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Ilya Voloshin - One of the best experts on this subject based on the ideXlab platform.
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what regions of the distal clavicle have the greatest bone mineral density and Cortical thickness a cadaveric study
Clinical Orthopaedics and Related Research, 2019Co-Authors: Raymond E Chen, Michael D Maloney, Sandeep Soin, Rami Elshaar, Gregg T Nicandri, Hani A Awad, Ilya VoloshinAbstract:BACKGROUND Osteosynthesis of distal clavicle fractures can be challenging because of comminution, poor bone quality, and deforming forces at the fracture site. A better understanding of regional differences in the bone structure of the distal clavicle is critical to refine fracture fixation strategies, but the variations in BMD and Cortical thickness throughout the distal clavicle have not been previously described. PURPOSE /questions (1) Which distal clavicular regions have the greatest BMD? (2) Which distal clavicular regions have the greatest Cortical thickness values? METHODS Ten distal clavicle specimens were dissected from cadaveric shoulders. Eight specimens were female and two were male, with a mean (range) age of 63 years (59 to 67). The specimens were selected to match known epidemiology, as distal clavicular fractures occur more commonly in older patients with osteoporotic bone, and clavicular fractures in older patients are more common in females than males. The clavicles were then imaged using quantitative micro-CT to create 3-D images. The BMD and Cortical thickness were calculated for 10 regions of interest in each specimen. These regions were selected to represent locations where distal clavicular fractures commonly occur and locations of likely bony comminution. Findings were compared between different regions using repeated measures ANOVA with Geiser-Greenhouse correction, followed by Bonferroni method multiple comparison testing. Effect size was also calculated to estimate the magnitude of difference between regions. RESULTS The four most medial regions of the distal clavicle contained the greatest BMD (anterior intertubercle space 887 ± 31 mgHA/cc, posterior intertubercle space 879 ± 26 mgHA/cc, anterior conoid tubercle 900 ± 21 mgHA/cc, posterior conoid tubercle 896 ± 27 mgHA/cc), while the four most lateral regions contained the least BMD (anterior lateral distal clavicle 804 ± 32 mgHA/cc, posterior lateral distal clavicle 800 ± 38 mgHA/cc, anterior medial distal clavicle 815 ± 27 mgHA/cc, posterior medial distal clavicle 795 ± 26 mgHA/cc). All four most medial regions had greater BMD than the four most lateral regions, with p < 0.001 for all comparisons. For the BMD ANOVA, η was determined to be 0.81, representing a large effect size. The four most medial regions of the distal clavicle also had the greatest Cortical thickness (anterior intertubercle space 0.7 ± 0.2 mm, posterior intertubercle space 0.7 ± 0.3 mm, anterior conoid tubercle 0.9 ± 0.2 mm, posterior conoid tubercle 0.7 ± 0.2 mm), while the four most lateral regions had the smallest Cortical thickness (anterior lateral distal clavicle 0.2 ± 0.1 mm, posterior lateral distal clavicle 0.2 ± 0.1 mm, anterior medial distal clavicle 0.3 ± 0.1 mm, posterior medial distal clavicle 0.2 ± 0.1 mm). All four most medial regions had greater Cortical thickness than the four most lateral regions, with p < 0.001 for all comparisons. For the Cortical thickness ANOVA, η was determined to be 0.80, representing a large effect size. No differences in BMDs and Cortical thicknesses were found between anterior and posterior regions of interest in any given area. CONCLUSIONS In the distal clavicle, BMD and Cortical thickness are greatest in the conoid tubercle and intertubercle space. When compared with clavicular regions lateral to the trapezoid tubercle, the BMD and Cortical thickness of the conoid tubercle and intertubercle space were increased, with a large magnitude of difference. CLINICAL RELEVANCE Distal clavicular fractures are prone to comminution and modern treatment strategies have centered on the use of locking plate technology and/or suspensory fixation between the coracoid and the clavicle. However, screw pullout or Cortical Button pull through are known complications of locking plate and suspensory fixation, respectively. Therefore, it seems intuitive that implant placement during internal fixation of distal clavicle fractures should take advantage of the best-available bone. Although osteosynthesis was not directly studied, our study suggests that the best screw purchase in the distal clavicle is available in the areas of the conoid tubercle and intertubercle space, as these areas had the best bone quality. Targeting these areas during implant fixation would likely reduce implant failure and strengthen fixation. Future studies should build on our findings to determine if osteosynthesis of distal clavicular fractures with targeted screw purchase or Cortical Button placement in the conoid tubercle and intertubercle space increase fixation strength and decreases construct failure. Furthermore, our findings provide consideration for novel distal clavicular locking plate designs with modified screw trajectories or refined surgical techniques with suspensory fixation implants to reliably capture these areas of greatest bone quality.
