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Purpose: The aim of this study was to describe the results of an arthroscopic Trillat procedure utilized to treat patients with symptomatic antero-inferior shoulder instability associated with hyperlaxity.Methods: A retrospective review was performed on 19 consecutive shoulders (17 patients, 2 bilateral) who underwent a Trillat procedure combined with anterio-inferior capsulolabral plasty from 2016 to 2019. Patients included in the study presented with shoulder instability combined with shoulder hyperlaxity and no glenoid or humeral bone loss. Clinical assessment included range of motion, apprehension, and instability tests. Outcome measures Constant-Murley score (CMS) scale, Walch-Duplay, ROWE, Subjective Shoulder Value (SSV), Visual Analogue Scale (VAS). Post-operatively, healing of the coracoid osteoclasy was evaluated by CT scan.Results: The mean follow-up was 24.8 months (range, 12-51). Post-operatively, none of the patients experienced a recurrent dislocation or subluxation and the anterior apprehension test was negative in all shoulders. Post-operative motion deficits of 22.1° ± 15.8 [p < 0.05] and 12.4° ± 10.1 [p < 0.05] loss were documented for ER1 and ER2, respectively. All functional scores exhibited significant improvements. Post-operative CT scan was available in 16 shoulders and revealed coracoid union in 15/16 shoulders and an asymptomatic fibrous non-union without coracoid or implant migration in one patient.Conclusion: The arthroscopic Trillat procedure combined with an antero-inferior capsulolabral plasty is effective in preventing recurrent instability and eliminating shoulder apprehension among patients suffering from anterior and or inferior hyperlaxity.Level Of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Objective: Distal biceps brachii tendon (DBBT) rupture is an uncommon but functionally significant injury given the loss of supination, flexion strength and pain that often result. Prompt surgical repair is preferred in most patients. Clinicoradiological post-operative follow-up is typically performed to assess DBBT repair integrity and function, frequently using ultrasound, though to date, no studies have described post-operative DBBT repair sonographic appearances. The purpose of this study was to evaluate post-operative DBBT sonographic appearances in the context of Endobutton repair with the following aims:i.Establish typical ultrasound appearances 12 months post-surgeryii.Establish the relationship between ultrasound appearances and clinical/functional outcomes.Materials and Methods: Sixty patients between February 2016 and October 2017 undergoing DBBT repair were prospectively recruited, all undergoing clinical and sonographic assessment 12 months post-surgery. Ultrasound data was collected on tendon integrity, tendon calibre and presence of intratendinous calcification, peritendinous fluid and peritendinous soft tissue/scarring. Clinical data was collected on active range of motion (ROM) (flexion, extension, supination, pronation) and strength (flexion and supination).Results: A total of 57/60 patients had intact DBBT repairs identified sonographically and clinically at 12 months. DBBT repairs had significantly increased cross-sectional area (mean 260%, 95% CI: 217%, 303%) compared with non-operated DBBT. Ninety-three percent of DBBT repairs were hypoechoic. Thirty percent contained intratendinous calcification. Peritendinous fluid/soft tissue was rarely observed. There was no significant correlation between DBBT calibre and strength/ROM parameters.Conclusion: Normal post-operative sonographic appearances of Endobutton DBBT repair comprise a hypoechoic tendon significantly increased in calibre compared with non-operated tendon ± intratendinous calcification. DBBT repair calibre varies greatly, but is not associated with any significant difference in strength/ROM. [ABSTRACT FROM AUTHOR]

Introduction: A commonly used method of fixation of the transferred coracoid in the traditional Latarjet-Bristow procedure (open or arthroscopic) is by two bicortical screws. Although mechanically effective, screw fixation is also a major source of hardware and neurologic complications. This study aimed to compare the biomechanical performances of traditional metal screws and endobuttons as fixators of the Latarjet-Bristow procedure.Materials and Methods: Nine fresh-frozen cadaveric human scapulae with the conjoined tendon attached to the coracoid process were used for the Latarjet-Bristow procedure. The specimens were randomly assigned one of two groups: fixation using two 4.5-mm cannulated partially threaded Latarjet-Bristow experience screws or fixation using a suture-button construct. Specimens were secured in a material testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for ten cycles. They were then pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The maximal load-to-failure, stiffness and stress were calculated using a custom script. The failure mechanism and site were recorded for each specimen.Results: There were no significant differences in the maximal load-to-failure or other biomechanical properties of the two fixation techniques, but the failure mechanisms were unique to each one. Four specimens fixated with screws underwent graft failures (fracture) through the proximal or distal drill hole. Five specimens fixated with endobuttons underwent failure due to glenoid bone fractures.Conclusions: A single endobutton fixation appears to be biomechanically comparable to screw fixation in the Latarjet-Bristow procedure and provides a lower risk for graft fracture. Further studies with more numerous specimens are warranted to conclusively validate these findings. [ABSTRACT FROM AUTHOR]

