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ABSTRACT: The carpometacarpal joint of the thumb is a common site of degenerative arthritis. Several surgical treatments exist, but arthroscopic management offers the potential benefit of earlier recovery. The current study evaluated the early clinical outcomes of a procedure involving arthroscopic hemitrapeziectomy with Artelon spacer (Artimplant, Västra Frölunda, Sweden) interposition arthroplasty into the newly created carpometacarpal space.A chart review of 9 patients treated with thumb carpometacarpal arthroscopic hemitrapeziectomy and Artelon spacer interposition arthroplasty between September 2005 and January 2009 was performed for postoperative complications, range of motion, and pinch strength (percentage of the contralateral limb). Subjective outcomes were analyzed by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Patient-rated Wrist Evaluation. Mean follow-up was 23.4 months (range, 13-33 months). All patients maintained full range of motion. By the 1-year follow-up, mean pinch strength returned to 59%±19.1% of the contralateral limb strength. The Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-rated Wrist Evaluation scores were 12.3±7.6 and 26.8±23.5, respectively. No significant complications occurred, and 1 patient with symptoms of synovitis was successfully treated with a corticosteroid injection. This study revealed excellent short-term results at the minimum 1-year follow-up for a less invasive treatment option that is appropriate for select patients with moderate thumb carpometacarpal arthritis (Eaton stages 2 and 3). The authors demonstrated a comparably good outcome of arthroscopic hemitrapeziectomy with Artelon spacer interposition arthroplasty with no evidence of foreign-body reaction. The authors also demonstrated the potential role of corticosteroid injections in the setting of a postoperative inflammatory reaction.
Orthopedics 12/2012; 35(12):e1759-e1764. · 2.66 Impact Factor
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Orthopedics 12/2012; 35(12):e1759-64. · 2.66 Impact Factor
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ABSTRACT: Exogenously administered mesenchymal stem cells and bioactive molecules are known to enhance tendon healing. Biomolecules have been successfully delivered using sutures that elute growth factors over time. We sought to evaluate the histologic and biomechanical effect of delivering both cells and bioactive substrates on a suture delivery vehicle in comparison with sutures coated with bioactive substrates alone.
Bone marrow-derived stem cells were harvested from Sprague-Dawley rat femurs. Experimental cell and substrate-coated, coated suture (CS) group sutures were precoated with intercellular cell adhesion molecule 1 and poly-L-lysine and seeded with labeled bone marrow-derived stem cells. Control (substrate-only [SO] coated) group sutures were coated with intercellular cell adhesion molecule 1 and poly-L-lysine only. Using a matched-paired design, bilateral Sprague-Dawley rat Achilles tendons (n = 105 rats) were transected and randomized to CS or SO repairs. Tendons were harvested at 4, 7, 10, 14, and 28 days and subjected to histologic and mechanical assessment.
Labeled cells were present at repair sites at all time points. The CS suture repairs displayed statistically greater strength compared to SO repairs at 7 days (12.6 ± 5.0 N vs 8.6 ± 3.7 N, respectively) and 10 days (21.2 ± 4.9 N vs 16.4 ± 4.8 N, respectively). There was no significant difference between the strength of CS suture repairs compared with SO repairs at 4 days (8.1 ± 5.1 N vs 6.6 ± 2.3 N, respectively), 14 days (22.8 ± 7.3 N vs 25.1 ± 9.7 N, respectively), and 28 days (40.9 ± 12.4 N vs 34.6 ± 15.0 N, respectively).
Bioactive CS sutures enhanced repair strength at 7 to 10 days. There was no significant effect at later stages.
The strength nadir of a tendon repair occurs in the first 2 weeks after surgery. Bioactive suture repair might provide a clinical advantage by jump-starting the repair process during this strength nadir. Improved early strength might, in turn allow earlier unprotected mobilization.
