Publications by authors named "Chanakarn Phornphutkul"

12 Publications

  • Page 1 of 1

Impact of shoulder, elbow and forearm position on biceps tendon excursion: A cadaveric study.

J Orthop Surg (Hong Kong) 2021 May-Aug;29(2):23094990211022675

Department of Orthopedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand.

Purpose: This experimental study investigated the long head biceps tendon (LHBT) excursion that occurs at various positions of the upper limb during tendon stabilizing procedures. We hypothesized that shoulder abduction, elbow extension and forearm pronation would maximize the excursion of the LHBT and potential impacts on tendon stabilization.

Materials & Methods: Forequarter specimens from 12 fresh frozen cadavers were used in this study. The study was performed at 0° and 30° of shoulder abduction. Elbow position was either 90° of flexion or full extension with the forearm either in full pronation or supination. A total of 14 combinations of positions were studied. A load of 55 N was applied to the distal biceps. The excursion of the proximal part of LHBT was measured for each of the different positions.

Results: At a shoulder position of 30° of flexion, shoulder abduction of 30° created significantly greater excursion than 0° of shoulder abduction ( < 0.001). Both full extension of the elbow and full pronation of the forearm also showed significant excursion of the tendon when compared to supination ( < 0.001).

Conclusions: The position of the shoulder, elbow and forearm has a significant effect on biceps excursion. Thirty degrees of shoulder abduction and 30° of forward flexion with the elbow in full extension and the forearm in full pronation maximizes excursion.

Clinical Relevance: Information about the excursion of the LHBT affected by the position of the upper limb is useful for any biceps tendon stabilizing procedure. During an operation, the position of the upper limb should be monitored in order to maintain a proper anatomic length-tension relationship.
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http://dx.doi.org/10.1177/23094990211022675DOI Listing
June 2021

Arthroscopic Bankart repair: A matched cohort comparison of the modified Mason Allen method and the simple stitch method.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2020 Oct 14;22:49-55. Epub 2020 Aug 14.

Orthopaedics Department, Faculty of Medicine, Chiang Mai University, Thailand.

Introduction: Arthroscopic Bankart repair (ABR) has become a standard treatment for recurrent anterior shoulder dislocation in cases with minimal bone loss. Using the standard Bankart repair technique, the failure rate has been reported to be approximately between 4 and 35%. In addition to the original injury, multiple pathologies can occur after a dislocation including a Bankart lesion, capsular redundancy and bone defects. In cases with no significant bone loss, soft tissue plays a major role in stabilizing the shoulder joint. We hypothesized that effective repair of soft tissue with good inferior capsular shifting and proper capsulolabral restoration can create a proper level of soft tissue tension so the horizontal mattress suture method should improve outcomes.

Materials And Methods: A retrospective cohort study was conducted by reviewing the records of patients with recurrent anterior instability who underwent ABR at a single institution between January 2009 and December 2017. Demographic information, preoperative radiographic data including glenoid bone loss, Hill-Sachs width, glenoid track and other surgical details were retrieved from the medical records. The patients identified were divided into 2 groups. Group 1 had one modified Mason Allen stitch plus simple stitches, while Group 2 had only simple stitches. Data obtained from the patient included failure rate, patient satisfaction, the ROWE score and Walch-Duplay score at a minimum of 2 years after surgery. Risk factors for failure were also identified.

Results: Group 1 included 50 patients (mean age 27.2 ± 9.4 years) who underwent modified Mason Allen stitch ABR (median follow-up, 59.2 months; range, 26.2-128.6 months). Group 2 included 30 patients (mean age 26.9 ± 8.5 years) who underwent simple stitch repair ABR (median follow-up, 68.0 months; range, 24.0-127.9 months). All patients met the inclusion criteria. Evaluation at the final follow-up compared Group 1 and Group 2: ROWE score (86.8 vs 76.3, P = 0.001), Walch-Duplay score (87.2 vs 82.0, P = 0.035), respectively. Failure rates were 6% in group 1 compared to 10% in group 2 (P = 0.511).

Conclusions: The modified Mason Allen stitch technique and the simple stitches technique ABR both result in excellent patient satisfaction at a minimum 2-year follow-up. Both techniques successfully restore shoulder stability, but the modified Mason Allen stitch technique results in better functional outcomes.

