Tenolysis of the flexor tendons was performed in 78 fingers (72 patients) by the same surgeon. Two technical modifications were introduced: reconstruction of a robust pulley; and initial immobilization with the tendon in a proximally migrated position, permitting later breakdown of early adhesions by gentle extension either by the surgeon or using an extension spring. After a mean follow-up of 21.5 months, the total active movement was improved from 135 degrees (pre-operative) to 203 degrees (post-operative) in 84% of fingers and from 65 degrees to 115 degrees in 78% of thumbs. This corresponds to a reduction in impairment of 10.1% for the thumb and 21.6% for the fingers. There was no improvement in four digits and nine cases were made worse, averaging a loss of range of 25.4 degrees. Among these were two cases of skin breakdown and two cases of tendon rupture (2.5%), one combined with skin necrosis.
Introduction: Total Knee Replacement (TKA) surgeries are frequently performed surgeries used to treat knee osteoarthritis. Several methods of medial soft tissue balancing in the varus knee during total knee replacement surgeries have been reported. Traditionally, they included releasing the superficial Medial Collateral Ligament (sMCL) in severe varus cases by several methods. However, this release can create instability in the knee. The aim of this study was to create an algorithm for soft tissue release in varus osteoarthritic knees and to evaluate its efficacy in achieving intraoperative gap balancing without releasing the superficial MCL. Materials and Methods: One hundred and five varus osteoarthritic knees who received primary posterior stabilized total knee arthroplasties between October 2015 and January 2016 were included in this study. Varus deformities ranged between 10 to 40 degrees. Sequential balancing was done into 5 steps: step 1 – releasing of deep MCL, step 2 – excision of osteophytes, step 3 – excision of scarred tissue in the posteromedial corner, step 4 – excision of the posteromedial capsule and step 5 – release of semimembranosus. The V-STAT® Variable Soft Tissue Alignment Tensor was used to ensure a balanced medial and lateral gap following each step. Once the gaps were balanced, no further soft tissue release were carried out. Results: All knees were balanced without releasing the superficial MCL ligament. The maximum release step necessary was: step 1 (0 cases), step 2 (31 cases), step 3 (35 cases), step 4 (25 cases) and step 5 (14 cases). Conclusion: Superficial medial collateral ligament should not be released during intraoperative varus knees soft tissue balancing in posterior stabilized total knee arthroplasties. Preserving the superficial MCL is beneficial in maintaining implant stability without any increase in the constraint level of the implant even in cases with severe deformity.
Creation of the femoral tunnel for single-bundle anterior cruciate ligament (ACL) reconstruction has a high rate of nonanatomic placement with the transtibial (TT) technique but yields better restoration with the anteromedial portal technique and close restoration of the anatomic femoral footprint with the outside-in technique. Modifications of the traditional (TT) technique have been described to restore the native femoral ACL footprint and to simulate doublebundle reconstruction. Modified TT techniques try to capture the anatomic femoral footprint through an anatomic tibial tunnel. In the technique described in this article, the anatomic femoral footprint is drilled first by the use of a 2.5-mm Kirschner wire through the parapatellar anteromedial portal, making an angle 30 to the sagittal plane and 20 to the horizontal plane. The wire is drilled while the knee is hyperflexed and then withdrawn from outside until its distal end reaches the intercondylar notch. The wire is then advanced in an antegrade manner while the knee is flexed 90 until it reaches the center of the marked tibial footprint. The angle of knee flexion may be slightly increased or decreased around 90 with or without slight internal rotation to capture the anatomic tibial footprint. The procedure is completed as a TT single-bundle ACL reconstruction.
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