Use of Tendon Allograft for Recurrent Extensor Carpi Ulnaris Instability in Ehlers–Danlos Syndrome: A Case Report

Background Subluxation of the extensor carpi ulnaris (ECU) tendon can be a challenging problem to the surgeon, with no options described for failure following autologous reconstruction. It is our intention to provide guidance on technique by describing our experience in a 20-year-old male with Ehlers–Danlos syndrome. Case Description The patient presented with pain and snapping of the ECU tendon, and failed both immobilization and ECU reconstruction with autologous extensor retinaculum. A gracilis tendon allograft was used to reconstruct the ECU sheath, in addition to ulnar groove deepening. At 1-year follow-up, the patient had no pain and the ECU was stable without recurrent subluxation. Literature Review To the authors' knowledge, the use of tendon allograft for stabilization of recurrent ECU subluxation following surgical repair or reconstruction has not been previously described in the medical literature. Clinical Relevance Utilization of tendon allograft is a viable technique to stabilize the ECU tendon while minimizing the risk in relying on compromised autologous tissue. This report represents the first account of successful reconstruction following failed autologous reconstruction.

Arthroscopic anatomical reconstruction of the lateral collateral ankle ligament: an examination of the learning curve and the influence of laterality and body mass index

Objectives: Anatomical reconstruction under arthroscopy by gracilis tendon autograft is an innovative technique in full development and requires a learning curve. Our objective was to evaluate this curve and determine the influence of the surgical side and the patient’s body mass index (BMI) on the performance of the procedure. Methods: In this retrospective study, conducted from January 2015 to March 2020, data was collected from 7 centers through 11 operators, and included the surgical side, body mass index and total procedure time. The ankle ligament reconstruction had to be performed entirely under arthroscopy, without any associated procedure, at the expense of the gracilis tendon. The learning curve was calculated over the total operating time. Results: The learning curve showed a logarithmic pattern with an average decrease of 20% in operating time for the 4th patient. In the largest cohort, there was a significant difference in operating time between the right and left sides (35.39 minutes vs. 32.29 minutes, p < 0.002, [CI95] = 1.23; 4.98). In the two largest cohorts, there was a correlation between operating time and BMI (ρ= 0.7022, p < 7.29E-20, [CI95] = 0.6006; 0.7814 and ρ= 0.2749, p < 0.025, [CI95] = 0.0371; 0.4832) for all the patients (ρ= 0.1753, p < 0.0001, [CI95] = 0.0867; 0.2612). Conclusion: Arthroscopic anatomical ligament reconstruction of the ATFL and CFL is a technical intervention with a fast learning curve, with good control of the procedure in less than ten procedures. The surgical side and the patient’s BMI were noted to have an influence on the duration of the procedure.

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 – 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. Patient and Method According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the “figure of eight” technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. Results and Conclusion One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authorsʼ knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.