Study Design: Cohort study; level of evidence, 3.
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http://dx.doi.org/10.1016/j.asmart.2020.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451849PMC
October 2020

Effects of type II SLAP lesion repair techniques on the vascular supply of the long head of the biceps tendon: a cadaveric injection study.

J Shoulder Elbow Surg 2021 Apr 23;30(4):772-778. Epub 2020 Jul 23.

Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: One option for the treatment of type 2 superior labral anterior to posterior (SLAP) lesions is arthroscopic repair. However, the fact that the vascular supply of the proximal long head of the biceps tendon (LHBT) arises from the soft tissue near the SLAP repair site must also be considered. The aims of this study were to evaluate the vascular channel of the proximal long head biceps tendon and to compare potential damage to the vascular supply with alternative SLAP techniques.

Methods: Forty-five fresh cadaveric shoulders were divided into 3 groups: 9 shoulders each for the normal group and the created SLAP group, and 27 shoulders for the repaired SLAP group. SLAP group shoulders were repaired using one of 3 techniques: 2 anchors with simple sutures, 1 anchor with double sutures, or 1 anchor with a horizontal mattress suture. India ink was then injected into the acromial branch of the thoracoacromial artery. The proximal LHBT was resected for a histologic cross-sectional study. The intratendinous vascular distance was measured and compared among the groups.

Results: The vascular supply of the proximal LHBT arises from soft tissue lying anterior and dorsal to the tendon origin. In the normal shoulders, the average intratendinous vascular distance was 16.9 ± 1.5 mm (95% confidence interval: 15.8-18.1). A comparison of nonrepaired SLAPs with each of the repair techniques found that using 2 anchors with simple sutures showed no significant difference in vascular distance (P = .716), whereas the other techniques showed a significant disruption of the blood supply. The differences in vascular distance among the 3 repair techniques were statistically significant (P = .0001).

Conclusions: The main vascular supply of the proximal LHBT comes from the anterior-dorsal direction. Some SLAP repair techniques can disrupt vascularization; however, the technique using 2 anchors with simple sutures, 1 anchor 3 mm anterior to the anterior border and 1 at the posterior border of the tendon, can preserve the vascularization of the LHBT.
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http://dx.doi.org/10.1016/j.jse.2020.07.014DOI Listing
April 2021

Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study.

Arch Orthop Trauma Surg 2018 Dec 11;138(12):1679-1689. Epub 2018 Aug 11.

Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Introduction: Fixation of a small Hoffa fragment requires a selection of the proper surgical approach for reduction and posterior to anterior screws fixation. However, currently there are no guidelines regarding how to select the best approach for small posterior Hoffa fractures.

Objectives: To compare the size of Hoffa fractures that are appropriate for reduction and fixation with the medial parapatellar approach (MPPA) and those which require the direct medial approach (DMA), and to make a similar comparison between the lateral parapatellar approach (LPPA) and the posterolateral approach (PLA).

Materials And Methods: Twenty extremities of fresh cadavers were included. After completion of each approach, the articular surface boundaries were marked and soft tissue was removed. On the medial condyle, an imaginary line was drawn from the most anterior (A) to the most posterior (B) point, representing the AP diameter (d). The most posterior boundary of MPPA (C) and the most anterior boundary of DMA (D) were similarly marked. Distances between B and C (d) and between B and D (d) were measured as well as the anterior-posterior diameter of the condyle (d). The same measurements were made for the lateral condyle.

Results: On the medial condyle, the average values of d, d, and d were 10.8 mm ± 3.8, 17.3 mm ± 3.3, and 60.1 mm ± 3.2, while percentages of d/d and d/d were 18.3% ± 6.4 and 28.7% ± 4.7. In lateral condyle, the averages for d, d, d were 6.1 mm ± 1.4, 12.1 mm ± 2.8 and 60.9 mm ± 3.3 mm and the percentages of d/d and d/d were 10.1% ± 2.3 and 19.9% ± 4.9.