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distal biceps brachii tendon repairs a single incision technique using a Cortical Button with interference screw versus a double incision technique using suture fixation through bone tunnels
American Journal of Sports Medicine, 2015Co-Authors: Edward Shields, Joshua R Olsen, Richard B Williams, Michael D Maloney, Lucien M Rouse, Ilya VoloshinAbstract:Background:Distal biceps brachii tendon repairs performed with a tension slide technique using a Cortical Button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature.Purpose:To perform a clinical comparison of the single-incision CB and double-incision BT techniques.Study Design:Cohort study; Level of evidence, 3.Methods:Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients >1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand).Results:Patients in the CB group (n = 20) were older (52 ± 9.5 vs 43.7 ± 8.7 years; P = .008), had a shorter interval from surgery to evaluation (17.7 ± 5 vs 30.8 ± 16.5 months; P = .001), a...
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a comparison of Cortical Button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Joshua R Olsen, Edward Shields, Richard B Williams, Richard K Miller, Michael D Maloney, Ilya VoloshinAbstract:Background Distal biceps brachii tendon repairs performed by a "tension slide technique" with a Cortical Button and interference screw (CB) are stronger than repairs by suture anchor (SA) techniques in biomechanical studies. However, clinical comparison of the 2 techniques is lacking in the literature. Methods Distal biceps tendon ruptures repaired with either a CB or SA technique through a single incision were identified from 2008 to 2013 at a single institution. Patients more than a year out from surgery completed a Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In addition, patients were assessed for range of motion, strength, and complications. All assessments were performed by individuals blinded to the surgical technique. Strength and motion values from the operative extremity minus the nonoperative arm values yielded differential values that were averaged and used to compare treatment groups. Results The CB (n = 20) and SA (n = 17) groups had similar demographics, except for the time from the surgery to evaluation (18 ± 5 vs 32 ± 15 months, respectively; P = .007). Range of motion differed slightly between the groups. The CB group demonstrated better pronation (0° ± 5° vs −4° ± 10°; P P P P P > .05). Conclusion CB and SA techniques provide good clinical results with similar complication rates.
Augustus D. Mazzocca - One of the best experts on this subject based on the ideXlab platform.
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Biomechanical performance of subpectoral biceps tenodesis: a comparison of interference screw fixation, Cortical Button fixation, and interference screw diameter.
Journal of Shoulder and Elbow Surgery, 2013Co-Authors: Paul M. Sethi, Arun Rajaram, Knut Beitzel, Thomas R. Hackett, David M. Chowaniec, Augustus D. MazzoccaAbstract:Background Subpectoral biceps tenodesis with interference screw fixation allows reproducible positioning of the tendon to help maintain the length–tension relationship. The aim of our study was to evaluate the role of Cortical Button fixation in isolation or as an augment to interference screw fixation and to determine if the diameter of the interference screw affected fixation strength. Materials and methods Thirty-two cadaveric shoulders were dissected and randomized to 1 of 4 groups: (1) 7-mm interference screw and Cortical Button, (2) Cortical Button alone, (3) 7-mm interference screw, or (4) 8-mm interference screw. Testing was performed on a materials testing system with a 100-N load cycled at 1 Hz for 5000 cycles, followed by an axial load to failure test. Cyclic displacement, ultimate load to failure, and site of failure were recorded for each specimen. Results The mean ultimate failure loads were 7-mm interference screw with Cortical Button augmentation, 237.8 ± 120.4 N; Cortical Button alone, 99.4 ± 16.9 N; 7-mm interference screw, 275.5 ± 56 N; 8-mm interference screw, 277.1 ± 42.1 N. All specimens failed through tendon failure at the screw–tendon–bone interface. Conclusions The biomechanical performance of subpectoral biceps tenodesis with interference screw fixation was not improved with Cortical Button augmentation. In addition, Cortical Button fixation alone yielded a significantly lower ultimate load to failure compared with interference screws. Finally, the biomechanical performance of smaller-diameter interference screws with matching bone tunnels was not affected by interference screw diameter.
