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Short-to Intermediate term Outcomes Following Interosseous Membrane Reconstruction Using Tightrope Suture-Button Suspensionplasty System
Michael P. Gaspar, MD; A. Lee Osterman, MD; Randall W. Culp, MD
Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA

Introduction: Forearm instability, such as that seen in Essex-Lopresti injuries, can have significantly debilitating clinical consequences when uncorrected. The purpose of this study is to describe our institution’s experience with forearm Interosseous Membrane (IOM) Reconstruction using Tightrope suture-button suspensionplasty device.
Methods: We retrospectively reviewed the charts of all patients who underwent IOM reconstruction using the Tightrope (Arthrex, Inc., Naples, FL) by one of two senior, fellowship-trained hand surgeons from 2011 through 2014. Demographic data, injury history, prior treatment(s) and clinical exam values were recorded. Bivariate statistical analysis with independent t-test was utilized for comparison of pre- and post-operative wrist and forearm range of motion and grip strength. Secondary outcomes of complications and/or need for revision surgery were also recorded.
Results: Ten (7 female, 3 male) patients satisfied inclusion in this study. Average age of all patients included was 45.3 years (range 22-59). Five surgeries were performed on each, the dominant and non-dominant extremity. One patient was treated for her Madelung’s deformity; another patient was treated for instability resulting from failed lateral elbow reconstruction while the remaining eight patients were treated for post-traumatic sequelae of Essex-Lopresti type injuries (7 radial head/neck fractures, one Monteggia-type fracture-dislocation). All ten surgeries were performed in conjunction with an ulnar shortening osteotomy (USO) and arthroscopic triangular fibrocartilage complex (TFCC) repair. Eight Tightrope (TR) devices were used primarily, while two were used in revisions of prior failed surgeries. The mean interval from initial injury to IOM reconstruction surgery with the TR and to final follow-up were 25.7 +/- 17.5, and 14.7 +/- 12.7 months, respectively . All ten patients reported subjective satisfaction with improvements in pain and function. Significant improvement was seen in elbow flexion/extension arc (97.0 +/- 23.9 deg pre-operatively vs. 119.5 +/- 18.0 deg post-operatively; p = 0.03). No significant difference was observed between pre- and post-operative forearm rotation or grip strength as measured by dynamometer. Four patients required additional surgery after IOM reconstruction: two required revision USO for recurrent abutment symptoms, one patient required elbow capsulectomy with excision of heterotopic ossification (HO) due to stiffness and one patient required open reduction and internal fixation (ORIF) of the radial shaft of her operative extremity after sustaining a fracture from a fall.
Conclusions: IOM Reconstruction using TR device an effective treatment option to treat forearm instability from post-traumatic or congenital deformities, and may also be useful for revision of prior failed treatments.

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