Conclusions: When the Hoffa fragment is less than 18.3% of the AP diameter of medial condyle or 10.1% of lateral condyle, the fracture is invisible with the PPA. When the Hoffa fragment is more than 28.7% of the medial condyle or 19.9% of the lateral condyle, the PPA should be selected. If the Hoffa fragment is less than 28.7% of the medial condyle or 19.9% of the lateral condyle, the DMA or PLA with posterior-to-anterior screws is recommended. Combined approaches should be considered in some complex cases with articular comminution.
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http://dx.doi.org/10.1007/s00402-018-3022-xDOI Listing
December 2018

Acromioclavicular joint dislocation: a Dog Bone button fixation alone versus Dog Bone button fixation augmented with acromioclavicular repair-a finite element analysis study.

Eur J Orthop Surg Traumatol 2018 Aug 20;28(6):1095-1101. Epub 2018 Mar 20.

Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Suspension suture button fixation was frequently used to treat acromioclavicular joint (ACJ) dislocation. However, there were many studies reporting about complications and residual horizontal instability after fixation. Our study compared the stability of ACJ after fixation between coracoclavicular (CC) fixation alone and CC fixation combined with ACJ repair by using finite element analysis (FEA).

Materials And Methods: A finite element model was created by using CT images from the normal shoulder. The model 1 was CC fixation with suture button alone, and the model 2 was CC fixation with suture button combined with ACJ repair. Three different forces (50, 100, 200 N) applied to the model in three planes; inferior, anterior and posterior direction load to the acromion. The von Mises stress of the implants and deformation at ACJs was recorded.

Results: The ACJ repair in the model 2 could reduce the peak stress on the implant after applying the loading forces to the acromion which the ACJ repair could reduce the peak stress of the FiberWire at suture button about 90% when compared to model 1. And, the ACJ repair could reduce the deformation of the ACJ after applying the loading forces to the acromion in both vertical and horizontal planes.

Conclusion: This FEA supports that the high-grade injuries of the ACJ should be treated with CC fixation combined with ACJ repair because this technique provides excellent stability in both vertical and horizontal planes and reduces stress to the suture button.
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http://dx.doi.org/10.1007/s00590-018-2186-yDOI Listing
August 2018

Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study.

Arch Orthop Trauma Surg 2018 Apr 19;138(4):505-513. Epub 2018 Jan 19.

Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

Introduction: The selection of a surgical approach for buttressing posterolateral tibial plateau fractures is controversial.

Objective: This study compared the surgical exposure area between the reversed L posteromedial approach (R-PM) and the posterolateral (PL) approach using the lateral plateau width as a metric.

Materials And Methods: Twenty lower extremities from fresh frozen cadavers were included. The R-PM approach was used first and the boundary of the posterior tibial cortex exposure was marked with metal pins. With the same specimens, the PL approach was then performed and the exposure area was marked. After removing all soft tissue, an imaginary line was drawn from the lateral plateau rim anterior to the fibular head (L) to the posteromedial ridge of the tibia (M). Additional metal pins were used to indicate bony reference landmarks at the joint line on the posterior tibial plateau, including the lateral tibial spine (S), the lateral boundary with the PM approach (PM) and the lateral boundary with the PL approach (PL). All distances were measured using S as the reference point.

Results: The average distance from S to L, referred to as the lateral plateau width (A), was 32.62 mm. The average distances from S to PM (B) and from S to PL measured as a percentage of A were 43.72 and 81.41%, respectively. The average R-PM approach blind distance from PM to PL (C) as a percentage of the lateral plateau width was 58.45%, while the distance PL to L (D), which represents the invisible blind distance with both approaches, was 15.37% of that width.

Conclusions: The PL approach provides better access for buttressing the posterolateral tibial plateau fracture than the R-PM approach. With the R-PM approach, the blind area on the lateral plateau which can be accessed only by the PL approach starts approximately at 43.72% and ends at 81.41% of the lateral tibial plateau width. When a fracture is located in this zone, the posterolateral approach is recommended.
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http://dx.doi.org/10.1007/s00402-018-2875-3DOI Listing
April 2018

Anatomical relationship between the deep peroneal nerve and the anterolateral surface of the tibia in Thai cadavers.

J Med Assoc Thai 2015 Feb;98(2):207-11

Background: The deep peroneal nerve innervates muscles of the anterior leg compartment and the dorsum of the foot, and also receives sensation from the first interdigital cleft of the foot. Along its course in lower part of the leg, this nerve is very close to the anterolateral surface of the tibia and might be vulnerable to injury in fractures of the tibia or during surgery.

