Background Although upward humeral head migration is a well-recognized phenomenon in patients with tears of the cuff, it is unclear whether it relates to patient function after cuff repair. The upward migration index (UMI) assesses proximal migration of the humeral head while controlling for patients' bony morphologic features. Questions/purposes We asked whether functional and quality-of-life (QOL) improvement occurs longitudinally in patients with low, moderate, or high degrees of proximal humeral migration after arthroscopic cuff repair and whether differences occur between groups. Patients and Methods We retrospectively reviewed 118 patients with full-thickness tears treated by arthroscopic cuff repair. Patients were divided into three groups depending on the severity of preoperative proximal humeral migration seen on MRI. We determined function using two functional scores and the Western Ontario Rotator Cuff Index (a QOL index). Evaluations were performed preoperatively and 6 and 12 months postoperatively. A general linear model analysis controlled for patient characteristics, including the UMI, to determine their effects on functional and QOL scores. Results Function and QOL improved after surgery in all three groups. The UMI did not correlate with final functional or QOL scores. Six-month functional and QOL scores correlated with final scores. The best predictor of final strength was initial strength. Conclusions Preoperative UMI did not correlate with functional or QOL improvements after surgery. The data suggest substantial proximal migration of the humeral head, as measured by the UMI, should not be considered a contraindication to arthroscopic rotator cuff repair. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

The mechanical behavior of human scapholunate ligaments is not well understood. Presently, intact scapholunate specimens were mechanically tested in linear distraction and torsion. Fresh bovine tendon grafts were used to reconstruct the scapholunate interval and the tests repeated. Tests yielded the following average values for intact specimens: linear stiffness (48.9 Nmm), linear load retained at 100 s (44%), torsional stiffness (19.5 N mmdeg), torque remaining at 100 seconds (66%), torque-to-failure (1253.9 N mm), and angle-to-failure (50.4 deg). Tests showed the following average values for reconstructed specimens: linear stiffness (5.4 Nmm), linear load retained at 100 s (49%), torsional stiffness (12.6 N mmdeg), torque remaining at 100 s (71%), torque-to-failure (936.8 N mm), and angle-to-failure (54.5 deg). There were no statistically significant differences between the intact and reconstructed specimens, with the exception of linear stiffness. Biomechanically, this is the first study in the literature to quantify torsional stress relaxation, failure torque, and failure angle for the intact and repaired human scapholunate ligament. Surgically, reconstruction with bovine tendon may warrant further investigation as a method to potentially retain function and strength after scapholunate injury.

We examined whether a single 1-gram preoperative dose of tranexamic acid (TXA) was effective in reducing 1) allogeneic blood transfusion, 2) haemoglobin (Hb) decreases, and 3) perioperative blood loss following primary total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). One hundred and thirty-two patients (88 THA, 44 RHA; 66M, 66F; mean age = 58.2 years) who received TXA were compared with a control group matched for starting Hb, body mass index (BMI), age and gender. For the THR, transfusion rates were 4.5% and 19.3% for the TXA and control groups, respectively (p = 0.001) with no difference for the resurfacing patients. The mean overall Hb decrease was significantly lower in the TXA treatment groups for both THA and RHA patients (p<0.0001 and p = 0.01 respectively). 1 g of tranexamic acid administered preoperatively significantly reduced the mean decrease in haemoglobin as well as risk of transfusion.

The mechanical behaviour of human scapholunate ligaments is not well described in the literature with regard to torsion. In this study, intact scapholunate specimens were mechanically tested in torsion to determine whether a simultaneous tensile load was generated. Human intact scapholunate specimens (n = 19) were harvested. The scaphoid and lunate bones were potted in square chambers using epoxy cement, while the interposing ligament remained exposed. Each specimen was mounted rigidly in a specially designed test jig and remained at a fixed axial length during all tests. Specimens were subjected to a torsional load regime that included cyclic preconditioning, ramp-up, stress relaxation, ramp-down, rest, and torsion to failure. Torque and axial tension were monitored simultaneously. The relationship between torsion and tension was determined. Graphs of torque versus tension were generated, from which outcome measures were extracted. Tests demonstrated a clear relationship between applied torsion and the resulting generation of tension for the ligament during ramp-up (torsion-to-tension ratio, 38.86 +/- 29.00 mm; linearity coefficient R2 = 0.89 +/- 0.15; n = 19), stress relaxation (torsion-to-tension ratio, 23.43 +/- 15.84 mm; R2 = 0.90 +/- 0.09; n = 16), and failure tests (torsion-to-tension ratio, 38.81 +/- 26.39mm; R2 = 0.77 +/- 0.20; n = 16). No statistically significant differences were detected between the torsion-to-tension ratios (p = 0.13) or between the linearity (R2) of the best-fit lines (p > 0.085). A strongly coupled linear relationship between torsion and tension for the scapholunate ligament was exhibited in all test phases. This may suggest interplay between these two parameters in the stabilization of the ligament during normal motion and for injury cascades.