Anatomical repair of distal biceps tendon ruptures has been shown to restore elbow supination and flexion strength. Here, we report the outcomes of distal biceps tendon reattachment using the ToggleLoc fixation device with ZipLoop technology through a single incision. This was a retrospective study of 38 patients with a mean age of 49.5 years. The mean follow-up time was 15 months (range 4/28). The average time to surgery was 21 days. The fixation button was introduced in a bone tunnel and the tendon passed through a bone window using the ToggleLoc™, which allows the tendon to be tensioned using sutures. The tendon was reattached in 30° elbow flexion. The mean strength deficit in supination was 23.9% in comparison with the contralateral side. We discovered four instances of heterotopic ossification on follow-up radiographs. There were seven cases of persistent lateral antebrachial cutaneous nerve paresthesia, but no damage to the posterior interosseous nerve. This new technique places the tendon in a bone tunnel using a single surgical approach. It provides the surgeon with good feedback on the tension of the repair, which is unique among endobutton-type devices. We recommend using the ToggleLoc™ with ZipLoop™ technology as it is a simple, reliable and reproducible technique for distal biceps tendon reattachment. [ABSTRACT FROM AUTHOR]

Purpose: Anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) graft is known to provide secure fixation due to the direct bone-to-bone integration of the bone plug and bone tunnel. It is important to know the time required for bone integration when designing the postoperative rehabilitation protocol or deciding when the patient can return to competition-level activity, especially if the patient is an athlete. However, because reports are scarce, the period necessary for bone-to-bone integration after ACL reconstruction using a BTB graft remains unclear. The purpose of this study was to clarify this issue. It was hypothesised that ACL reconstruction using a BTB graft via an anatomical rectangular tunnel would help in the integration between bone plugs and bone tunnels on both the femoral and tibial sides after at least 6 months, at which point basic exercises similar to pre-injury sporting activity levels can be resumed.Methods: This study included 40 knees treated with ACL reconstruction using a BTB graft via anatomical rectangular tunnel reconstruction between 2013 and 2014 in a single institute. The integration between bone plugs and bone tunnels was evaluated using multi-slice tomosynthesis, which is a technique for producing slice images using conventional radiographic systems, at 1, 3, and 5 months postoperatively. All procedures were performed by two experienced surgeons. Bone integration was evaluated by two orthopaedic doctors.Results: The rates of integration of the bone plug and femoral bone tunnel on tomosynthesis at 1, 3, and 5 months postoperatively were 0, 55, and 100%, respectively. On the tibial side, the corresponding rates were 0, 75, and 100%, respectively. The rate of integration on the tibial side was significantly higher than that on the femoral side at 3 months postoperatively (p = 0.031).Conclusions: Bone-to-bone integration on the femoral and tibial sides was complete within 5 months after surgery in all cases. Since the time required for bone integration is important in designing the postoperative rehabilitation approach, these results will serve as a useful guideline for planning rehabilitation protocols.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Treatment of acute (≤3 weeks) acromioclavicular joint dislocation type III-VI is still controversial. Currently, the two modern techniques that are widely used are hook plate (HP) fixation and coracoclavicular ligament fixation using a suspensory loop device that consists of either a tightrope (single or double), endo-button (single or double), or synthetic ligament and absorbable polydioxansulfate sling.Materials and Methods: This systematic review was conducted according to the PRISMA guidelines. Relevant studies that reported Constant-Murley score (CMS), Pain Visual Analog score (VAS) and postoperative complications of either technique were identified from Medline and Scopus from inception to 5 October 2015.Results: Sixteen studies were included for the analysis of HP fixation, and 25 studies were included for analysis of loop suspensory fixation (LSF). Pooling of mean CMS and VAS scores gave 90.35 (95% CI 87.16, 93.54), 1.51 (95% CI 0.73, 2) in the HP group, and 92.48 (95% CI 90.91, 94.05), 0.32 (95% CI 0, 0.64) in the suspensory loop devices group, respectively. The pooled unstandardized mean differences (UMD) scores of CMS and VAS in LSF were 2.13 (95% CI -1.43, 5.69) and -1.19 (95% CI -2.03, -0.35) when compared to hook plating. The pooled prevalence of LSF and hook plating were 0.08 (95% CI 0.06, 0.10) and 0.05 (95% CI 0.02, 0.08) scores. The chance of having complications in the LSF group was 1.69 (95% CI 1.07, 2.60), which was statistically significantly higher than in the HP group.Conclusion: LSF have higher shoulder function scores (CMS) and lower postoperative pain when compared to HP fixation; however, there are higher complication rates with LSF when compared to hook plating.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The method of graft fixation is critical in anterior cruciate ligament (ACL) reconstruction surgery. Success of surgery is totally dependent on the ability of the implant to secure the graft inside the bone tunnel until complete graft integration. The principle of EndoButton is based on the cortical suspension of the graft. The Cross-Pin is based on graft expansion. The aim of this study was to evaluate the biomechanical performance of EndoButton and Bio Cross-Pin to fix the hamstring graft at femoral side of porcine knee joints and evaluate whether they are able to support of loading applied on graft during immediate post-operative tasks. Methods: Fourteen ACL reconstructions were carried out in porcine femurs fixing superficial flexor tendons with Titanium EndoButton (n = 7) and with 6 × 50 mm HA/PLLA Bio Cross-Pin (n = 7). A cyclic loading test was applied with 50-250 N of tensile force at 1 Hz for 1000 cycles. The displacement was measured at 20, 100, 500 and 1000 load cycles to quantify the slippage of the graft during the test. Single-cycle load-to-failure test was performed at 50 N/mm to measure fixation strength. Results: The laxity during cyclic loading and the displacement to failure during single-cycle test were lower for the Bio Cross-Pin fixation (8.21 ± 1.72 mm) than the EndoButton (11.20 ± 2.00 mm). The Bio Cross-Pin (112.22 ± 21.20 N.mm–1) was significantly stiffer than the EndoButton fixation (60.50 ±10.38 N.mm–1). There was no significant difference between Bio Cross-Pin (failure loading: 758.29 ± 188.05 N; yield loading: 713.67 ± 192.56 N) and EndoButton strength (failure loading: 672.52 ± 66.56 N; yield loading: 599.91 ± 59.64 N). Both are able to support the immediate post-operative loading applied (445 N). Conclusion: The results obtained in this experiment indicate that the Bio Cross-Pin technique promote stiffer fixation during cyclic loading as compared with EndoButton. Both techniques are able to support the immediate post-operative loading applied. [ABSTRACT FROM AUTHOR]

