Background: Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction technique (ART) and the LaPrade reconstruction technique (LRT). To the authors’ knowledge, these techniques have not been biomechanically compared against one another. Purpose: To identify if one of these reconstruction techniques better restores stability to a PLC-deficient knee and if concomitant injury to the proximal tibiofibular joint or anterior cruciate ligament affects these results. Study Design: Controlled laboratory study. Methods: Eight matched-paired cadaveric specimens from the midfemur to toes were used. Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned (phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase 4A) or anterior cruciate ligament (phase 4B) sectioning with PLC reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º, and 90º of knee flexion were quantified at each phase. Results: In phase 3, both reconstructions were effective at restoring laxity back to the intact state. However, in phase 4A, both reconstructions were ineffective at stabilizing the joint owing to tibiofibular instability. In phase 4B, both reconstructions had the potential to restrict varus angulation motion. There were no statistically significant differences found between reconstruction techniques for varus angulation or external rotation at any degree of flexion in phase 3 or 4. Conclusion: The LRT and ART are equally effective at restoring stability to knees with PLC injuries. Neither reconstruction technique fully restores stability to knees with combined PLC and proximal tibiofibular joint injuries. Clinical Relevance: Given these findings, surgeons may select their reconstruction technique based on their experience and training and the specific needs of their patients.

Background: In a cadaveric model, we evaluated thumb metacarpal subsidence, indicated by a decreased metacarpal-to-scaphoid distance, after 2 surgical procedures used to treat thumb carpometacarpal (CMC) osteoarthritis (OA): partial trapeziectomy with capsular interposition (PTCI), which involves removal of 2 mm of both the distal trapezium and base of the metacarpal; and total trapeziectomy with capsular interposition (TTCI). Methods: Nine matched pairs of cadaveric hands were randomly assigned to undergo either PTCI or TTCI. Preoperatively, physiologic forces were applied across the thumb CMC joint by loading 6 tendons, simulating lateral pinch. Anteroposterior radiographs were obtained, and the metacarpal-to-scaphoid distance on each image was estimated independently by 3 separate readers using customized software. A hand surgeon then performed the PTCI and TTCI procedures, and the measurements under loading were repeated. The results were assessed for interrater reliability. Mean values for metacarpal-to-scaphoid distance before and after the surgical procedures were compared. Results: Preoperatively, the metacarpal-to-scaphoid distance in the PTCI and TTCI groups was not significantly different. Postoperatively, metacarpal subsidence was significantly less in the PTCI group (17% compared with 34% for TTCI; P = .05). Conclusions: Metacarpal subsidence occurred after both PTCI and TTCI, but significantly less subsidence was observed after PTCI; thus, thumb length was better preserved. Previous research has shown an inverse correlation between maintenance of thumb length and overall Disabilities of the Arm, Shoulder, and Hand (DASH) score. A procedure for treating thumb CMC OA that preserves thumb length and minimizes disruption of stabilizing joint tissue may provide enhanced maintenance of thumb stability and improved patient outcomes.

Purpose: To biomechanically compare intramedullary (IM) versus extramedullary (EM) distal biceps button fixation under cyclic loading conditions, which is most representative of postoperative physiologic status. Methods: This controlled laboratory study used 13 fresh‐frozen matched paired cadaver elbows. One specimen from each pair was randomized to either IM (unicortical) or EM (bicortical) distal biceps button fixation via onlay technique. A servohydraulic actuator was used to cycle each specimen from full extension to 90° of flexion at 0.5 Hz for 3,000 cycles. All specimens were subsequently loaded to failure to simulate an acute postoperative load. Results: During cyclic loading, the mean change in force from cycle 5 to cycle 3000 was 2.1 ± 3.2 N for the IM group and 0.6 ± 4.2 N for the EM group ( P = .19). The increase in tendon gap for the IM group was 1.02 mm and for the EM group was 1.83 mm ( P = .37). During failure loading, the IM group had a mean failure load of 154.9 ± 44.5 N and the EM group a mean failure load of 191.1 ± 62.6 N ( P = .16). Conclusions: No significant differences exist between the IM and EM techniques in loss of force and tendon gap formation under cyclic loading or load to failure conditions. Thus, IM fixation may adequately facilitate optimal bone‐tendon apposition, with less risk of iatrogenic injury to the posterior interosseous nerve that can be seen with bicortical extramedullary fixation. Clinical Relevance: The most common major complication following distal biceps repair is PIN palsy. IM fixation may be sufficient in facilitating optimal bone‐tendon apposition and healing with onlay technique, while minimizing risk of iatrogenic PIN injury associated with EM fixation.

Background: Although experiences in the operating room can help surgeons to learn simple bone-drilling techniques, outside training may be better suited for complex procedures. We adapted a rotary handpiece to evaluate the bone-drilling skills of orthopaedic resident physicians during the 2017 Southwest Orthopaedic Trauma Association (SWOTA) motor skills course. Methods: Twenty-five postgraduate year (PGY)-1 orthopaedic residents from 7 institutions were asked to perform a bicortical drilling task 3 times both before and after attending a motor skills course. Kinetic and kinematic data were collected using force, acceleration, and visual sensors. Results: Sixteen parameters were measured. The interdependence of these parameters (taken separately for precourse and postcourse performance) is presented. Evidence for motor skill acquisition across a short time scale is elucidated. Noteworthy correlations include overpenetration with force (0.65 mm), palmar-dorsal (P-D) toggle (0.65°), vibration in the P-D direction (0.53 m/s²), time (−0.41 sec), and RPM (revolutions per minute; −0.36); time with both RPM (0.38) and P-D toggle (−0.40°); and force with both RPM (−0.41) and P-D toggle (0.32°). Differences in performance before and after the motor skills course include reduction in overpenetration (28.8 to 18.2 mm), reduction in skiving (22% to 6%), and reduction in preparation time (27.3 to 9.65 sec). Additionally, there were several differences in performance by institution that were significant (overpenetration, toggle in the P-D and radial-ulnar [R-U] directions, and both drilling force and drilling time). Conclusions: Understanding how performance and outcome parameters are correlated provides powerful insight into how surgical procedures can be best performed. In particular, we hope that these findings will inform new training paradigms. Variations in resident training from 1 institution to another are evidenced in surgical performance. Similarly, the methods used here to quantify changes in performance across the 3-day SWOTA training course allow a unique vehicle for optimization of these types of training opportunities outside of the operating room.