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biomechanical properties of repairs for dislocated ac joints using suture Button systems with integrated tendon augmentation
Knee Surgery Sports Traumatology Arthroscopy, 2012Co-Authors: Knut Beitzel, Elifho Obopilwe, David M. Chowaniec, Augustus D. Mazzocca, Michael D Nowak, Robert A Arciero, Bryan T Hanypsiak, James J GuerraAbstract:Purpose To evaluate the biomechanical performance of different techniques for CC reconstruction using suture Button systems with integrated tendon augmentation. Hypothesis was that (1) reconstructions using a Cortical Button combined with a biological augmentation (semitendinosus allograft) will demonstrate improved stability than a modified Weaver–Dunn procedure and (2) constructs using two tunnels at the clavicle for fixation will show superior horizontal stability than single-tunnel constructs.
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biomechanical evaluation of effect of coracoid tunnel placement on load to failure of fixation during repair of acromioclavicular joint dislocations
Arthroscopy, 2012Co-Authors: Joel V Ferreira, Elifho Obopilwe, David M. Chowaniec, Michael D Nowak, Robert A Arciero, Augustus D. MazzoccaAbstract:Purpose To evaluate the effect of entry and exit points of the coracoid tunnel on load to failure and mode of failure, to reduce the incidence of coracoid fractures and acromioclavicular joint repair failures. Methods This study investigates 5 tunnel placements based on different entry and exit points in the coracoid process: center-center orientation represents perfect placement of the bone tunnel and served as perfect tunnel placement in our study. Four common errors in drilling were then tested and acted as the experimental groups in our study (medial-center, center-medial, lateral-center, and center-lateral). Using 35 cadaveric shoulders (mean age, 68.0 ± 13.0 years), we tested these 5 tunnel orientations using a single repair technique (Cortical Button) loaded to failure on an MTS 858 Servohydraulic test system (MTS Systems, Eden Prairie, MN). A control group of 7 cadaveric shoulders without the presence of a coracoid tunnel was also tested to determine the type of fracture pattern that occurred. Results The coracoids without tunnel drilling fractured in patterns similar to traumatic coracoid injuries. With regard to the 5 tunnel groups, it was found that the loads to failure with center-center and medial-center tunnel placement were significantly higher than those with center-medial, center-lateral, and lateral-center tunnel placement. The failure modes of the former were primarily within the repair constructs, whereas those of the latter were primarily due to bony failure. Conclusions Our biomechanical results showed a higher peak load to failure with a center-center or medial-center tunnel orientation, which may lessen the risk of coracoid fracture during drilling with a 6-mm cannulated drill bit. Clinical Relevance Proper trajectory of the drill during formation of a coracoid bone tunnel can help reduce the risk of coracoid process fracture and repair failure.
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biomechanical evaluation of distal biceps reconstruction with Cortical Button and interference screw fixation
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Paul M. Sethi, Elifho Obopilwe, Lina Rincon, Seth R Miller, Augustus D. MazzoccaAbstract:Hypothesis Tension slide repair maintains the strength of the standard Cortical Button repair but reduces gap formation at the repair. Distal biceps tendon repair with a suspensory Cortical Button has yielded the strongest published repair, despite observed gap formation and tendon pistoning. The tension slide technique (TST) was described to reduce gap formation while maintaining the strength of Cortical Button repair. This study evaluates the biomechanics of the TST compared with previously described EndoButton (Smith & Nephew, Memphis, TN) repair and the TST with and without an interference screw. Materials and methods The study used 20 matched specimens: 5 had a standard Cortical Button repair, and 5 had biceps repair with the TST. An additional 10 specimens underwent a TST, 5 with an interference screw and 5 without. All were cyclically loaded for 3600 cycles. Gap formation and load to failure were measured. Results The mean (SD) load to failure for standard technique was at 389 (148) N vs 432 (66) N for the TST ( P = .28). The mean (SD) gap formation was 2.79 (1.43) mm with the standard repair and 1.26 (0.61) mm with the TST ( P = .03). The mean (SD) load to failure with TST repair was 436 (103) N without the interference screw and 439 (94) N ( P = 0.48) with the screw. The mean gap formation was 1.63 (1.09) mm without the screw and 1.45 (0.67) mm with the screw ( P = .38.) Conclusion This TST maintains the strength of the standard Cortical Button repair, but significantly reduces gap formation and motion at the repair site. Level of evidence Basic science study.