Purpose: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop on the femoral side, and an IS/staple on the tibial side. Methods: Between 2006 and 2009, at a single institution, 72 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon grafting were retrospectively reviewed. Fixation was performed, and with the EndoButton-Continuous Loop device (Group Ι) in 48 patients (mean age 29.1 ± 7.3 years) with a bioabsorbable IS (Group ΙΙ) in 24 patients (mean age 28.5 ± 8.4 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. Results: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (n.s.). Femoral TW at the proximal and middle levels (on both AP and lateral views) in Group ΙΙ was significantly greater than in Group Ι ( p < 0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (n.s.). Conclusion: Femoral TW is less after EndoButton-Continuous Loop fixation and not reduced after IS fixation. Surgeons should be aware of TW when selecting a fixation device for hamstring graft. Level of evidence: Therapeutic, retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the clinical outcomes of arthroscopy-assisted reconstruction of the coracoclavicular (CC) ligament using Endobutton for treating acromioclavicular (AC) joint dislocation. Methods: From March 2012 to May 2013, a total of 22 patients with fresh AC joint dislocation (Rockwood type III and type V) were treated with arthroscopy-assisted Endobutton reconstruction of the CC ligament. The regular post-operation follow-up was performed. Shoulder joint function was assessed with Constant-Murley scores. Postoperative efficacy of the surgery was evaluated using the Karlsson criterion. Results: The 22 patients were followed postoperatively for an average of 24 months (16-31 months). Among them, 20 patients achieved good functional recovery with no pain. Two patients had slight pain in the acromion during shoulder joint motion with limited abduction at 3 months, both of whom had recovered at 6 months. Radiography confirmed anatomical reduction of the AC joint in all patients. At 1 year, the Constant-Murley scores were 93.1 ± 2.4 points on the injured side versus 94.2 ± 2.7 points on the uninjured side. The difference did not reach statistical significance ( P > 0.05). Postoperative Karlsson evaluation ranked 20 patients (90.9 %) as grade A and 2 as grade B (9.1 %) at the 3-month follow-up. All patients had become grade A at 6 months. None of the patients had brachial plexus or peripheral vascular injuries. Conclusion: Arthroscopy-assisted reconstruction of the coracoclavicular ligament by Endobutton fixation is a safe, easy method for treating AC joint dislocation. It provides reliable fixation, causes little trauma, and has a fast recovery. [ABSTRACT FROM AUTHOR]

