studies conducting long-term evaluation are required.

The aim of this study was to evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction with an artificial ligament of the Ligament Augmentation and Reconstruction System (LARS) via an 8–15-year follow-up. Between January 1996 and January 2003, 38 patients received arthroscopic anterior cruciate reconstruction with the LARS artificial ligament at the Show Chwan Memorial Hospital, Changhua, Taiwan. Among them, 28 cases were included in this study. Excluding two failure cases, 26 cases were involved in the statistical analysis of various clinical assessments. The mean follow-up period after reconstruction was 11.4 ± 1.9 years. Assessment of clinical results included physical examination, magnetic resonance imaging, radiography, KT-1000 arthrometer test for knee stability, range of motion measurement, Lysholm score, and Tegner scale activity evaluations. The outcomes showed that among these 28 follow-up patients, there were two failure cases. The survival rate of LARS ligament reconstruction in this long-term follow-up was 92.9%. Among the 26 clinical assessed cases, the stability of the knee joint was improved as the anterior translation displacement measured by arthrometer reduced from 7.0 ± 3.1 mm (range: 4–17 mm) pre-operatively to 1.7 ± 1.7 mm (range: 0–6 mm) post-operatively. The Lysholm score improved from 39.7 ± 11.5 pre-operatively to 85.9 ± 19.6 post-operatively. Tegner activity scale improved from 3.2 ± 1.5 pre-operatively to 5.4 ± 2.4 post-operatively. All three improvements have statistic significance as the p-values were less than 0.05. In conclusion, ruptured ACL reconstruction with LARS artificial ligament has a survival rate of 92.9% and complication rate of 28.6% in this 8–15-year follow-up.