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Background: The primary aim of this study was to assess the long-term patient reported outcomes of arthroscopic rotator cuff tear (ARCR) using a single anchor tension band (TB) technique for small and medium supraspinatus tears at minimum 5-years follow-up., Methods: A retrospective cohort study of consecutive ARCRs of small and medium supraspinatus tears using a knotless single anchor TB technique with minimum 5-year follow-up was carried out. Outcomes of interest included: range of motion (ROM) on examination under anaesthesia (EUA), visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores, Oxford Shoulder Score (OSS) and Short-Form (SF-12)., Results: From 243 consecutive ARCR procedures, 82 patients with a mean age of 55 ± 9.5 years met the inclusion criteria at 6.7 ± 1.5 years follow-up. There were significant improvements in VAS (5.5 ± 2.2 vs. 0.7 ± 1.5), ASES (47.6 ± 16.8 vs. 92.8 ± 13.0), OSS (31.3 ± 7.2 vs. 45.3 ± 3.5) and SF-12 (37.6 ± 7.6 vs. 50.3 ± 7.7) post-operatively (all p  < 0.001)., Conclusions: The single anchor TB ARCR technique has excellent patient reported outcomes at a minimum of 5 years and is suitable for supraspinatus tears smaller than 20 mm in the sagittal plane., Level of Evidence: Level IV; Consecutive Case Series., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The last decade has seen a large increase in rotator cuff surgery and arthroscopic surgery. We were asked to define the relevance of open rotator cuff repair in 2021., Purpose: To define whether there are proven advantages to arthroscopic or open rotator cuff repair surgery., Method: We reviewed the recent literature regarding recent trends, anaesthetic time, rehabilitation, post-operative pain, complications, economic considerations, the learning curve and outcomes. We outlined the senior authors' technique preferences, rationale and patient reported outcomes., Results: There is no clear evidence of proven advantage in arthroscopic rotator cuff repair compared to open rotator cuff repairs, with regard to outcomes or the other aspects reviewed. There were no differences in the outcomes of arthroscopic and open repairs in the senior authors practice with his procedure indications., Conclusions: Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. We believe surgeons should learn both techniques and the principles of good patient selection, tissue handling, and fixation techniques are of paramount importance in both arthroscopic and open rotator cuff surgery., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Indian Orthopaedics Association 2021.)

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress., Competing Interests: Conflict of Interest None declared., (Society of Indian Hand & Microsurgeons. This article is published by Thieme.)

Background: Evaluation of shoulder joint laxity is an important component of the shoulder examination, especially in the setting of shoulder instability. Measures of generalized joint laxity, particularly the Beighton score, are often recorded and used to help make management decisions in these cases. However, no evidence is available to show that the Beighton score corresponds to specific measures of shoulder joint laxity., Purpose: To assess the correlation between the Beighton score and validated measures of shoulder joint laxity., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 160 participants (age range, 16-35 years) with no history of shoulder joint abnormality were examined. The Beighton score, glenohumeral external rotation (standing and lying), glenohumeral abduction, and the sulcus sign were recorded. The relationship between the Beighton score and each measure of shoulder joint laxity was assessed., Results: A high proportion of participants (34%) had a Beighton score of 4 or higher. Rates of positive shoulder laxity tests were lower (11%-19%). A positive Beighton score was a poor predictor of abnormal shoulder laxity, with low sensitivity (range, 0.40-0.48) and low positive predictive values (range, 0.13-0.31). Spearman correlation coefficients demonstrated poor correlation between the Beighton score and all measures of shoulder joint laxity when assessed as continuous variables (range, 0.29-0.45)., Conclusion: The Beighton score has poor correlation with specific measures of shoulder joint laxity and should not be considered equivalent to these tests as a method of clinical assessment., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Purpose: To assess elbow extension strength and complications after deltoid-triceps transfers using hamstring tendon graft compared with tibialis anterior and synthetic tendon grafts., Methods: A retrospective review of deltoid-triceps transfers in patients with tetraplegia performed between 1983 and 2014., Results: Seventy-five people (136 arms) had surgery performed, with the majority undergoing simultaneous bilateral surgery (n = 61; 81%). Tibialis anterior tendon grafts were used in 68 arms, synthetic grafts in 23 arms, and hamstring tendon grafts in 45 arms. The average age at surgery was 31 years. Sixty-three arms (46%) were assessed between 12 and 24 months after surgery. Seventy percent of the group (n = 54) were able to extend their elbow against gravity (grade 3 of 5 or greater) following surgery. Seventy-nine percent of those with hamstring grafts achieved grade 3 of 5 or more compared with 77% with tibialis anterior and 33% with synthetic grafts. There was a statistically significant difference in postsurgery elbow extension between the tibialis anterior group and the synthetic graft group and the hamstring and the synthetic graft group but not between the tibialis anterior and the hamstring group. Complications occurred in 19 arms (14%), the majority occurring immediately after surgery and associated with the wounds. The remaining complications were with the synthetic graft group in which dehiscence of the proximal attachment occurred in 30% of the arms., Conclusions: Autologous tendon grafting is associated with achievement of antigravity elbow extension in a greater proportion of individuals than with prosthetic grafting., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Study Design: Retrospective audit., Objectives: The objective of this study was to identify the proportion of patients with cervical spinal cord injury who would potentially benefit from nerve transfer surgery to gain active hand opening, and to determine when a safe nerve transfer decision can be made., Setting: Christchurch, New Zealand., Methods: Case note review of the first 12 months following acute cervical spinal cord injury (2007-2012). Neurological assessment at 6 weeks, 12 weeks and 1 year following injury., Results: Fifty-three patients had complete assessments and showed changes in the level of injury and severity of neurological injury between assessments. Forty-two percent of patients had motor complete C5-7 level injuries 12 weeks following injury and would benefit from consideration for nerve transfer to improve hand opening. Fewer (26%) would benefit 1 year following injury owing to a change in the neurological level of injury., Conclusions: Twelve-week neurological assessment identifies patients who may benefit from nerve transfer surgery. This enables referral for comprehensive upper limb assessment and reassessment of motor function to determine suitability for surgical intervention. Nerve transfer within the window of opportunity provides active hand opening for patients following cervical spinal cord injury.

