BackgroundUpper limb amputation is a devastating injury. Patients may choose to use a passive prosthesis, a traditional body‐powered prosthesis or a myoelectric prosthesis driven by electromyography (EMG) signals generated by underlying muscles. Targeted muscle reinnervation (TMR) aims to surgically create strong and reliable signals to permit the intuitive use of a myoelectric prosthesis with the greatest number of movements possible. We review the Alfred Hospital experience of using TMR to improve upper limb prosthesis control.MethodsA retrospective review of all cases of TMR performed at the Alfred Hospital was undertaken. Patient demographics, injury, surgical complications and outcomes were examined. Comparison was made to preoperative prosthesis use.ResultsSeven patients have undergone TMR to improve upper limb prosthesis control at the Alfred Hospital between 2015 and 2018. Within the patient group, pre‐TMR EMG signal numbers ranged from 1 to 2, and post‐TMR signal numbers ranged from 3 to 5. Six patients were able to achieve six degrees of freedom post‐operatively, and one patient achieved four degrees. No patients required the use of co‐contraction to switch function post‐operatively. There were no significant surgical complications.ConclusionThe use of TMR to improve and increase the number of EMG signals has been successful in generating more degrees of freedom for upper limb amputees with myoelectric prostheses.
Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the “ligamentization” of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices.
Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization.
Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria.
Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time.
Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery.
Level of Evidence This is a level I/II, review study.
Introduction
Scapholunate interosseous ligament (SLIL) injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date, no reconstructive technique has been described that discusses the potential benefit of the preservation of the scapholunate ligament remnant. Little is known about the ‘ligamentization’ of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices.
Method
We conducted a systematic review of the literature using Pubmed, Embase and Medline. Keywords were ‘Ligament’ AND ‘Reconstruction’ AND ‘Remnant’. We identified 366 original studies for title and abstract review. A total of 5 studies were included in the final analysis.
Results
In 5 animal studies, remnant stump integration resulted in enhanced ligamentization of grafted tissue as measured by vascularity, biomechanics, and proprioception.
Conclusions
Our review demonstrates a trend towards enhanced early ligamentization in grafts that incorporate the remnant stump. Remnant preservation is not currently performed in SLIL reconstruction and may provide an avenue for enhanced therapies. As such, it is a promising area for further, wrist specific, research.
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