The Journal of hand surgery 06/2012; 37(8):1639-45. · 1.33 Impact Factor
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The Journal of hand surgery 01/2012; 37(1):168-70. · 1.33 Impact Factor
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ABSTRACT: Lunate fractures are rare and are usually associated with high-energy trauma. Typically, they are described in isolation or with associated carpal injuries such as scaphoid, capitate, or radial styloid fractures. We report a case of a complex lunate fracture in combination with a perilunate dissociation injury.
The Journal of hand surgery 11/2011; 37(1):63-7. · 1.33 Impact Factor
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Hand 09/2011; 6(3):313-6.
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Jeffrey Yao
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ABSTRACT: Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity.
Hand clinics 08/2011; 27(3):237-42. · 0.69 Impact Factor
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ABSTRACT: Percutaneous screw fixation of nondisplaced or reducible scaphoid fractures has become more popular as techniques and implants have improved. Many authors have advocated for the dorsal approach, citing difficulties with adequate screw placement from the volar approach. We have developed a straightforward and reproducible technique for volar percutaneous scaphoid screw fixation that mitigates most of the drawbacks of the approach. The wrist is held in extension and ulnar deviation with traction through the thumb. A 14-gauge angiocatheter needle is then used to localize the starting point and as a cannula for the guide wire. Specific fluoroscopic views help to confirm optimal guide wire placement.
The Journal of hand surgery 05/2011; 36(5):916-21. · 1.33 Impact Factor
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ABSTRACT: The FasT-Fix device (Smith and Nephew Endoscopy, Andover, MA), initially developed for knee meniscal tears, is described for all-arthroscopic triangular fibrocartilage complex (TFCC) repairs. Potential benefits of this technique are ease of use, the lack of prominent suture knots, and strength of repair. This case series evaluates the early clinical outcomes of this technique.
We conducted a retrospective review of patients with TFCC Palmer type 1B injuries treated by 1 hand surgeon from 2005 to 2009. The patients' charts were reviewed for postoperative complications, range of motion, grip strength (percentage of contralateral), and return to full activity. In addition, each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires.
Twelve patients had all-arthroscopic peripheral (1B) TFCC repairs using the FasT-Fix suture device. The mean follow-up period was 17.5 months (range, 11-27). Mean supination was 78° (± 14°), and mean grip strength was 64% (±16%) of the nonsurgical extremity by 3 months after surgery. All other range of motion was full. The mean QuickDASH score was 11 (±12), and the mean PRWE score was 19 (±14). Average time to full activity was 5 months. There were no surgical complications of the procedure. One patient complained of persistent ulnar-sided wrist pain 12 months after surgery and had an ulnar shortening osteotomy. Arthroscopy at the time of the osteotomy revealed that the TFCC was stable.
At mean 1-year follow-up, 11 out of 12 patients achieved excellent subjective outcomes based on QuickDASH and PRWE questionnaires. Although range of motion and grip strength were slightly decreased compared to prior case series reports, the short-term results indicate that the FasT-Fix all-arthroscopic, all-inside technique is a safe and effective technique for repair of Palmer type 1B TFCC tears.
The Journal of hand surgery 04/2011; 36(5):836-42. · 1.33 Impact Factor
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ABSTRACT: We evaluated the fate of pluripotential stem cells adherent to a suture carrier after being passed through tendon tissue in vitro.
FiberWire suture segments were coated with poly-L-lysine (PLL) and a 2 × 10(6) C3H10T1/2 (a mouse embryo pluripotential cell line) cell suspension. The sutures were incubated for 7 days, passed through two 1-cm segments of acellularized rabbit Achilles tendons and tied (horizontal mattress). The repairs were frozen and sectioned (6 μm). The sections were stained with 4',6-diamidino-2-phenylindole and a live/dead viability/cytotoxicity (calcein/ethidium homodimer) kit and examined with fluorescent microscopy to evaluate cell presence and viability. Alamar Blue was used in parallel to assess metabolic activity.