Background: Lesions of the acromioclavicular joint are the most common injuries of the shoulder girdle and therefore routine cases in a trauma department. Therapy options: The indications for operative stabilization depend on the amount of vertical and horizontal instability. There are two fundamentally different methods for surgical treatment in use: the acromioclavicular stabilization and the coracoclavicular stabilization. The common method in Europe for acromioclavicular stabilization is the hook plate. Coracoclavicular stabilization is performed increasingly more with arthroscopic assistance. Results: Both techniques achieve good to excellent clinical results, although in both methods comparable partial recurrent vertical instability can be observed. However, good results with the arthroscopic method will only be achieved by surgeons experienced in arthroscopy, limiting this operation technique to specialized centers. In comparison the learning curve with stabilization using hook plates is flat and the operation is feasible for young residents. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of EndoButton (Smith & Nephew Endoscopy, Andover, MA, USA) location on post-operative migration in anterior cruciate ligament (ACL) reconstruction. Methods: Seventy-seven patients underwent anatomical double-bundle ACL reconstruction using EndoButtons. Comparing patient radiographs immediately post-operatively with those at 1 year, migration was defined when EndoButtons moved more than 1 mm or rotated over 5°. Initial location of EndoButtons was evaluated on radiographs immediately post-operatively. We measured distances from the EndoButton to the posterior and distal edge of the femur (D1, D2) on lateral radiographs and distances from the EndoButton to the lateral and distal edge of the femur (D3, D4) on anteroposterior radiographs. The relationship between supracondylar line and the ratio of migration was also investigated. Results: D1 in the migrated group were significantly lower than those in the non-migrated group (11.8 ± 12.7 vs. 16.0 ± 10.2 mm). D2, D3 and D4 were not of significant difference in the two groups. The ratio of migration in the area posterior to the supracondylar line was significantly higher than that in the anterior area (54.3 vs. 15.1 %). Conclusion: EndoButtons, which was located distally and posteriorly, especially in the area posterior to the lateral supracondylar line, migrated more frequently, although migration of the button had no effect on the clinical parameters evaluated in this study. Clinical relevance: It is preferable to settle EndoButton anteriorly to the lateral supracondylar line in order to avoid its migration for the graft tension due to our findings about the relationship between initial location of EndoButton and the rate of migration. Level of evidence: Prognostic case series, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the operation time required and the clinical outcome 2 years postoperatively, after anatomic double-bundle ACL reconstructions using hamstring tendon grafts fixed with either the EndoButton-CL-BTB (ECL-BTB) or the EndoButton-CL (ECL). Methods: Forty-six patients, who underwent anatomic double-bundle ACL reconstruction, were non-randomly divided into 2 groups. Patients with a combined ligament injury or complete meniscal tear were excluded from this study. In group I, an ECL was used with 23 patients. In group II, an ECL-BTB was used with the remaining 23 patients. In groups I and II, the ECL or ECL-BTB was attached to the femoral ends of the hamstring tendon autografts. In both groups, a polyester tape was connected in series with the tibial ends of the grafts. The patients were examined with standard clinical evaluations at 2 years after surgery. Results: The operation time in group II was significantly shorter than that in group I ( P = 0.0459). Concerning the intra- and postoperative complications, there were no serious complications in either group. No significant differences were found between the 2 groups in terms of knee laxity measurements, the peak muscle torque of quadriceps and hamstrings, the Lysholm score and the IKDC evaluation. Conclusions: This study demonstrated that the usage of the ECL-BTB for graft preparation significantly shortens the total operation time in comparison with the ECL and that there were no significant differences in the 2-year clinical outcome and the intra- and postoperative complications between the 2 graft preparation procedures of the anatomic double-bundle ACL reconstruction. The ECL-BTB can be an alternative device for the hamstring tendon graft in double-bundle ACL reconstruction. Level of evidence: Prospective comparative cohort study, Level II. [ABSTRACT FROM AUTHOR]