Although genetically compact, HIV-1 commandeers vast arrays of cellular machinery to sustain and protect it during cycles of viral outgrowth. Transposon-mediated saturation linker scanning mutagenesis was used to isolate fully replication-competent viruses harbouring a potent foreign epitope tag. Using these viral isolates, we performed differential isotopic labelling and affinity-capture mass spectrometric analyses on samples obtained from cultures of human lymphocytes to classify the vicinal interactomes of the viral Env and Vif proteins as they occur during natural infection. Importantly, interacting proteins were recovered without bias, regardless of their potential for positive, negative or neutral impact on viral replication. We identified specific host associations made with trimerized Env during its biosynthesis, at virological synapses, with innate immune effectors (such as HLA-E) and with certain cellular signalling pathways (for example, Notch1). We also defined Vif associations with host proteins involved in the control of nuclear transcription and nucleoside biosynthesis as well as those interacting stably or transiently with the cytoplasmic protein degradation apparatus. Our approach is broadly applicable to elucidating pathogen-host interactomes, providing high-certainty identification of interactors by their direct access during cycling infection. Understanding the pathophysiological consequences of these associations is likely to provide strategic targets for antiviral intervention.

After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury. Tendon transfer surgery has been performed in the tetraplegic population since the early 1970s. The goals of surgery are to provide a person with tetraplegia with active elbow extension, wrist extension (if absent), and sufficient pinch and/or grip strength to perform activities of daily living without the need for adaptive equipment or orthoses. These procedures are suitable for a specific group, usually with spinal cord impairment of C4-8, with explicit components of motor and sensory loss. Comprehensive team assessments of current functioning, environment, and personal circumstances are important to ensure success of any procedure. Rehabilitation after tendon transfer surgery involves immobilization for tendon healing followed by specific, targeted therapy based on motor learning and goal-orientated training. Outcomes of tendon transfer surgery are not limited to the improvements in an individual's strength, function, and performance of activities but have much greater life affects, especially with regard to well-being, employment, and participation. This article will provide an overview of the aims of surgery, preoperative assessment, common procedures, postoperative rehabilitation strategies, and outcomes based on clinical experience and international published literature., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

This reports presents the case of a combined clavicle fracture malunion and chronic Type IV acromioclavicular (AC) joint dislocation. The patient was seen acutely in the emergency department following a mountain bike accident at which time the clavicle fracture was identified and managed conservatively however the AC dislocation was not diagnosed. The patient presented 25 months following the injury with persistent pain and disability and was treated with clavicle osteotomy and AC stabilization. We document the clinical details, surgical treatment and outcome.