PLL-coated sutures showed a 3-fold increase in fluorescence when compared with the phosphate-buffered saline-coated controls. At day 3, fluorescence was 2.2 times greater. At day 5, a 2-fold increase was found, and at day 8 there was no significant difference in values. Furthermore, after delivery of the cells into tendon, fluorescence readings for the samples (n = 19) showed 9450 compared with the positive control at 21,218. At 96 hours the mean was 27,609 compared with 34,850 for the positive control. The difference in fluorescence means at 48 hours and 96 hours were significant (p < .001). Live-dead and DAPI staining confirmed the presence of live cells at the tendon repair site.
Sutures seeded with pluripotential embryonic cells deliver cells to a tendon repair site. The cells deposited at the repair site survive the trauma of passage and remain metabolically active, as seen in staining and metabolic assay studies. Use of bioactive sutures leads to repopulation of the acellular zone surrounding sutures within the tendon.
The Journal of hand surgery 02/2011; 36(2):252-8. · 1.33 Impact Factor
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ABSTRACT: Scapholunate injuries are the most frequent of the intercarpal ligament injuries in the wrist. Current repair methods generally involve an open approach the dorsal capsule of the wrist. Arthroscopic repair of the dorsal portion of the scapholunate interosseus ligament would carry the advantages of less stiffness and would preserve the important dorsal capsular stabilizers. In the development of this technique, we first sought to determine the anatomic location and accessibility of the dorsal scapholunate ligament and the site in which a suture anchor would be placed. Ten fresh-frozen cadaver limbs were used. With the arthroscope in the 4 to 5 portal, the most dorsal portion of the SLIL was visualized in each specimen. K-wires were inserted through the 3 to 4 portal into the scaphoid adjacent to most distal portion of the dSLIL visualized. All limbs were dissected and the location of the wires relative to the prominence on the scaphoid directly adjacent to the central portion of the dSLIL was measured. The location of the prominence relative to the dSLIL was studied through magnified photography of a stained section of a cadaveric scaphoid. The mean distance of these wires distal to the center of the dSLIL is presented. Then the technique of arthroscopic repair of the dSLIL was developed using additional cadaveric wrist specimens. The technique is described.
Techniques in hand & upper extremity surgery 12/2010; 14(4):204-8.
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ABSTRACT: Hematoma distraction arthroplasty has regained popularity as a treatment for thumb carpometacarpal arthritis with reports of satisfactory results. Our goal was to investigate the use of a suture button device to maintain the posttrapeziectomy space height of the thumb metacarpal. Our hypothesis is that a suture button that suspends the thumb metacarpal from the second metacarpal, when applied to the hematoma distraction arthroplasty technique, would provide subsidence resistance comparable to traditional K-wire fixation.
Ten fresh frozen matched pairs of human cadaveric arms were used. After open trapeziectomy, suspension of the thumb metacarpal was performed with either a 1.4-mm (0.045-inch) K-wire advanced through the base of the thumb metacarpal into the second metacarpal shaft or a suture button device that suspended the thumb metacarpal from the second metacarpal shaft. Cyclic pinch was simulated by using a lateral pinch model previously described and validated. Lateral pinch is simulated by loading the extensor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis longus in a 1:5:6:10 ratio. Dynamic pinch is achieved with cyclic unloading of the abductor pollicis brevis, adductor pollicis, and flexor pollicis longus tendons. Measurements were made of the height of excised trapeziums, the distance from the metacarpal base to the scaphoid after trapeziectomy (trapeziectomy space height) at time zero, both loaded and unloaded, and at sequential loading cycles of 1,000, 2,000, 3,000, 4,000, 5,000, and 10,000 cycles.
Student t-test evaluation showed no significant differences between the groups in initial trapeziectomy space height (p = .10), postfixation trapeziectomy space height (p = .10), or loss of trapeziectomy space height between precycling and after 10,000 cycles (p = .80).
Suture button fixation maintains similar posttrapeziectomy space height and prevents subsidence of the thumb metacarpal when compared with K-wire fixation in this model. This technique may allow for earlier range of motion after the hematoma distraction arthroplasty.