Objective: The objective of this study is to clarify the relationship between the deep peroneal nerve and anterolateral surface of tibia.

Material And Method: Variations in the course of the deep peroneal nerve related to the anterolateral surface of tibia were investigated by dissection of 82 legs from 45 fresh cadavers. The distance by which the deep peroneal nerve was directly contacted to the tibia was measured and compared to the length from the tibial tuberosity to the medial malleolus. The length of that association, as a percentage ofthe distance from the tibial tuberosity to the medial malleolus, was calculated.

Results: The fraction of the distance along which the deep peroneal nerve was in direct contact with the anterolateral surface of the tibia as a percentage of the distance between the tibial tuberosity and the medial malleolus ranged from 40.38% to 84.11%, with an average of 64.87% (95% confidence interval: 63.23-66.52%). In the majority of the legs studied (52.44%), the percentage range between 60-70%.

Conclusion: An majority of the deep peroneal nerve was directly in contact with the anterolateral surface of tibia and ranged from 60-70% of the distance between tibia tuberosity and medial malleolus. Surgical incision along this area should be carefully performed.
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February 2015

Autologous chondrocyte implantation for cartilage injury treatment in Chiang Mai University Hospital: a case report.

J Med Assoc Thai 2013 Nov;96(11):1518-22

Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Autologous chondrocyte implantation (ACI) has become one of the standard procedures for articular cartilage defect treatment. This technique provides a promising result. However the procedural process requires an approach of several steps from multidisciplinary teams. Although the success of this procedure has been reported from Srinakharinvirot University since 2007, the application of ACI is still limited in Thailand due to the complexity of processes and stringent quality control. This report is to present the first case of the cartilage defect treatment using the first generation-ACI under Chiang Mai University's (CMU) own facility and Ethics Committee. This paper also reviews the process of biotechnology procedures, patient selection, surgical, and rehabilitation techniques. The success of the first case is an important milestone for the further development of the CMU Human Translational Research Laboratory in near future.
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November 2013

Less invasive plate osteosynthesis in humeral shaft fractures.

Oper Orthop Traumatol 2009 Dec;21(6):602-13

Department of Orthopaedics, Chiang Mai University, Chiang Mai, Thailand.

Objective: Stable internal fixation of the humeral shaft by less invasive percutaneous plate insertion using two separate (proximal and distal) incisions, indirect reduction by closed manipulation and fixation to preserve the soft tissue and blood supply at the fracture zone. Early mobilization of the shoulder and elbow to ensure a good functional outcome.

Indications: Humeral shaft fractures (classified according to AO classification as: 12-A, B, C). Humeral shaft fractures extending to the proximal or distal shaft, small or deformed medullary canal or open growth plate.

Contraindications: Humeral shaft fractures with primary radial nerve palsy. Proximal humeral shaft fractures extending to the humeral head. Distal humeral fractures extending to the elbow joint.

Surgical Technique: Two incisions proximal and distal to the fracture zone are used. A 3-cm proximal incision lies between the lateral border of the proximal part of the biceps and the medial border of the deltoid. Distally, a 3-cm incision is made along the lateral border of the biceps. The interval between biceps and brachialis is identified. The biceps is retracted medially to expose the musculocutaneous nerve. The brachialis muscle has dual innervation, the medial half being innervated by the musculocutaneous nerve and the lateral half by the radial nerve. The brachialis is split longitudinally at its midline. The musculocutaneous nerve is retracted along with the medial half of the brachialis, while the lateral half of the brachialis serves as a cushion to protect the radial nerve. A deep subbrachial tunnel is created from the distal to the proximal incision. The selected plate is tied with a suture to a hole at the tip of the tunneling instrument for pulling the plate back along the prepared track. The plate is aligned in the correct position on the anterior surface of the humerus. Traction is applied and the fracture reduced to restore alignment by image intensifier, followed by plate fixation with at least two bicortical locking screws or three bicortical conventional screws in each fragment.