Purpose: Posterior cruciate ligament (PCL) avulsion fractures are uncommon injuries, and their treatment, still, remains difficult. There are procedures described in the literature which are minimal invasive and use either sutures or screws to stabilize the avulsed fragment. The purpose of this study was to present an innovative arthroscopic technique using a suspensory device with specific biomechanical properties. The aim of this study was to determine whether this technique was effective in the treatment of PCL avulsion fractures and applicable in everyday clinical practice. Methods: Two patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. The Endobutton device was used to stabilize the fracture, and a double-spike plate was used to secure the fixation. The clinical assessment of patients was made by plain radiographs, CT scan, MRI and IKDC examination form. Results: The median operative time was 57.5 min (range 55-60). No posterior tibial sag was noticed, and the range of motion was normal. No complications were recorded, and both patients returned to their usual daily activities. Both fractures had healed at 10 months postoperatively. Conclusions: Treatment outcomes using a suspensory device in the fixation of posterior cruciate ligament avulsion fractures are encouraging. The small size of the device makes it easy to handle, and the procedure is simple and does not require multiple sutures and bony tunnels. This technique offers sufficient compression, restores the length of posterior cruciate ligament and can fix avulsion fragments of any size. Level of evidence: Therapeutic study, Case series with no comparison group, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies that have encouraged early postoperative motion after distal biceps repair shows little agreement on exactly when activity should be resumed after surgery or on the level of weight restriction that should be used. The aim of the current study was to define a service load that would permit, without failure, 2,000 cycles of immediate motion after single-incision EndoButton distal biceps repair with FiberWire. Methods: In each of 15 cadaveric elbows, the distal biceps tendon was divided at its insertion and then repaired using a single-incision EndoButton technique with FiberWire. The repairs were then challenged according to the 'staircase method' by cyclically loading the biceps tendon, so that the forearm flexed between 0° and 90°. Results: The mean failure load of the repair was 166.7 N (95% confidence interval, 132.6-200.8). The data suggested that a 0.9 kg (9-N) weight at the hand was the limit for a 2,000-cycle early rehabilitation protocol after repair of a ruptured distal biceps tendon via a single-incision EndoButton repair technique. Conclusion: Early active motion with a 0.9-kg weight restriction may therefore be possible in those patients undergoing distal biceps tendon repair using this technique. [ABSTRACT FROM AUTHOR]

Purpose: This study is to compare the clinical and radiographic results of anterior cruciate ligament (ACL) reconstruction with four-stranded autogenous hamstring tendon and two-stranded free tendon Achilles allograft fixed with EndoButton in the femoral tunnel and Intrafix in the tibial tunnel. Materials and methods: 106 patients diagnosed with ACL rupture underwent ACL reconstruction. Autogenous hamstring tendon was used in 33 patients (group I) and free tendon Achilles allografts were used in 32 patients (group II). Median age was 23 years old (20-51) in group I and 22 years old (20-55) in group II. Range of motion, Lachman test, Pivot shift test, IKDC score, Lysholm score and side-to-side difference (SSD) were evaluated preoperatively and at the last follow-up. Tegner activity scale was evaluated before injury and at the last follow-up. Results: The mean follow-up periods were 28.1 months in group I and 31.6 months in group II. Range of motion of the knee was not different from that of the unaffected side in most cases except one flexion deficit in group I and three in group II (n.s.). One in group I and three in group II showed grade two or three laxity on Lachman test at the last follow-up. One in group I and three in group II showed clear positive results on Pivot shift test at the last follow-up. Thirty in group I and 26 in group II were classified to IKDC A or B at the last follow-up (n.s.). Median Lysholm scores were 98 (85-100) in group I and 99 (85-100) in group II at the last follow-up (n.s.). Median Tegner activity scales were 6 (5-9) in group I and 6 (4-9) in group II at the last follow-up (n.s.). The mean SSD at the last follow-up were 1.4 ± 2.0 mm in group I and 1.9 ± 2.4 mm in group II (n.s.). Conclusion: Clinical and radiological outcomes of ACL reconstruction with two-stranded free tendon Achilles allograft were comparable to those of four-stranded autogenous hamstring tendon. This technique is reasonable to accomplish good results without some weaknesses when using allograft with bone block. Level of evidence: Therapeutic randomized controlled prospective study, Level I. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) reconstruction is becoming increasingly popular in active middle-aged patients with symptomatic instability. The purpose of this study was to retrospectively evaluate the results of ACL reconstruction in patients over the age of 40. Twenty-one patients with a median age of 44 (range 40–56) who had arthroscopically assisted reconstruction using four-stranded hamstring autograft were reviewed. RCI titanium interference screw fixation was used in the tibia, and Endobutton CL fixation in the femur. The clinical results were assessed at a mean follow-up of 2 years. The median value for the Lysholm knee score was 92 (range 74–100), and the median value for the International Knee Documentation Committee score was 83 (range 53–97). For the Tegner activity scale, the median value was 6 (range 4–8) at follow-up. The median side-to-side difference using the KT-1000 arthrometer was 2 mm (range 0–3.5 mm). Hamstring ACL reconstruction in appropriately selected middle-aged patients can yield successful and satisfactory results. [ABSTRACT FROM AUTHOR]