Michael D Maloney - One of the best experts on this subject based on the ideXlab platform.
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what regions of the distal clavicle have the greatest bone mineral density and Cortical thickness a cadaveric study
Clinical Orthopaedics and Related Research, 2019Co-Authors: Raymond E Chen, Michael D Maloney, Sandeep Soin, Rami Elshaar, Gregg T Nicandri, Hani A Awad, Ilya VoloshinAbstract:BACKGROUND Osteosynthesis of distal clavicle fractures can be challenging because of comminution, poor bone quality, and deforming forces at the fracture site. A better understanding of regional differences in the bone structure of the distal clavicle is critical to refine fracture fixation strategies, but the variations in BMD and Cortical thickness throughout the distal clavicle have not been previously described. PURPOSE /questions (1) Which distal clavicular regions have the greatest BMD? (2) Which distal clavicular regions have the greatest Cortical thickness values? METHODS Ten distal clavicle specimens were dissected from cadaveric shoulders. Eight specimens were female and two were male, with a mean (range) age of 63 years (59 to 67). The specimens were selected to match known epidemiology, as distal clavicular fractures occur more commonly in older patients with osteoporotic bone, and clavicular fractures in older patients are more common in females than males. The clavicles were then imaged using quantitative micro-CT to create 3-D images. The BMD and Cortical thickness were calculated for 10 regions of interest in each specimen. These regions were selected to represent locations where distal clavicular fractures commonly occur and locations of likely bony comminution. Findings were compared between different regions using repeated measures ANOVA with Geiser-Greenhouse correction, followed by Bonferroni method multiple comparison testing. Effect size was also calculated to estimate the magnitude of difference between regions. RESULTS The four most medial regions of the distal clavicle contained the greatest BMD (anterior intertubercle space 887 ± 31 mgHA/cc, posterior intertubercle space 879 ± 26 mgHA/cc, anterior conoid tubercle 900 ± 21 mgHA/cc, posterior conoid tubercle 896 ± 27 mgHA/cc), while the four most lateral regions contained the least BMD (anterior lateral distal clavicle 804 ± 32 mgHA/cc, posterior lateral distal clavicle 800 ± 38 mgHA/cc, anterior medial distal clavicle 815 ± 27 mgHA/cc, posterior medial distal clavicle 795 ± 26 mgHA/cc). All four most medial regions had greater BMD than the four most lateral regions, with p < 0.001 for all comparisons. For the BMD ANOVA, η was determined to be 0.81, representing a large effect size. The four most medial regions of the distal clavicle also had the greatest Cortical thickness (anterior intertubercle space 0.7 ± 0.2 mm, posterior intertubercle space 0.7 ± 0.3 mm, anterior conoid tubercle 0.9 ± 0.2 mm, posterior conoid tubercle 0.7 ± 0.2 mm), while the four most lateral regions had the smallest Cortical thickness (anterior lateral distal clavicle 0.2 ± 0.1 mm, posterior lateral distal clavicle 0.2 ± 0.1 mm, anterior medial distal clavicle 0.3 ± 0.1 mm, posterior medial distal clavicle 0.2 ± 0.1 mm). All four most medial regions had greater Cortical thickness than the four most lateral regions, with p < 0.001 for all comparisons. For the Cortical thickness ANOVA, η was determined to be 0.80, representing a large effect size. No differences in BMDs and Cortical thicknesses were found between anterior and posterior regions of interest in any given area. CONCLUSIONS In the distal clavicle, BMD and Cortical thickness are greatest in the conoid tubercle and intertubercle space. When compared with clavicular regions lateral to the trapezoid tubercle, the BMD and Cortical thickness of the conoid tubercle and intertubercle space were increased, with a large magnitude of difference. CLINICAL RELEVANCE Distal clavicular fractures are prone to comminution