Management of proximal biceps tendon pathology

The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.

Arthroscopic treatment of iliopsoas tendinitis after total hip arthroplasty with acetabular cup malposition: Two case reports

BACKGROUND Optimal treatment for iliopsoas tendinitis after total hip arthroplasty(THA)with cup malposition,iliopsoas release alone or with cup revision,is controversial,particularly in young,active patients.Moreover,arthroscopic iliopsoas tendon(IPT)release in these patients has been rarely described,and midterm effects of this procedure on THA longevity and groin pain recurrence remain unclear.We performed arthroscopic IPT release after THA and report midterm outcomes in two young patients with acetabular cup malposition.CASE SUMMARY In the two patients,groin pain started early after THA.Physical examination revealed nonspecific findings,and laboratory tests showed no evidence of infection.Radiography and computed tomography showed reduced acetabular component anteversion angle and anterior cup prominence of more than 16 mm.For therapeutic diagnosis,ultrasonography-guided lidocaine with steroid was injected into the IPT sheath.In both patients,groin pain improved initially but worsened after a few months.Therefore,the patients underwent arthroscopic IPT release under spinal anesthesia.Arthroscopy revealed synovitis with fibrous tissues around the IPT and various lesions related to the implants after THA.IPT tenotomy and debridement with biopsy were performed;histopathologic studies showed chronic inflammation with synovial hyperplasia.Both patients were encouraged to start walking immediately after surgery,and they returned to complete daily function early after surgery.They experienced no recurrence of groin pain or any implant-related problems 5 years postoperatively.CONCLUSION Arthroscopic IPT release for cup malposition produced excellent midterm outcomes without recurrence of groin pain and implant-related problems.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain.However,currently accepted treatment protocols are not always successful.Based on the abnormal bone alignment reported in this disease,some studies have noted a correlation between radiographic characteristics and outcome,but this correlation remains debated.AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome.METHODS To predict the outcome and prevent early failure of the Ponseti’s method,we used a simple radiographic method to predict outcome.Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022.After Achilles tenotomy and a long leg cast were applied,the surgeon obtained a single lateral radiograph.Radiographic parameters included the tibiocalcaneal angle(TiCal),talocalcaneal angle(TaCal),talofirst metatarsal angle(Ta1st)and tibiotalar angle(TiTa).During the follow-up period,the Dimeglio score and functional score were examined 1 year after surgery.Additionally,recurring events were reported.The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression,and the optimal predictor was also identified.RESULTS In total,54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days.The average TiCal,TaCal,Ta1st,and TiTa angles were 75.24,28.96,7.61,and 107.31 degrees,respectively.After 12 mo of follow up,we found 66%excellent-to-good and 33.3%fair-to-poor functional outcomes.The Dimeglio score significantly worsened in the poor outcome group(P value<0.001).Tical and TaCal showed significant differences between each functional outcome(P value<0.05),and the TiCal strongly correlated with outcome,with a smaller angle indicating a better outcome,each 1 degree decrease improved the functional outcome by 10 percent.The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.CONCLUSION The TiCal,derived from lateral radiographs immediately after Achilles tenotomy,can predict functional outcome at 1 year postoperatively,justifying its use for screening patients who need very close follow-up.

Results of Ponseti Method in the Management of the Congenital Clubfoot

Background: Clubfoot is a debilitating pathology and a source of abnormal gait in children. Treatment with the Ponseti method is the treatment used in the management of congenital clubfoot in children under 9 years old. This study aims to identify the proportion of children with clubfoot supported by the Ponseti method and to evaluate their effectiveness. Materials and Method: A multicenter retrospective descriptive study for six (06) months from June 1st to November 30th, 2019 concerning the evaluation of the Ponseti method in the management of clubfoot in Madagascar was conducted. Results: One hundred ninety-one (191) children with club feet were screened during the study period. One hundred and fifty children, or 226 congenital equine varus clubfoot were treated with the Ponseti method during the study period. The male gender was the most affected compared to the female gender with a sex ratio of 1.75. The clubfoot was bilateral in 50.66% of cases and idiopathic in 92.66%. The initial Pirani score was on average (±SD) 5.04/4.98 (±1.22/1.20). A proportion of 23.33% of cases of recurrence was recorded at 3 months of use of brace abduction splint. Conclusion: In Madagascar, the incidence of congenital clubfoot remains relatively low but clubfoot is still the main limitation of walking and a lack of footwear in children. Ponseti method is the gold standard in the management of this pathology. However, it requires a long-term follow-up.