In shoulder surgery, a precise understanding of anatomical relationships is required for accurate reconstruction. Reports in recent literature have challenged the traditional definitions of the humeral footprints of the supraspinatus and infraspinatus tendons. This study aims to precisely delineate these footprints. The rotator cuffs of 54 shoulders from 27 Australian Caucasoid donor cadavers were examined. The tendinous portions were dissected down to their region/footprint of attachment upon the humerus. Measurements of those footprints, upon the greater and lesser tuberosities, were made. Those measurements were statistically analyzed for any association with age, sex, height, or side. Twenty-seven cadavers had an average age at death of 74.9 (± 12.8), 56% were male, average height was 168 (± 8.6) cm. Due to premorbid fracture, or degeneration, 11 shoulders were excluded. The footprint of the supraspinatus was triangular, with a medial, anteroposterior length of 20.4 ± 4.2 mm. Its lateral anteroposterior length was 6.3 ± 1.6 mm and its maximal mediolateral width was 6.6 ± 2.7 mm. Its calculated area was 122.0 ± 66.6 mm(2). The footprint of the infraspinatus was trapezoidal, with a medial anteroposterior length 22.6 ± 3.0 mm. Its lateral anteroposterior length was 25.4 ± 3.3mm and its maximal mediolateral width was 12.0 ± 2.7 mm. Its calculated area was 294.9 ± 74.1 mm(2). There was no statistical correlation between size of the footprint and age, sex, side, or height. The humeral footprints of the supraspinatus and infraspinatus tendons upon the greater tuberosity were distinct. The lateral border of the infraspinatus' humeral attachment extended much farther anteriorly upon the highest facet of the greater tuberosity than in traditional descriptions., (© 2015 Wiley Periodicals, Inc.)

Purpose: To evaluate the effects of aging on hand function among patients with tetraplegia who had forearm tendon transfer surgery between 1982 and 1990., Methods: The study used a longitudinal cohort design that compared hand function outcomes in 2012 with those obtained 11 years earlier. A digital analyzer was used to measure key pinch and grip strength, and results were compared with those obtained in 2001 to determine changes in strength over time. The study also evaluated changes in participant's employment status, wheelchair use, and subjective changes in function using the Lamb and Chan questionnaire., Results: Participants had a mean key pinch strength force between 11.5 N (tenodeses) and 32.9 N (active transfers) and grip strength forces between 23 N (tenodeses) and 59 N (active transfers). Since 2001, people with active transfers either maintained strength or experienced decreased strength of 5% to 14%. Thumb tenodesis power decreased 40% to 51%, whereas finger tenodeses power increased 32% to 70%. Three activities in the Lamb and Chan questionnaire were identified by the majority of participants as being worse or much worse over the past 11 years. These were performing a pressure relief and propelling a manual wheelchair on level ground and up a ramp. These findings correspond with the increased number of participants who used a power wheelchair in 2012 (64%) compared with 2001 (26%). Close to half of the participants (46%) were employed compared with the 90% in 2001., Conclusions: Tendon transfers continued to provide pinch and grip function for individuals with tetraplegia for many years following spinal cord injury. The decrease in strength of those with active transfers over the 11-year period was within the reported aging loss for the normal population. The small number of participants with tenodesis, however, limited our ability to draw meaningful conclusions for this group., Type of Study/level of Evidence: Prognostic III., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The aim was to review the funding, organization, data handling, outcome measurements, and findings from existing national shoulder and elbow joint replacement registries; to consider the possibility of pooling data between registries; and to consider wether a pan european registry might be feasible., Materials and Methods: Web sites, annual reports, and publications from ongoing national registries were searched using Google, PubMed, and links from other registries. Representatives from each registry were contacted., Results: Between 1994 and 2004, 6 shoulder registries and 5 elbow registries were established, and by the end of 2009, the shoulder registries included between 2498 and 7113 replacements and the elbow registries between 267 and 1457 replacements. The registries were initiated by orthopedic societies and funded by the government or by levies on implant manufacturers. In some countries, data reporting and patient consent are required. Completeness is assessed by comparing data with the national health authority. All registries use implant survival as the primary outcome. Some registries use patient-reported outcomes as a secondary outcome., Conclusions: A registry offers many advantages; however, adequate long-term funding and completeness remain a challenge. It is unlikely that large-scale international registries can be implemented, but more countries should be encouraged to establish registries and, by adopting compatible processes, data could be pooled between national registries, adding considerably to their power and usefulness., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.)

A requisite step in the life cycle of human immunodeficiency virus type 1 (HIV-1) is the insertion of the viral genome into that of the host cell, a process catalyzed by the 288-amino-acid (32-kDa) viral integrase (IN). IN recognizes and cleaves the ends of reverse-transcribed viral DNA and directs its insertion into the chromosomal DNA of the target cell. IN function, however, is not limited to integration, as the protein is required for other aspects of viral replication, including assembly, virion maturation, and reverse transcription. Previous studies demonstrated that IN is comprised of three domains: the N-terminal domain (NTD), catalytic core domain (CCD), and C-terminal domain (CTD). Whereas the CCD is mainly responsible for providing the structural framework for catalysis, the roles of the other two domains remain enigmatic. This study aimed to elucidate the primary and subsidiary roles that the CTD has in protein function. To this end, we generated and tested a nested set of IN C-terminal deletion mutants in measurable assays of virologic function. We discovered that removal of up to 15 residues (IN 273) resulted in incremental diminution of enzymatic function and infectivity and that removal of the next three residues resulted in a loss of infectivity. However, replication competency was surprisingly reestablished with one further truncation, corresponding to IN 269 and coinciding with partial restoration of integration activity, but it was lost permanently for all truncations extending N terminal to this position. Our analyses of these replication-competent and -incompetent truncation mutants suggest potential roles for the IN CTD in precursor protein processing, reverse transcription, integration, and IN multimerization.

