Purpose of the study: A medial incision for implantation of a total knee arthroplasty (TKA) offers an excellent surgical exposure while minimising the length of the skin opening. This incision however implies section of the proximal portion of the infrapatellar branch of the medial saphenous nerve, potentially associated with lateral hypoesthesia and formation of a neuroma (painful scar). We hypothesised that an anterolateral skin incision would produce less hypoesthesia and postoperative discomfort.

Material and methods: We conducted a prospective randomised study to compare the degree of hypoesthesia after a medial or lateral skin incision for the implantation of a TKA. Fifty-knees in 43 patients, mean age 65.9±8.4 years were included; 26 knees for the lateral incision and 24 for the medial. All patients had the same type of implant. Clinical results were assessed with WOMAC, KOOS and SF36. Semme-Weinstein monofilaments were applied to measure sensitivity at 13 characteristic points. Patients were assessed at six weeks and six months. The zone of hypoesthesia was delimited and photographed for measurement with Mesurim Pro9^®. Satisfaction with the surgery and the scar was noted. Data were processed with Statview^®; p< 0.05 was considered significant.

Results: The two groups were comparable preoperatively regarding age, gender, body weight, height, body mass index, body surface area, aetiology, and clinical score. Operative time, blood loss, and number of complications were comparable. The functional outcomes (WOMAC, KOOS, SF36) were comparable at six weeks and six months. Active flexion was significantly greater at six months in the lateral incision group (p=0.03). The zone of hypoesthesia was significantly smaller in the lateral incision group at six weeks (p< 0.01) and at six months (p< 0.01), as were the number of points not perceived on the filament test (p< 0.01 in both cases) while the length of the incision was comparable (p> 0.05). This was associated subjectively, with less loss of sensitivity and less anterior pain reported by the patient at six months.

Discussion: Lateral and medial incisions enable comparable functional outcomes. The lateral incision produces less hypoesthesia and less anterior pain. This improves the immediate postoperative period and facilitates rehabilitation as is shown by the gain in flexion at six months.

Purpose: Anatomic repair of an acute distal biceps tear has been demonstrated to improve flexion and supination strength compared with conservative treatment. The most commonly used fixation methods for a distal biceps tendon repair include suture anchors, bioabsorbable screws, and endobutton. The goal of this study was to

perform a radiologic evaluation of bioabsorbable screw tunnel osteolysis and

Method: We included twenty (20) consecutive patients who underwent primary anatomic repair of the distal biceps tendon since 2005. We used a 7x23mm biote-nodesis^® screw (Arthrex) in 18 cases, and 8x23mm and 8x12mm screws in the other two cases. First, from the x-ray view done in the immediate postoperative period showing the complete screw tunnel, we measured the ratio of the volume of the bone tunnel to the volume of the radius bone section. A mathematical formula for cylindrical volume was used (¶ x r2 x h). We used a relation between two volumes rather than the tunnel volume itself for scaling purposes. Secondly, we calculated the same relation on the x-ray from the last follow-up. We then obtained the percentage of tunnel enlargement by relating the volumetric ratio from the first x-ray to the ratio from the last x-ray. Afterwards, we performed a retrospective chart review noting any bioabsorbable screw-related and postoperative complications.

Results: In the group, the average age was forty-six (46) years. All subjects were male. Eighteen (18) cases were acute complete ruptures operated in the first three weeks, one case was a partial rupture and one case was chronic (one year). The average follow up was eighteen (18) months. We found that the average initial relative volume occupied by the screw tunnel was 47 % of the bone section. At the last follow-up, this volume increased to 68%. After our chart review, we found that one patient presented with a broken screw and increased pain and that another patient developed a severe foreign-body reaction with re-rupture of the tendon requiring three reoperations.

Conclusion: The use of a bioabsorbable screw for distal biceps tendon fixation results in significant osteolysis of the radial bone at short term follow-up. Consequences of osteolysis in the radius are worrisome since iatro-genic fractures are more likely to occur. Osteolysis can be secondary to an inflammatory reaction to the screw material, bone necrosis secondary to pressure or initial thermal necrosis. We also noted two cases of severe bio-tenodesis screw-related complications among our series of twenty (20) patients. These results call into question the use of the bioabsorbable screw in distal biceps tendon repair and are important to present. Exact volume of bone loss using 3D computed tomography scan analysis as well as quality of life questionnaires and strength testing will be available for presentation.

Purpose: Antero-medial parapatellar skin incision in total knee arthroplasty (TKA) provides excellent surgical exposure with minimal skin incision length. However, it is associated with the infrapatellar branch of the saphenous nerve section, leading to antero-lateral knee hypoesthesia and sometimes painful nevroma. We hypothesized that

antero-lateral skin incision in TKA produces a lower rate of hypoesthesia compared to the medial parapatellar cutaneous approach, and

Method: A total of 69 knees in 64 patients who underwent TKA were randomized for antero-medial (n=35) or antero-lateral (n=34) skin incision. Mean age was 66.4±8.2 years. Functional outcome was assessed by WOMAC, KOOS and SF-36 scores pre-operatively and at six weeks, six months and one year follow-up. Range of motion (active and passive flexion and extension) was measured. The area of hypoesthesia was analyzed in a standardized manner by an independent observer using a calibrated Semme-Weinstein monofilament applied on 13 reference points. A digital photograph was taken, and the area of hypoesthesia was then measured informatically (Mesurim Pro^® software). Patient satisfaction with their scar and their surgery was evaluated. Statistical analysis was carried out with p< 0.05 considered as significant.

Results: The two groups were comparable pre-operatively. There was no significant difference in functional outcome (WOMAC, KOOS, SF-36 scores) at six weeks, six months and one year between the two groups. Active and passive ranges of motion were comparable. The area of hypoesthesia and the number of non-perceived points in the monofilament test were significantly lower after antero-lateral incision at six weeks (p=0.007 and p=0.02, respectively) and 6 months (p=0.02 and p=0.005, respectively). At one year, the area of hypoesthesia was lower in the antero-lateral group, but was not significant (p=0.08). Antero-lateral incision patients reported a lower rate of subjective sensitivity loss and anterior knee pain at six weeks, six months and one year.

Conclusion: Antero-medial and antero-lateral parapatellar skin incisions in TKA have a similar functional outcome. However, antero-lateral cutaneous incision produces a lower rate of hypoaesthesia and less anterior knee pain in the early recovery period.