Background: Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown. Purpose: To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models. Results: Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P = .037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P = .047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P = .038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P = .001) were risk factors for greater tuberosity resorption. Conclusion: Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.
A 40-year-old patient and a 45-year-old patient presented with chronic dorsal and lateral subluxation of the proximal interphalangeal (PIP) joint of the little finger and underwent surgeries. Through a dorsal approach, the ulnar lateral band was transected and transferred to the radial side through the volar side of the PIP joint. The transferred lateral band and the remnant of the radial collateral ligament were secured with an anchor on the radial side of the proximal phalanx. Satisfactory results were obtained without the loss of flexion and recurrence of subluxation of the finger. This method enabled the correction of both dorsal and lateral instability of the PIP joint through a dorsal incision. The modified Thompson–Littler technique was useful for chronic instability of the PIP joint.– Level of Evidence: Level V (Therapeutic)
The aim of this retrospective study was to assess the effectiveness of autogenous bone grafting for arthrodesis of the thumb carpometacarpal joint by comparing the bone union rates with and without bone grafting. We included 36 patients who underwent arthrodesis of the thumb carpometacarpal joint for arthritis (20 patients with bone grafts and 16 without bone grafts). Implants used for internal fixation were K-wire, tension band wiring, headless compression screw and locking plate. The presence of bone union and the time from surgery to bone union were evaluated. The bone union rate was 20/20 (100%) in the bone grafting group and 12/16 (75%) in the non-bone grafting group ( p = 0.03). There were no significant differences between the two groups in the time from surgery to bone union and patient characteristics. In conclusion, autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis. Level of evidence: III
Background: Hand surgeons sometimes place more weight on clinical findings and may not always consider the results of electrodiagnostic studies (EDX) in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to determine factors associated with a change in diagnosis of CTS after EDX. Methods: This is a retrospective study of all patients with an initial clinical diagnosis of CTS who underwent EDX at our hospital. We identified patients whose diagnosis changed from CTS to non-CTS after EDX and used univariate and multivariate analysis to determine if age, sex, hand dominance, unilateral symptoms, history of diabetes mellitus, rheumatoid arthritis, haemodialysis, cerebral lesion, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items in CTS-6 and a CTS-negative EDX result were associated with a change in diagnosis after EDX. Results: A total of 479 hands with a clinical diagnosis of CTS underwent EDX. The diagnosis was changed to non-CTS in 61 hands (13%) after EDX. Univariate analysis demonstrated that unilateral symptoms, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items and a CTS-negative EDX result were significantly associated with a change in diagnosis. In the multivariate analysis, only the number of examined items was significantly associated with a change in diagnosis. Conclusions: EDX results were particularly valued in hands where the initial diagnosis was uncertain for CTS. In hands with an initial diagnosis of CTS, the performance of sufficient history-taking and physical examination was more valued at the final diagnosis than EDX results or other aspects of the patient’s background. The process of confirming a clear initial clinical diagnosis of CTS using EDX may be of little value for decision-making at the final diagnosis. Level of Evidence: Level III (Therapeutic)
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