Michael P Gaspar1,2, Kenneth A Kearns3, Randall W Culp3, A Lee Osterman3, Patrick M Kane3. 1. Philadelphia Hand to Shoulder Center, Department of Orthopedic Surgery, Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA. michaelpgaspar@gmail.com. 2. Darden School of Business, University of Virginia, Charlottesville, VA, 22903, USA. michaelpgaspar@gmail.com. 3. Philadelphia Hand to Shoulder Center, Department of Orthopedic Surgery, Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
Abstract
PURPOSE: Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique. METHODS: Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups. RESULTS: Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred. CONCLUSION: These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction. LEVEL OF EVIDENCE: Therapeutic Level IV.
PURPOSE: Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique. METHODS: Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups. RESULTS: Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred. CONCLUSION: These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction. LEVEL OF EVIDENCE: Therapeutic Level IV.
Authors: Check C Kam; Christopher M Jones; Jordan L Fennema; Loren L Latta; E Anne Ouellette; Peter J Evans Journal: J Hand Surg Am Date: 2010-10 Impact factor: 2.230
Authors: George D Chloros; Ethan R Wiesler; Kathryne J Stabile; Anastasios Papadonikolakis; David S Ruch; Gary R Kuzma Journal: J Hand Surg Am Date: 2008-01 Impact factor: 2.230
Authors: Michael P Gaspar; Patrick M Kane; Emily M Pflug; Sidney M Jacoby; A Lee Osterman; Randall W Culp Journal: J Shoulder Elbow Surg Date: 2016-06-30 Impact factor: 3.019