To understand better the relationship among radionuclide renal scan differential function, renal histology and the outcome of pyeloplasty we performed ipsilateral renal biopsies in a series of patients undergoing primary pyeloplasty. A total of 17 consecutive patients with unilateral ureteropelvic junction obstruction underwent renal biopsy at the time of pyeloplasty. Biopsies were examined systematically after sections were stained with hematoxylin and eosin, periodic acid, Schiff, Jones modified silver or Masson trichrome stains, and they were reviewed by 1 pathologist. Biopsy results were correlated with preoperative and postoperative radionuclide renal scan differential functions. Patient age ranged from 1 month to 7 years (mean 19.8 months). Renal biopsy was abnormal in 6 kidneys, of which 5 had a preoperative differential function of less than 33%. None of these kidneys had evidence of postoperative improvement in renal function on followup scans despite a technically successful result. All remaining 11 kidneys had normal biopsies and a preoperative differential function of greater than 44%. We conclude from these data that patients with ureteropelvic junction obstruction with a differential function of less than 35% have a high probability of significant histological changes on biopsy and a low probability of postoperative improvement in differential function.
Background: Medial ulnar collateral ligament (MUCL) repair has been proven to be effective in nonprofessional overhead-throwing athletes, with faster and higher rates of return to play (RTP) than the more traditional Tommy John reconstruction. Biomechanical studies and clinical data suggest that MUCL repair augmented with a collagen-coated internal brace may be an effective treatment option in this patient population. Purpose: To evaluate the functional outcomes of young nonprofessional athletes who underwent MUCL repair with internal brace augmentation for medial elbow instability. The hypothesis was that these patients will have high rates of RTP and improved functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Nonprofessional overhead athletes treated with MUCL repair with internal brace augmentation between 2015 and 2017 were prospectively evaluated for a minimum of 1 year. Preoperatively, all patients had evidence of medial elbow pain caused by MUCL insufficiency, as confirmed by signal changes on magnetic resonance imaging and valgus instability on arthroscopic examination. These findings did not allow them to participate in their chosen sport or profession, and each patient had failed nonoperative treatment. Postoperative outcomes were evaluated using the Overhead Athlete Shoulder and Elbow Score of the Kerlan-Jobe Orthopaedic Clinic. Complications were recorded and detailed. Results: A total of 40 nonprofessional overhead athletes were included in this study (35 men and 5 women; mean age, 17.8 years [range, 14-28 years]). The mean follow-up time was 23.8 months (range, 12-44 months). The mean postoperative Kerlan-Jobe Orthopaedic Clinic score was 92.6 (range, 64-100). Overall, 37 athletes (92.5%) returned to play or profession at the same level or higher at a mean time of 6.9 months (range, 2-12 months). Three patients did not RTP: 1 was limited by a concomitant medical diagnosis, and the other 2 chose not to resume athletics after the procedure but remained symptom free. Conclusion: In the nonprofessional athlete, primary MUCL repair with internal brace augmentation is a viable alternative to traditional repair techniques or reconstruction, allowing for a rapid RTP and promising functional outcomes.
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