Purpose: To perform a 10-year re-review of hand function outcome for 24 tetraplegic persons who had received bilateral tendon transfers and tenodeses., Methods: The Lamb and Chan questionnaire with additional questions, the Quadriplegic Index of Function (QIF), the Swanson sphygmomanometer technique for hook grip, the Preston Pinch Meter (PP) for key pinch, and a digital analyzer (DA) for both hook and key pinch were the test instruments used. The QIF and DA had not been used previously., Results: Levels of functional independence and expectations were maintained. Mean hook grip values were maintained for the right hand but increased significantly for the left to reach right hand values. Mean pinch grip values decreased significantly. DA measurements confirmed similar hook grip values for both hands but key pinch values were significantly higher than the PP values. Active transfers averaged approximately twice the strength of tenodeses., Conclusions: Hand function improvements gained from tendon transfers and tenodeses are maintained over time.

The purpose of this study was to assess the accuracy and utility of the posteroanterior (PA) 15 degrees caudad view of the clavicle to assess shortening of clavicular fractures. The first stage involved taking radiographs of an adult skeleton, centered on the clavicle, with the standard anterosuperior 15 degrees cephalad view and the PA 15 degrees caudad view. Additional images were taken in the 15 degrees caudad view with a series of oblique rotational views and oblique images in the vertical plane. Metal markers were placed on the clavicle at 10-mm intervals. Clavicular length and the interval between markers were measured on the radiographs. The second stage involved obtaining the PA 15 degrees caudad radiograph in 50 patients with clavicular fractures. The noninjured clavicle also underwent radiography. The lengths of the noninjured clavicle and of the fragments of the fractured clavicle were recorded. The length of the skeletal clavicle in the standard anterosuperior image was 149 mm, with up to 19 mm of variation on oblique views. The length in the PA 15 degrees caudad image was 130 mm, with a maximum of 4 mm of variation on the oblique views up to 30 degrees. The true length of the skeletal clavicle was 124 mm. Forty-five fractures were diaphyseal, and five were outer-third fractures. There was less than 5 mm of measured difference in the length of injured and noninjured clavicles in 38 of 45 patients with diaphyseal fractures (84%). We have identified a more accurate technique for the assessment of fractures of the clavicle in evaluating length and clavicular alignment. The PA 15 degrees caudad clavicle radiograph technique is well tolerated by patients.

The objective of this study was to develop a method to evaluate the biomechanical performance of Bankart repairs in a human cadaveric shoulder in a clinically relevant orientation. Twenty fresh-frozen human cadaveric shoulder girdles were used to compare the biomechanical performance of intact anteroinferior capsulolabral complexes with the biomechanical performance of three Bankart lesion reconstruction techniques. Repairs were performed on surgically created Bankart lesions. Evaluations were performed with the shoulders in glenohumeral abduction and external rotation. The repair techniques employed interosseous sutures, Mitek GII suture anchors, or Acufex T-Fix devices. The suture material used in all repairs was No. 2 Ti-Cron. The biomechanical performance of the three reconstruction techniques did not differ, but each was significantly inferior compared with that of the intact shoulder samples. The interosseous repairs failed by suture pullout through soft tissue. Repairs in the Mitek GII group failed by pullout of the suture anchors, suture breakage, or pullout of the suture through soft tissue. Repairs in the T-Fix group failed by pullout of the suture through soft tissue or failure of the polymer portion of the T-Fix suture.

We reviewed the results of reconstruction of 97 upper limbs in a consecutive series of 57 tetraplegic patients, treated from 1982 to 1990. Of these, 49 had functional and eight had cosmetic reconstructions. The principal functional objectives were to provide active elbow extension, hook grip, and key pinch. Elbow extension was provided in 34 limbs, using deltoid-to-triceps transfer. Hook grip was provided in 58 limbs, mostly using extensor carpi radialis longus to flexor pollicis longus transfer, and key pinch in 68, mostly using brachioradialis to flexor pollicis longus transfer. Many other procedures were employed. At an average follow-up of 37 months, 70% had good or excellent subjective results, and objective measurements of function compared favourably with other series. Revisions were required for 11 active transfers and three tenodeses, while complications included rupture of anastomoses and problems with thumb interphalangeal joint stabilisation and wound healing. We report a reliable clinical method for differentiating between the activity of extensor carpi radialis longus and brevis and describe a successful new split flexor pollicis longus tenodesis for stabilising the thumb interphalangeal joint. Bilateral simultaneous surgery gave generally better results than did unilateral surgery.