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Objectives:Operative repair of distal biceps tendon ruptures have shown successful outcomes. However, little is known about the amount of tendon or repair site lengthening or creep. Treatment algorithms in regards to repair fixation, immobilization, initiation of activity and physical therapy are largely made on previous tendon healing principles and anecdotal findings. The purpose of our study was to evaluate distal biceps tendon repair via intratendinous radiostereometric analysis to evaluate tendon lengthening/creep at different time intervals of healing.Methods:Ten patients were recruited who sustained a distal biceps rupture requiring operative repair. Distal biceps repairs were performed using an endobutton only, single incision technique. Intraoperatively, two 2-mm tantalum beads with laser-etched holes were sutured to the distal biceps tendon. One bead was placed at the radius tendon interface and the other placed 1cm proximal to the first bead. Beads were evaluated via both CT scans immediately post-operatively and at 16 weeks and x-rays obtained at time 0 and then at 4, 8, and 16 weeks. Measurements were made using the endobutton to bead and bead-to-bead distances in order to assess repair site elongation as well as tendon elongation over time. Following final follow-up, patients underwent a DASH questionnaire and ultrasound to confirm the integrity of the tendon.Results:Ten patients were included in the study. Nine patients had complete ruptures with one having a partial rupture that underwent completion and subsequent repair. All patients showed statistically significant lengthening after surgery. The mean amount of lengthening after surgery was 21.8 mm (range 10.1-29.7 mm, p < 0.05). The repair site lengthened a mean of 12.5 mm (range 8.8-17.0 mm, p <0.05) and the tendon lengthened a mean of 9.4 mm (range: 4.0-18.8 mm, p<0.05) from surgery to final follow-up. The greatest change in lengthening was noted between time 0 and week 4 (mean: 11.8 mm, range: 4.0-18.0 mm, p<0.05), with the least amount of lengthening between week 8 and week 16 (mean: 3.6 mm, range: 2.1-5.5 mm, p<0.05). Average DASH scores after surgery was 4.5 (range: 2.5-16.7). Final ultrasound evaluations found no re-ruptures in any of the patients.Conclusion:This study’s findings suggest that all patients undergoing distal biceps tendon repair have significant elongation of their repair site and tendon after surgery, with the greatest amount of lengthening seen in the early post-operative period. These findings lend insight into decision-making with regards to intraoperative repair fixation and post-operative activity protocols while also adding knowledge to overall tendon repair principles.

Background To evaluate the accuracy of intravitreal injection volume of the pre-filled syringe (PFS) in which aflibercept is packaged compared to the BD Luer-Lok 1-mL syringe. Methods Ophthalmologists injected their typical intravitreal volume for aflibercept using either the PFS or BD Luer-Lok 1-mL syringe for 5 times each. The injected fluid was weighed using a micro-scale and converted to volume. The volume of fluid injected was also evaluated when the 0.05 mL line on the PFS was lined up to the tip or base of the dome-shaped plunger. Results Injection volume was measured for 12 physicians. The average injected fluid volume was 74.22 ± 15.87 µL for PFS and 53.42 ± 4.61 µL for the BD Luer-Lok 1-mL syringe (p < 0.0001). The average deviation in volume injected for the PFS was higher compared to the BD Luer-Lok 1-mL syringe (11.36 µL vs. 3.35 µL, p < 0.0001). When the PFS was lined up with the tip of the dome-shaped plunger at the 0.05-mL line, the average injected volume was 71.03% higher. Conclusions The intravitreal injection volume and variability using the new PFS were significantly higher than the volume injected using the BD Luer-Lok 1-mL syringe previously used, potentially leading to higher rates of visually significant elevation of intraocular pressures.

Objectives: Operative repair of distal biceps tendon ruptures have shown successful outcomes. However, little is know about the amount of tendon or repair site lengthening after repair and how this may affect strength. The purpose of our study was to evaluate distal biceps tendon repair via radiostereometric analysis and correlate with final strength changes. Methods: Eleven patients with distal biceps ruptures were recruited. During repair, two 2-mm tantalum beads with laser-etched holes were sutured to the distal biceps tendon. Beads were evaluated via CT scans immediately postoperatively and at 16 weeks. X-rays were obtained at time 0 and then at 4, 8, and 16 weeks. Seven patients were available for final strength testing at minimum of 9 months postoperative. Results: The mean amount of tendon lengthening after surgery was 22.8 mm (range 11.2 -30.9 mm, p < 0.05). The greatest change in lengthening was noted between time 0 and week 4 (mean: 11.3 mm, p<0.05), with the least amount of lengthening between week 8 and week 16 (mean: 2.6 mm, p<0.05). DASH averaged 8.2. Strength testing performed at final follow-up (n=7) showed 78% supination and 88% flexion strength compared to contralateral side (33% with dominant arm repaired). Supination strength loss showed the greatest decreases with increased lengthening from 0-4 weeks (Correlation coefficient: -0.39). Final ultrasound evaluations found all tendons to be in continuity. Conclusion: This study's findings suggest that all patients undergoing distal biceps tendon repair have significant lengthening after surgery. The greatest amount of lengthening was noted in the early post-operative period, in which the greater the amount of lengthening trended toward a greater loss of supination strength. Further studies will focus on post-operative protocols as they may have an impact on early tendon lengthening and could be adjusted to minimize this consequence on long-term supination strength.

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performed in professional baseball with a special focus on outcomes (return to play rates and time) and survivorship. Methods: Three resources (including the Major League Baseball [MLB] injury tracking system) were combined to identify all professional baseball players who had ever undergone primary UCL reconstruction (1974 to 2015). Variables analyzed included the date of injury, date of surgery, time out of play, geographical region, and revision status. Trends over time were analyzed collectively and based on level of play at the time of surgery. A minimum of 2 years of follow up was required to determine return to play status. Results: A total of 1,313 UCL reconstructions were identified. The annual rate of primary and revision UCL reconstructions rose significantly (p<0.001). The mean time to return to play (RTP) was 436 days (range 98 to 1,643). The rate of RTP to any level was 93.9% for MLB pitchers vs. 76.3% for MiLB pitchers (p<0.001), and MLB pitchers RTP at the MLB level in 73.1% of cases. The time to RTP was longer (by 54 days) for revisions (p¼0.025) compared to primaries, and MLB pitchers RTP from primary surgery 95.6% of the time but only 81.8% for revision surgery (p¼0.008). The revision rate was 10.7%, and the percentage of players free of revision and still playing professional baseball was 92% at 2 years, 53% at 5 years, and 17% at 10 years. Conclusion: This study represents the most robust epidemiologic report of UCL reconstruction in baseball to date, and a number of novel findings are reported. Although the revision rate (10.7%) is higher than prior reports, 75% of players who had surgery before age of 25 are revision free and still playing professional baseball four years post operative.