Results: Between January 2003 and January 2006, 23 patients were operated on using the less invasive plate osteosynthesis technique. The minimum follow-up period of 12 months was completed in 20 patients. The mean healing time was 14.6 weeks, defined as three of four cortices having stable bridging callus. In one patient with delayed union, healing was observed after 28 weeks. Functional outcomes were evaluated using the Constant Score and the Hospital for Special Surgery (HSS) Score. 19 patients had good to excellent elbow function with a mean HSS Score of 93.5 points. All patients achieved satisfactory shoulder function with a mean Constant Score of 85.8 points compared to 90.6 on the healthy side. Complications observed were one paresthesia of lateral cutaneous nerve of forearm (no radial nerve injury) and one loosening of the LCP (Locking Compression Plate) screws due to technical error.
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http://dx.doi.org/10.1007/s00064-009-2008-9DOI Listing
December 2009

Incidence of positive intraoperative allograft cultures used in knee ligament reconstruction.

J Knee Surg 2009 Jul;22(3):191-5

Sports Medicine Unit, Department of Orthopaedics, Chiangmai University, Chiangmai, Thailand.

Soft-tissue allografts are valuable options in knee ligament reconstructive surgery. The purpose of this study was to determine the risk of soft-tissue contamination before implantation and the occurrence of infection after implantation in patients who received soft-tissue allografts for knee reconstructive procedures. A retrospective review of medical records was performed for patients who had undergone knee ligament surgery with allograft tissues at one institution between 1993 and 2004. Cultures were positive in 6 (5.7%) of 105 cases. Coagulase-negative Staphylococcus was the most common organism. None of these patients developed postoperative infections. The culture-positive group had a longer period of joint effusion postoperatively, compared with the culture-negative group (14.2 weeks versus 9.6 weeks). Patients with positive cultures required no additional treatment other than close observation.
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http://dx.doi.org/10.1055/s-0030-1247748DOI Listing
July 2009

Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning.

J Bone Joint Surg Am 2007 Jul;89(7):1565-74

Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0391, USA.

Background: Loss of knee extension has been reported by many authors to be the most common complication following anterior cruciate ligament reconstruction. The objective of this in vitro study was to determine the effect, on loss of knee extension, of the knee flexion angle and the tension of the bone-patellar tendon-bone graft during graft fixation in a reconstruction of an anterior cruciate ligament.

Methods: The anterior cruciate ligament was reconstructed with use of tibial and femoral bone tunnels placed in the footprint of the native anterior cruciate ligament in ten cadavers. The graft was secured with an initial tension of either 44 N (10 lb) or 89 N (20 lb) applied with the knee at 0 degrees or 30 degrees of flexion. The knee flexion angle was measured with use of digital images following graft fixation.

Results: Tensioning of the graft at 30 degrees of knee flexion was associated with loss of knee extension in this cadaver model. Graft tension did not affect knee extension under the conditions tested.

Conclusions: The results suggest that one of the common causes of the loss of full knee extension may be diminished if the graft is secured in full knee extension when the tibial and femoral tunnels are placed in the footprint of the native anterior cruciate ligament. More importantly, even when the femoral and tibial tunnels are placed in the femoral and tibial footprints of the native anterior cruciate ligament, fixing a graft in knee flexion can result in the loss of knee extension.
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http://dx.doi.org/10.2106/JBJS.F.00370DOI Listing
July 2007

Sonographic imaging of the patellofemoral medial joint stabilizing structures: findings in human cadavers.

Orthopedics 2007 06;30(6):472-8

Department of Orthopedic Surgery, MedSport, Section of Orthopedic Surgery, University of Michigan Medical Center, Ann Arbor, MI 48106-0391, USA.

The medial soft-tissue restraints of the patella, specifically the medial patellofemoral ligament and the vastus medialis obliquus muscle, are critical to patellofemoral joint stability. A reliable and inexpensive imaging technique would be clinically useful especially after acute patellar dislocation. The medial patellofemoral ligament and the vastus medialis obliquus muscle were identified in cadaveric dissection. The attachments of the medial patellofemoral ligament to the patella and the adductor tubercle, and the attachments of the vastus medialis obliquus muscle to the adductor magnus tendon, adductor tubercle, and patella were carefully observed. Sonography then was performed on four thawed fresh frozen cadaver knees. After sonographic examination of these structures, the knees were dissected and the structures previously identified by sonography were verified. In all four specimens, these restraints of the patellofemoral joint were identified by sonography based on their imaging characteristics and surrounding bony and soft-tissue landmarks.
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http://dx.doi.org/10.3928/01477447-20070601-15DOI Listing
June 2007