The Journal of hand surgery 12/2010; 35(12):2061-5. · 1.33 Impact Factor
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ABSTRACT: A myriad of techniques for reconstruction of the arthritic thumb carpometacarpal joint have been described. In the modern era, there has been a push, driven by both clinicians and patients, for more rapid rehabilitation after these procedures. A majority of the historically described techniques require pinning of the thumb ray for 4 weeks. Suture button placement between the thumb and index ray metacarpals has been shown in biomechanical studies to effectively resist subsidence of the thumb ray. We describe a novel technique of using a suture button for suspensionplasty of the thumb ray after arthroscopic partial trapeziectomy. This technique allows for early mobilization and may offer a potential improvement on current techniques. Early results of use of this technique are encouraging, but well-conducted follow-up studies are necessary.
Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2010; 26(10):1395-403. · 3.02 Impact Factor
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The Journal of hand surgery 08/2010; 35(8):1360-1. · 1.33 Impact Factor
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ABSTRACT: The palmaris longus muscle exhibits significant anatomical variance compared with other muscles of the upper extremity. The most frequent variation is complete absence of the muscle, but a number of other variations exist. These variations include reversed, duplicated, bifid, or hypertrophied palmaris longus muscles. Many authors have reported the variations in case reports and described them using their own terms. In this case report and review of literature, we aim to consolidate the current knowledge regarding the anatomic variations of the palmaris longus muscle and its clinical relevance.
American journal of orthopedics (Belle Mead, N.J.) 02/2010; 39(2):89-94.
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ABSTRACT: AbstrAct The palmaris longus muscle exhibits significant ana-tomical variance compared with other muscles of the upper extremity. Most frequently, the muscle may be completely absent, but a number of other variations exist. These variations include reversed, duplicated, bifid, or hypertrophied palmaris longus muscles. Many authors have reported the variations in case reports and described them using their own terms. In this case report and review of literature, we aim to consolidate the current knowledge regarding the ana-tomic variations of the palmaris longus muscle and its clinical relevance.
The American journal of orthopedics 02/2010;
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ABSTRACT: Triangular fibrocartilage complex injuries are one of the most common causes of ulnar-sided wrist pain. Although pain and discomfort may improve with simple immobilization for a short period of time, a significant number of patients eventually require surgical intervention. The purpose of this study was to investigate the incidence of surgical intervention on patients with a clinical diagnosis of a triangular fibrocartilage complex injury. A retrospective chart review was performed to identify patients with ulnar-sided wrist pain identified with the appropriate ICD-9 code from September 2005 to September 2007. All patients were evaluated and treated by a board-certified, fellowship-trained hand surgeon. Any patients with associated pathology were excluded from the study. All patients were initially treated with a minimum of 4 weeks of either a volar wrist splint worn all the time or a short-arm cast. Magnetic resonance images were obtained on patients without symptomatic relief, and in these cases, surgical arthroscopy was performed. Of the 84 patients identified, 36 patients required surgical intervention. All 36 patients had evidence of triangular fibrocartilage complex injury during arthroscopy. All patients had symptomatic improvement postoperatively. The use of short-arm cast versus a splint did not affect the rate of surgical intervention (P=.38). Among the patients with clinical diagnosis of triangular fibrocartilage complex injury, the rate of surgical intervention required after a minimum 4 weeks of immobilization was 43%. The use of a short-arm cast or volar wrist splint did not affect the rate of surgical intervention.
Orthopedics 01/2010; 33(11):806. · 2.66 Impact Factor
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The Journal of hand surgery 11/2009; 35(3):489-90. · 1.33 Impact Factor
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The Journal of hand surgery 11/2009; 35(2):316-8; quiz 319. · 1.33 Impact Factor
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The Journal of Bone and Joint Surgery 05/2009; 91(4):950-4. · 3.27 Impact Factor
