BACKGROUND: This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. METHODS: From November 2008 to December 2016, 23 patients (57.5 ± 4.4 years; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was 4.7 ± 4.0 years (range, 2–12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. RESULTS: ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last follow-up (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. CONCLUSIONS LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.

Purpose: Anterolateral minimally invasive plate osteosynthesis (MIPO) was performed to treat patients with distal tibial fractures associated with open fractures or extensive soft tissue injuries, which is limited medial MIPO. The treatment results of the anterolateral MIPO technique were evaluated and analyzed. Materials and Methods: Seventeen patients with distal tibial fractures associated with an open fracture or large bullae formation on the distal tibia medial side were treated with anterolateral MIPO using anterolateral locking plates. Within 24 hours of visiting the emergency room, external fixation was applied, and the medial side wound was managed. After damage control, the anterolateral locking plate was applied using an anterolateral MIPO technique. The union time, nonunion, or malunion were evaluated with regular postoperative radiographs. The ankle range of motion, operative time, blood loss, Iowa score, and wound complications were investigated. Results: Radiological evidence of bony union was obtained in all cases. The mean time to union was 16.7 weeks (12∼25 weeks). The mean operation time was 44.0 minutes. Regarding the ankle range of motion, the mean dorsiflexion was 15°, and the mean plantarflexion was 35°. Satisfactory results were obtained in 15 out of 17 cases; five results were classified as excellent, four were good, and six were fair. The mean blood loss was 125.2 mL. Two complications were recorded. Conclusion In distal tibial fractures with severe medial soft tissue damage caused by high-energy trauma, the staged anterolateral MIPO technique using anterolateral locking plates is a useful alternative treatment to achieving optimal wound care, rapid union with biological fixation, and intra-articular reduction.

Background: The increasing prevalence of cementless total knee arthroplasty (TKA) necessitates a reliable assessment of bone quality. Central bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DEXA) in the lumbar spine and hip, is conventionally used to estimate bone quality. However, its effectiveness in predicting the actual bone strength at the knee, which is crucial for cementless TKA, is under scrutiny. This study investigated the relationship between central BMD and actual bone strength at the knee. Methods: This prospective study included 191 knees undergoing standard posterior-stabilized TKA between November 2021 and March 2023. Central BMD was assessed 3 months before TKA, and the failure load of bone fragments collected during box preparation was directly measured using an indentation test. Relationships between central BMD and failure load as a measure of the actual bone strength at the knee were analyzed. Results: Linear regression analysis revealed a weak correlation between central BMD and the actual bone strength at the knee (R 2= 0.146 in all patients; < 0.001 in osteoporosis group; 0.126 in non-osteoporosis group). The correlation suggested by the regression models was particularly insignificant in the osteoporosis subgroup, showing that central BMD is not a reliable predictor of bone strength for cementless TKA. Conclusions Central BMD measurements have limited utility in accurately predicting the real bone strength at the knee for cementless TKA. This study highlights the need for more specific and direct methods of assessing bone quality at the knee to ensure the success of cementless TKA.

Background: The increasing prevalence of cementless total knee arthroplasty (TKA) necessitates a reliable assessment of bone quality. Central bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DEXA) in the lumbar spine and hip, is conventionally used to estimate bone quality. However, its effectiveness in predicting the actual bone strength at the knee, which is crucial for cementless TKA, is under scrutiny. This study investigated the relationship between central BMD and actual bone strength at the knee. Methods: This prospective study included 191 knees undergoing standard posterior-stabilized TKA between November 2021 and March 2023. Central BMD was assessed 3 months before TKA, and the failure load of bone fragments collected during box preparation was directly measured using an indentation test. Relationships between central BMD and failure load as a measure of the actual bone strength at the knee were analyzed. Results: Linear regression analysis revealed a weak correlation between central BMD and the actual bone strength at the knee (R 2= 0.146 in all patients; < 0.001 in osteoporosis group; 0.126 in non-osteoporosis group). The correlation suggested by the regression models was particularly insignificant in the osteoporosis subgroup, showing that central BMD is not a reliable predictor of bone strength for cementless TKA. Conclusions Central BMD measurements have limited utility in accurately predicting the real bone strength at the knee for cementless TKA. This study highlights the need for more specific and direct methods of assessing bone quality at the knee to ensure the success of cementless TKA.

Background: The increasing prevalence of cementless total knee arthroplasty (TKA) necessitates a reliable assessment of bone quality. Central bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DEXA) in the lumbar spine and hip, is conventionally used to estimate bone quality. However, its effectiveness in predicting the actual bone strength at the knee, which is crucial for cementless TKA, is under scrutiny. This study investigated the relationship between central BMD and actual bone strength at the knee. Methods: This prospective study included 191 knees undergoing standard posterior-stabilized TKA between November 2021 and March 2023. Central BMD was assessed 3 months before TKA, and the failure load of bone fragments collected during box preparation was directly measured using an indentation test. Relationships between central BMD and failure load as a measure of the actual bone strength at the knee were analyzed. Results: Linear regression analysis revealed a weak correlation between central BMD and the actual bone strength at the knee (R 2= 0.146 in all patients; < 0.001 in osteoporosis group; 0.126 in non-osteoporosis group). The correlation suggested by the regression models was particularly insignificant in the osteoporosis subgroup, showing that central BMD is not a reliable predictor of bone strength for cementless TKA. Conclusions Central BMD measurements have limited utility in accurately predicting the real bone strength at the knee for cementless TKA. This study highlights the need for more specific and direct methods of assessing bone quality at the knee to ensure the success of cementless TKA.

Background: The increasing prevalence of cementless total knee arthroplasty (TKA) necessitates a reliable assessment of bone quality. Central bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DEXA) in the lumbar spine and hip, is conventionally used to estimate bone quality. However, its effectiveness in predicting the actual bone strength at the knee, which is crucial for cementless TKA, is under scrutiny. This study investigated the relationship between central BMD and actual bone strength at the knee. Methods: This prospective study included 191 knees undergoing standard posterior-stabilized TKA between November 2021 and March 2023. Central BMD was assessed 3 months before TKA, and the failure load of bone fragments collected during box preparation was directly measured using an indentation test. Relationships between central BMD and failure load as a measure of the actual bone strength at the knee were analyzed. Results: Linear regression analysis revealed a weak correlation between central BMD and the actual bone strength at the knee (R 2= 0.146 in all patients; < 0.001 in osteoporosis group; 0.126 in non-osteoporosis group). The correlation suggested by the regression models was particularly insignificant in the osteoporosis subgroup, showing that central BMD is not a reliable predictor of bone strength for cementless TKA. Conclusions Central BMD measurements have limited utility in accurately predicting the real bone strength at the knee for cementless TKA. This study highlights the need for more specific and direct methods of assessing bone quality at the knee to ensure the success of cementless TKA.