and modern treatment strategies have centered on the use of locking plate technology and/or suspensory fixation between the coracoid and the clavicle. However, screw pullout or Cortical Button pull through are known complications of locking plate and suspensory fixation, respectively. Therefore, it seems intuitive that implant placement during internal fixation of distal clavicle fractures should take advantage of the best-available bone. Although osteosynthesis was not directly studied, our study suggests that the best screw purchase in the distal clavicle is available in the areas of the conoid tubercle and intertubercle space, as these areas had the best bone quality. Targeting these areas during implant fixation would likely reduce implant failure and strengthen fixation. Future studies should build on our findings to determine if osteosynthesis of distal clavicular fractures with targeted screw purchase or Cortical Button placement in the conoid tubercle and intertubercle space increase fixation strength and decreases construct failure. Furthermore, our findings provide consideration for novel distal clavicular locking plate designs with modified screw trajectories or refined surgical techniques with suspensory fixation implants to reliably capture these areas of greatest bone quality.
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distal biceps brachii tendon repairs a single incision technique using a Cortical Button with interference screw versus a double incision technique using suture fixation through bone tunnels
American Journal of Sports Medicine, 2015Co-Authors: Edward Shields, Joshua R Olsen, Richard B Williams, Michael D Maloney, Lucien M Rouse, Ilya VoloshinAbstract:Background:Distal biceps brachii tendon repairs performed with a tension slide technique using a Cortical Button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature.Purpose:To perform a clinical comparison of the single-incision CB and double-incision BT techniques.Study Design:Cohort study; Level of evidence, 3.Methods:Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients >1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand).Results:Patients in the CB group (n = 20) were older (52 ± 9.5 vs 43.7 ± 8.7 years; P = .008), had a shorter interval from surgery to evaluation (17.7 ± 5 vs 30.8 ± 16.5 months; P = .001), a...
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a comparison of Cortical Button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Joshua R Olsen, Edward Shields, Richard B Williams, Richard K Miller, Michael D Maloney, Ilya VoloshinAbstract:Background Distal biceps brachii tendon repairs performed by a "tension slide technique" with a Cortical Button and interference screw (CB) are stronger than repairs by suture anchor (SA) techniques in biomechanical studies. However, clinical comparison of the 2 techniques is lacking in the literature. Methods Distal biceps tendon ruptures repaired with either a CB or SA technique through a single incision were identified from 2008 to 2013 at a single institution. Patients more than a year out from surgery completed a Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In addition, patients were assessed for range of motion, strength, and complications. All assessments were performed by individuals blinded to the surgical technique. Strength and motion values from the operative extremity minus the nonoperative arm values yielded differential values that were averaged and used to compare treatment groups. Results The CB (n = 20) and SA (n = 17) groups had similar demographics, except for the time from the surgery to evaluation (18 ± 5 vs 32 ± 15 months, respectively; P = .007). Range of motion differed slightly between the groups. The CB group demonstrated better pronation (0° ± 5° vs −4° ± 10°; P P P P P > .05). Conclusion CB and SA techniques provide good clinical results with similar complication rates.
Rene Attal - One of the best experts on this subject based on the ideXlab platform.