The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons. [ABSTRACT FROM AUTHOR]

Arthroscopic EndoButton fixation of anterior cruciate ligament (ACL) grafts over the femoral cortex has become popular in recent years. However, elongation of fixation materials has lead to tunnel enlargement, graft tunnel motion and instability. Synovial fluid passages along femoral tunnels following ACL reconstruction may result in destruction of tissues. The purpose of the present study was to identify the seating position of the EndoButton in regard to the boundaries of the knee capsule in single-incision arthroscopic ACL reconstruction. A total of 20 cadaveric knees were dissected and arthroscopic drill guides were used to create tibial and femoral tunnels. The distances between the exit points and boundaries of the suprapatellar bursa at three different degrees of knee flexion were measured. The average distances from the exit points to the superior boundaries of the suprapatellar bursa were 6.89 ± 5.40 mm (range, 16.87–1.21). However, in knee flexion of greater than 90°, tunnel exits were placed below the superior boundaries of the suprapatellar bursa (−7.08 ± 3.69 mm, range, −3.24 to −12.87). In order to place the EndoButton extraarticularly, a safe degree of knee flexion during femoral tunnel drilling was defined as 80°. [ABSTRACT FROM AUTHOR]

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Introduction: We report results of the anterior cruciate ligament reconstruction using a four-strand hamstring graft without detachment of the tibial insertion of the tendons. Material and Methods: In 74 patients the hamstring graft was fixed using an endobutton on the femoral side and a barbed staple on the tibial side. There were 69 male and 5 female patients. The mean age at the time of operation was 35.1 years (21–53 years). Postoperatively, an accelerated rehabilitation was followed with no protective braces. The mean follow-up period was 64 months (range 48 to 84 months). Results: All patients achieved full range of motion with a stable knee joint. The mean side-to-side difference using KT-1000 was 1.43 mm (SD 3.86). The average Lysholm score improved from 42 to 79.2 and the Tegner score improved from 3.4 to 5.9. Conclusion: Detachment of hamstring tendons from their tibial insertion is unnecessary and our results with accelerated rehabilitation without protective braces are satisfactory and comparable to other studies. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, we seek to present the outcome of repair of acute distal biceps tendon rupture using the intramedullary Endobutton® technique. We retrospectively assessed all patients undergoing repair of a distal biceps tendon rupture using a new technique with a single incision volar approach and repair with an Endobutton inserted into the intramedullary canal. Seven patients were included in the study. Patients were assessed clinically and also with dynamometry. All of the patients were male and had a mean age 49. On dynamometry assessment: the mean difference in power between arms on flexion/extension post-operatively was a reduction of 3% in the affected arm and the mean difference in work over a 60-s period was unchanged. There was no significant difference in post-op range of motion in the operated arm when compared to the unaffected side. No complications were identified. The results obtained in this study demonstrate a good short-term functional outcome with this technique. [ABSTRACT FROM AUTHOR]

We report a case study of a patient who underwent bone-patellar tendon-bone ACL reconstruction using an Endobutton. Although the fact that the Endobutton did not pass outside the femoral cortex was realized after the operation, Lachman's test was negative. The Endobutton appeared to hang onto the femoral tunnel as an anchor, and it was decided to observe rather than intervene. One year later no laxity had developed, and a second-look arthroscopy showed a good ligament reconstruction. Although it is quite easy to perform, Endobutton fixation in ACL surgery requires that maximum care be taken to ensure that the Endobutton has flipped. [ABSTRACT FROM AUTHOR]