Several latissimus dorsi tendon transfer techniques for shoulder problems have been previously described and developed. These techniques involve the transfer in obstetric palsy, transfer in irreparable posterosuperior rotator cuff tears and subscapularis tears, and transfer in reverse shoulder arthroplasty. We detail the differences in planning and surgery and the need for different approaches. This historical and technical description provided in this study will benefit surgeons wishing to use the procedure.

This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple). Each graft fixation was exposed to cyclic loading conditions. Significant differences were determined in failure load among the three groups (p = 0.008). The mean failure load was significantly higher in group B (717.04 ± 218.51 N) than in group A (308.03 ± 17.22 N) (p = 0.006). No significant differences were observed among the groups regarding axial stiffness (p = 0.442). Cyclic displacement differed significantly among the three groups (p = 0.005). In pairwise comparisons, the mean cyclic displacement was significantly higher in group A (8.22 ± 3.24 mm) compared with group C (1.49 ± 0.41 mm) (p = 0.005). Failure displacement varied considerably among the groups (p = 0.037). Although group B (15.53 ± 6.43 mm) exhibited a greater mean failure displacement than both group A (4.9 ± 0.75 mm) and group C (8.84 ± 4.65 mm), these differences did not reach statistical significance (p = 0.602 and p = 0.329, respectively). Interference screw fixation alone and supplementary staple fixation have biomechanically similar characteristics in terms of initial strength and stiffness of tibial ACL soft tissue graft fixation. Regardless of staple use, an interference screw with the same diameter as the tibial tunnel can ensure sufficient tensile strength in tibial ACL graft fixation.

Unstable femoral neck fractures with medial calcar defects are difficult to manage. The optimal fixation methods for these fractures have been a subject of ongoing debate among orthopedic surgeons. In this study, three different fixation techniques for vertical, medial defected femoral neck fractures were compared. In this study, a biomechanical analysis was conducted to compare three fixation methods: cannulated screws (Group 1), cannulated screws combined with a medial buttress plate (Group 2), and intramedullary nails (Group 3). Synthetic composite bone models representing vertical collum femoris fractures with medial calcar defects were used. Each group consisted of seven specimens, and, to maintain consistency, a single surgeon performed the surgical procedure. Biomechanical testing involved subjecting the specimens to axial loading until failure, and the load to failure, stiffness, and displacement values were recorded. Normality was tested using the Shapiro–Wilk test. One-way ANOVA and Tukey’s HSD post hoc test were used for comparisons. The difference in the load to failure values was statistically significant among the groups, with Group 2 exhibiting the highest load to failure value, followed by Group 3 and Group 1. Stiffness values were significantly higher in Group 2 than in the other groups. Displacement values were not significantly different between the groups. Fracture and displacement patterns at the point of failure varied across the groups. The results of this study indicate that fixation with a medial buttress plate in combination with cannulated screws provides additional biomechanical stability for vertical femoral neck fractures with medial calcar defects. Intramedullary nail fixation also demonstrated durable stability in these fractures. These findings can be used to better understand current management strategies for these challenging fractures to promote the identification of better evidence-based recommendations.

Background: Subcoracoid cysts (ScCs) are often associated with rotator cuff tears, but their relationship with rotator cuff retears remains unclear. Purpose: To investigate the correlation between ScCs and retears in patients having undergone arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was conducted on patients who underwent arthroscopic rotator cuff repair from November 2016 to March 2022. Patients with Patte stage 1 or 2 tears were included. Preoperative magnetic resonance imaging (MRI) assessed subscapularis and supraspinatus tendons, biceps pulley, and ScC volume. Postoperative MRI evaluated the same parameters as preoperative MRI, with the addition of rotator cuff retear assessment. On the basis of preoperative MRI, patients were classified into group A (with cyst) and group B (without cyst). According to postoperative MRI, groups were further divided into A1 (without retear), A2 (with retear), B1 (without retear) and B2 (with retear). Postoperative decrease in ScC volume (ScC delta), Sugaya classification, and Constant score were compared. Results: The study included 109 patients: 69 in group A (A1 = 40, A2 = 29) and 40 in group B (B1 = 35, B2 = 5). The retear rate was significantly higher in group A (34.8%) than in group B (12.5%) ( P = .02). In group A, the median (minimum-maximum) ScC delta value was significantly greater in group A1 (2422 mm ³ [257 to 7503 mm ³ ]) compared with group A2 (625 mm ³ [–1060 to 1978 mm ³ ]), indicating no recurrence of the ScC ( P = .03). Postoperative Constant shoulder scores were higher in the no retear groups (group A1, 79.3 ± 8.2; group A2, 66.2 ± 13.4; group B1, 83.2 ± 8.5; group B2, 61.4 ± 5.9) ( P < .001). Conclusion: For the patients with ScCs detected on preoperative MRI scans, preserved tendon integrity after rotator cuff repair was associated with a reduction in ScC volume. This reduction was evident on postoperative MRI scans when compared with preoperative measurements. Conversely, compromised tendon integrity did not lead to a significant reduction in ScC volume after surgery, potentially suggesting cyst reformation. Therefore, the postoperative identification of an ScC may indirectly indicate rotator cuff retear.

Background: Total hip arthroplasty (THA) is an effective treatment for advanced hip osteoarthritis, particularly in complex cases such as Crowe Type 3 and 4 developmental dysplasia of the hip (DDH). This study aimed to compare radiological and early clinical outcomes of conventional (cTHA) and robotic (rTHA) THA in patients with Crowe Type 3 and 4 DDH. Methods: Patients who underwent cTHA or rTHA were retrospectively analysed. Preoperative and postoperative clinical parameters, including range of motion (ROM), visual analogue scale (VAS) pain scores, modified Harris Hip Score (mHHS), and leg-length discrepancy, were evaluated. Radiological assessments included implant positioning (acetabular inclination and anteversion, femoral anteversion) using x-ray and CT imaging. Operative durations for cTHA and rTHA were also compared. Results: A total of 45 patients (52 hips) were included. Both groups showed significant improvements in clinical and radiological outcomes. Postoperative VAS pain scores were lower in the rTHA group (1.35 ± 1.00 vs. 2.41 ± 1.14 for cTHA), and mHHS was higher (92.34 ± 5.68 vs. 79.68 ± 5.92 for cTHA). ROM and radiological parameters, such as acetabular inclination (37.11 ± 3.37° for rTHA vs. 41.13 ± 6.49° for cTHA) and anteversion (17.59 ± 1.78° for rTHA vs. 21.87 ± 1.71° for cTHA), were more precise in rTHA. Operative time was longer for rTHA (117.06 ± 8.16 vs. 79.71 ± 6.79 minutes). Conclusions: Robotic THA achieved better implant positioning and superior early clinical outcomes compared to conventional THA in complex DDH cases, despite longer surgical times.