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acl reconstruction with adjustable length loop Cortical Button fixation results in less tibial tunnel widening compared with interference screw fixation
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Raul Mayr, Martin Eichinger, Christian Coppola, Vinzenz Smekal, Christian Koidl, Ansgar Rudisch, Christof Kranewitter, Rene AttalAbstract:PURPOSE To compare tunnel widening and clinical outcome after anterior cruciate ligament reconstruction (ACLR) with interference screw fixation and all-inside reconstruction using Button fixation. METHODS Tunnel widening was assessed using tunnel volume and diameter measurements on computed tomography (CT) scans after surgery and 6 months and 2 years later, and compared between the two groups. The clinical outcome was assessed after 2 years with instrumented tibial anteroposterior translation measurements, hop testing and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores. RESULTS The study population at the final follow-up was 14 patients with screw fixation and 16 patients with Button fixation. Tibial tunnels with screw fixation showed significantly larger increase in tunnel volume over time (P = 0.021) and larger tunnel diameters after 2 years in comparison with Button fixation (P < 0.001). There were no significant differences in femoral tunnel volume changes over time or in tunnel diameters after 2 years. No significant differences were found in the clinical outcome scores. CONCLUSIONS All-inside ACLR using Button fixation was associated with less tibial tunnel widening and smaller tunnels after 2 years in comparison with ACLR using screw fixation. The need for staged revision ACLRs may be greater with interference screws in comparison with Button fixation at the tibial tunnel. The clinical outcomes in the two groups were comparable. LEVEL OF EVIDENCE II. RCT: Consort NCT01755819.
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biomechanical comparison of 2 anterior cruciate ligament graft preparation techniques for tibial fixation adjustable length loop Cortical Button or interference screw
American Journal of Sports Medicine, 2015Co-Authors: Raul Mayr, Christian H Heinrichs, Martin Eichinger, Christian Coppola, Werner Schmoelz, Rene AttalAbstract:Background:Cortical Button fixation at the femoral side and interference screws within the tibial bone tunnel are widely used for anterior cruciate ligament graft fixation. Using a bone socket instead of a full tunnel allows Cortical Button fixation on the tibial side as well. If adjustable-length loop Cortical Button devices are used for femoral and tibial fixation, the tendon graft has to be secured with sutures in a closed tendon loop. The increased distance of fixation points and potential slippage of the tendon strands at the securing sutures might lead to greater risk of postoperative graft elongation when compared with conventional graft preparation with tibial interference screw fixation.Hypothesis:Compared with an anterior cruciate ligament graft with tibial adjustable-length loop Cortical Button fixation, a graft with tibial interference screw fixation will show less graft elongation during cyclic loading and lower ultimate failure loads.Study Design:Controlled laboratory study.Methods:Grafts wi...
Joshua R Olsen - One of the best experts on this subject based on the ideXlab platform.
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distal biceps brachii tendon repairs a single incision technique using a Cortical Button with interference screw versus a double incision technique using suture fixation through bone tunnels
American Journal of Sports Medicine, 2015Co-Authors: Edward Shields, Joshua R Olsen, Richard B Williams, Michael D Maloney, Lucien M Rouse, Ilya VoloshinAbstract:Background:Distal biceps brachii tendon repairs performed with a tension slide technique using a Cortical Button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature.Purpose:To perform a clinical comparison of the single-incision CB and double-incision BT techniques.Study Design:Cohort study; Level of evidence, 3.Methods:Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients >1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand).Results:Patients in the CB group (n = 20) were older (52 ± 9.5 vs 43.7 ± 8.7 years; P = .008), had a shorter interval from surgery to evaluation (17.7 ± 5 vs 30.8 ± 16.5 months; P = .001), a...
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a comparison of Cortical Button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Joshua R Olsen, Edward Shields, Richard B Williams, Richard K Miller, Michael D Maloney, Ilya VoloshinAbstract:Background Distal biceps brachii tendon repairs performed by a "tension slide technique" with a Cortical Button and interference screw (CB) are stronger than repairs by suture anchor (SA) techniques in biomechanical studies. However, clinical comparison of the 2 techniques is lacking in the literature. Methods Distal biceps tendon ruptures repaired with either a CB or SA technique through a single incision were identified from 2008 to 2013 at a single institution. Patients more than a year out from surgery completed a Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In addition, patients were assessed for range of motion, strength, and complications. All assessments were performed by individuals blinded to the surgical technique. Strength and motion values from the operative extremity minus the nonoperative arm values yielded differential values that were averaged and used to compare treatment groups. Results The CB (n = 20) and SA (n = 17) groups had similar demographics, except for the time from the surgery to evaluation (18 ± 5 vs 32 ± 15 months, respectively; P = .007). Range of motion differed slightly between the groups. The CB group demonstrated better pronation (0° ± 5° vs −4° ± 10°; P P P P P > .05). Conclusion CB and SA techniques provide good clinical results with similar complication rates.
