BackgroundThe concept of utilizing nonabsorbable suture tape fixed directly to bone to augment Brostrom repairs of the anterior talofibular ligament (ATFL) has been proposed. However, no clinical data are currently available regarding the arthroscopic modified Brostrom operation with an internal brace.Materials and methodsThis study involved 85 consecutive patients (22 in the with internal brace group; 63 in the without internal brace group) who could be followed up for >6 months after undergoing an arthroscopic modified Brostrom operation. The American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status. At preoperation and at 24 weeks after surgery, the anterior drawer test was examined clinically.ResultsImprovement of mean AOFAS score in the internal brace group from before surgery to two weeks after surgery was statistically significant (p < 0.05). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 19 patients (86.4 %) and grade 1 in three patients (13.6 %). Improvement of AOFAS score in the group without an internal brace from before surgery to 6 weeks after surgery was not statistically significant (p = 0.001). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 54 patients (85.7 %) and grade 1 in nine patients (14.3 %).ConclusionPatients in the internal brace group were able to quickly return to activity and sports. We believe this technique could be a viable option for surgically treating chronic lateral ankle instability in patients who need an early return to activity and sports.Level of evidenceIII.

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Background: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. Methods: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. Results: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation ( n = 3, 10.7%) was less than that of hook LCP fixation ( n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. Conclusion: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. Level of Evidence: Level III, retrospective study.

Background and purpose Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness. This study investigated the performance of SE for the differentiation of supraspinatus (SSP) tendon alterations of tendinopathy compared to magnetic resonance imaging (MRI) and conventional ultrasonography (US). Methods One hundred and eighteen consecutively registered patients with symptoms and MRI findings of SSP tendinopathy were assessed with US and SE. Coronal images of the SSP tendon were obtained using US and SE. Increased signal intensity on T2-weighted images in the coronal planes were graded according to the extent of the signal changes from ventral to dorsal. SE images were evaluated by reviewers using an experimentally proven color grading system. Results Using SE, 7.6 % of the SSP tendons were categorized as grade 0, 30.5 % as grade 1, 19.5 % as grade 2, and 42.4 % as grade 3. Evaluation of the interobserver reliability of the SE findings showed ''almost perfect agreement'', with a weighted kappa coefficient of 0.83. By comparing the MRI findings with the SE findings, grades of MRI and SE had a positive correlation (r = 0.829, p = \0.001). Furthermore, grades of US and SE also had a positive correlation (r = 0.723, p = \0.001). Conclusions SE is valuable in the detection of the intratendinous and peritendinous alterations of the SSP tendon and has excellent interobserver reliability and excellent correlation with MRI findings and conventional ultrasonography findings.Keywords Rotator cuff Á Tendinopathy Á Ultrasonography Á Sonoelastography Riassunto Obiettivi La sonoelastografia (SE) è una nuova tecnica in grado di valutare le differenze di rigidità dei tessuti. Questo studio ha valutato le capacità della SE nella differenziazione delle alterazioni tendinee da tendinopatia del sovraspinato (SSP) rispetto a risonanza magnetica (MRI) ed ecografia convenzionale (US). Materiali e Metodi Centoventuno pazienti con sintomi e reperti MRI di tendinopatia del SSP sono stati valutati con US e SE. Si sono realizzate immagini coronali del tendine SSP utilizzando US e SE. Sono state valutate immagini T2-pesate, per la maggiore intensità del segnale, nei piani coronali, da ventrale a dorsale. Immagini di SE sono state valutate da revisori che utilizzavano un sistema di grading di colore sperimentale. Risultati Utilizzando la SE, 7,4 % dei tendini SSP sono stati classificati come di grado 0, 29,8 % di grado 1, 19,8 % di grado 2, e 43,0 % di grado 3. La valutazione inter-osservatori dei risultati SE ha mostrato ''accordo quasi perfetto'', con un coefficiente kappa pesato di 0,83. Confrontando i risultati della risonanza magnetica con i risultati della SE, risonanza magnetica e SE hanno avuto una correlazione positiva (r = 0,849, p = \ 0.001). Inoltre, anche US e SE hanno avuto una correlazione positiva (r = 0,706, p = \ 0,001). Conclusioni La SE è valida nella rilevazione delle alterazioni intra-tendinee e peri-tendinee del tendine SSP e ha un'ottima affidabilità inter-osservatori e un'eccellente ...

PurposeDespite the high failure rates of techniques used to maintain the reduction of single‐tunnel coracoclavicular (CC) fixation, analyses of the etiology of loss of reduction related to surgical techniques are limited. Therefore, it was hypothesized that the initial coracoclavicular tunnel angle was related to loss of reduction in the single‐tunnel technique for AC joint dislocation. This study aimed to evaluate the clinical and radiological outcomes of arthroscopic single‐tunnel CC suture button fixation according to the initial coracoclavicular tunnel angle. MethodsThirty‐two consecutive patients who underwent arthroscopic single‐tunnel CC suture button fixation for AC joint dislocation from 2014 to 2018 were enrolled. The tunneling‐first technique was used in the first 11 patients, while the reduction‐first technique was used in the remaining 22 consecutive patients. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score and Korean Shoulder Score (KSS) were recorded. For radiological evaluation, coracoclavicular distance ratio, coracoclavicular tunnel angle, coracoid, and clavicular tunnel widths were measured. ResultsThe ASES score did not differ significantly between the two groups (n.s.). However, the KSS was significantly better in the reduction‐first group (p = 0.031). No significant intergroup differences were observed in the pre‐ and postoperative coracoclavicular distance ratio. However, at the last follow‐up, loss of coracoclavicular distance ratio was significantly smaller in the reduction‐first group (p < 0.001). At the final follow‐up, loss of the coracoclavicular distance ratio was positively correlated with the postoperative coracoclavicular tunnel angle (p < 0.001, Spearman’s rho correlation coefficient = 0.602). The final follow‐up clavicular tunnel width was also significantly smaller in the reduction‐first group (p = 0.002). Finally, the last follow‐up clavicular tunnel width was positively correlated with the postoperative coracoclavicular tunnel angle (p = 0.008, Spearman’s rho correlation coefficient = 0.459). ConclusionThe reduction‐first technique showed better clinical and radiological outcomes than the tunneling‐first technique in single‐tunnel CC fixation for AC joint dislocation. A large postoperative coracoclavicular tunnel angle was associated with loss of reduction and clavicular tunnel widening. Therefore, obtaining a straight coracoclavicular tunnel angle is crucial for achieving better outcomes and minimizing loss of reduction. Level of evidenceIII.