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Background: Distal biceps tendon repair to the radial tuberosity can be conducted by means of an interference screw in combination with a transosseous button. Bioabsorbable interference screws have been associated with complications such as severe osteolytic reactions. We questioned whether patients with a distal biceps tendon repair with bioabsorbable poly-L-lactide (PLLA) screws had different functional, clinical, and radiologic outcome than patients with nonabsorbable poly-ether ether ketone (PEEK) screws. Methods: Between 2010 and 2014, 23 patients with an acute distal biceps tendon rupture were treated with reinsertion of the distal biceps tendon in a bone tunnel at the radial tuberosity through a single anterior incision using a transosseous button combined with an interference screw. A PLLA screw was used in 12 patients and a PEEK screw in 11 patients. All patients were retrospectively evaluated with a minimal follow-up of 1 year clinically and by means of the visual analog scale for pain, Mayo Elbow Performance Score, and Disabilities of Arm, Shoulder and Hand Outcome Measure score. Bone tunnel volume was measured with computed tomography segmentation. Results: Elbow mobility and arm and forearm circumference were symmetric for all patients. The visual analog scale for pain was 0.2 in the PLLA group and 0.7 in the PEEK group. The Disabilities of Arm, Shoulder and Hand score and Mayo Elbow Performance Score were 5.4 and 98.7 in the PLLA group vs. 3.1 and 95.9 in the PEEK group. Bone tunnel enlargement of 43% in the PLLA and 38% in the PEEK group was noted. Conclusions: Clinical and functional outcome at more than 1 year after distal biceps tendon repair was excellent in both groups. Bone tunnel widening occurred in all patients.

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The optimal treatment for isolated posterior cruciate ligament (PCL) injuries is an ongoing debate among orthopaedic surgeons. Improved understanding of the anatomy and biomechanics of the PCL, advances in surgical techniques and an ever more active population, has led to a trend towards surgical management. However, good-quality evidence to support this trend is lacking. Our objective was to evaluate the evidence for different treatment strategies (including surgical and non-operative management) of isolated PCL injuries. Using Pubmed, EMBASE and Cochrane databases we conducted a systematic review of studies investigating the treatment of PCL injuries published until July 2020. Quality assessment was performed with the Cochrane risk of bias tool (level I), the Newcastle-Ottowa Scale (level II-III) and the National Institute of Health quality assessment tool (level IV). Clinical outcome measures included residual instability, return to sports, patient reported outcome measures, subsequent articular degeneration and complications. Twenty-seven studies (23 case-series, 2 case-control, 1 cohort study and 1 randomized controlled trial (RCT)) including 5,197 patients (5,199 knees) with a mean age of 29.5 ± 3.6 years (range, 15-68) fulfilled the study requirements. Significantly less residual instability was found after posterior cruciate ligament reconstruction (PCLR) compared to non-operative management (3.43 vs 5.47 mm, CI: 1.84 to 2.23, p<0.001). Both treatment modalities yielded satisfying functional outcomes and a high return to sports (64-77%, mean: 70.3, CI: 67.8-72.2). Osteoarthritis occurred less frequently following PCLR (21.5 vs 44.1%, p<0.001) In the absence of level I RCTs, our systematic review suggests that surgical management for selected isolated PCL injuries is a reasonable option to consider, especially when the surgeon aims at minimizing residual instability and/or secondary osteoarthritis. Keywords: systematic review, posterior cruciate ligament, reconstruction, non-operative treatment, PCL injury, PCLR

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ABSTRACT Introduction Chronic low back pain is a prevalent, multidimensional condition that is a major cause of disability. Treatment is costly and can’t cure persistent low back pain. Instead it is aimed at reducing pain and disability, and preventing the consequences of long-lasting pain. In search for alternative cost-effective treatment options, therapeutic climbing has been developed and has become increasingly popular in rehabilitation. Objectives The aim of this review is to systematically assess current literature on bouldering in the treatment of patients with chronic non-specific low back pain. Secondly, the review aims to optimize the intervention of therapeutic climbing, based on the obtained results and current guidelines in the treatment of non-specific low back pain. Methods We searched in the bibliographic databases of PubMed, Embase, Cochrane Library and Web of Science for all relevant articles by combining search terms related to mountaineering and low back pain. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines for conducting a qualitative systematic review. Results Of the 30 records identified, 5 studies were included in this review based on the inclusion criteria. The overall risk of bias was found to be moderate to high in all of the included articles. Results show that climbing activates and strengthens the abdominal and back muscles. Furthermore, it improves a person’s physical and mental health and reduces pain and disability over time. Conclusion Therapeutic climbing has to be promoted to become a multidimensional intervention with education being a central part. The strengths of therapeutic bouldering can be combined with current evidence-based guidelines for chronic non-specific low back pain and include elements of physical therapy, cognitive behavioral therapy and mindfulness-oriented recovery enhancement. Together with the recommendations on self-management and lifestyle, all can be combined into one educative bouldering program. This could then become an approachable cost-effective treatment preferred by certain patients with chronic low back pain.

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Abstract Study design: retrospective study. Objective: to determine the short-term clinical succesrate of the M6-C cervical disc prosthesis (Spinal Kinetics, Sunnyvale, CA, USA) in primary and secundary surgery. Summary of background data: Cervical Disc Arthroplasty (CDA) provides an alternative to Anterior Cervical Decompression and Fusion (ACDF) for the treatment of spondylotic radiculo- or myelopathy. The prevention of Adjacent Segment Disease (ASD), a possible complication of ACDF, is its most cited though unproven benefit. Unlike older arthroplasty devices that rely on a ball-and-socket type design, the M6-C cervical disc prosthesis represents a new generation of unconstrained implants, developed to achieve better restoration of natural segmental biomechanics. This device should therefore optimize clinical performance of CDA and reduce ASD. Methods: All patients had preoperative CT or MRI and postoperative x-rays. Clinical outcome was assessed using the Neck Disability Index (NDI), a Visual Analog Scale (VAS) and the SF-36 questionnaire. Patients were asked about overall satisfaction and whether they would have the surgery again. Results: 33 patients were evaluated 17.1 months after surgery, on average. 9 patients had a history of cervical interventions. Results for NDI, VAS and SF-36 were significantly better among patients that had undergone primary surgery. In this group, 87.5% of patients reported a good or excellent result and 91.7% would have the procedure again. In contrast, all 4 device-related complications occurred in the small group of patients that had secondary surgery.