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Sample records for arthroscopic rotator interval

  1. Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity.

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    Kim, Sung-Jae; Kim, Sung-Hwan; Lee, Su-Keon; Seo, Jae-Wan; Chun, Yong-Min

    2013-08-21

    Few studies of large-to-massive contracted rotator cuff tears have examined the arthroscopic complete repair obtained by a posterior interval slide and whether the clinical outcomes or structural integrity achieved are better than those after partial repair without the posterior interval slide. The study included forty-one patients with large-to-massive contracted rotator cuff tears, not amenable to complete repair with margin convergence alone. The patients underwent either arthroscopic complete repair with a posterior interval slide and side-to-side repair of the interval slide edge (twenty-two patients; Group P) or partial repair with margin convergence (nineteen patients; Group M). The patient assignment was not randomized. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and range of motion were used to compare the functional outcomes. Preoperative and six-month postoperative magnetic resonance arthrography (MRA) images were compared within or between groups. At the two-year follow-up evaluation, the SST, ASES score, UCLA score, and range of motion had significantly improved (p repair group with an aggressive release had no better clinical or structural outcomes compared with the partial repair group with margin convergence alone for large-to-massive contracted rotator cuff tears. In addition, the complete repair group had a 91% retear rate and a greater defect on follow-up MRA images. Even though this study had a relatively short-term follow-up, a complete repair of large-to-massive contracted rotator cuff tears, with an aggressive release such as posterior interval slide, may not have an increased benefit compared with partial repair without posterior interval slide.

  2. Speed of recovery after arthroscopic rotator cuff repair.

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    Kurowicki, Jennifer; Berglund, Derek D; Momoh, Enesi; Disla, Shanell; Horn, Brandon; Giveans, M Russell; Levy, Jonathan C

    2017-07-01

    The purpose of this study was to delineate the time taken to achieve maximum improvement (plateau of recovery) and the degree of recovery observed at various time points (speed of recovery) for pain and function after arthroscopic rotator cuff repair. An institutional shoulder surgery registry query identified 627 patients who underwent arthroscopic rotator cuff repair between 2006 and 2015. Measured range of motion, patient satisfaction, and patient-reported outcome measures were analyzed for preoperative, 3-month, 6-month, 1-year, and 2-year intervals. Subgroup analysis was performed on the basis of tear size by retraction grade and number of anchors used. As an entire group, the plateau of maximum recovery for pain, function, and motion occurred at 1 year. Satisfaction with surgery was >96% at all time points. At 3 months, 74% of improvement in pain and 45% to 58% of functional improvement were realized. However, only 22% of elevation improvement was achieved (P rotation. Smaller tears had higher motion and functional scores across all time points. Tear size did not influence pain levels. The plateau of maximum recovery after rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. At 3 months, approximately 75% of pain relief and 50% of functional recovery can be expected. Larger tears have a slower speed of recovery. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Arthroscopic undersurface rotator cuff repair versus conventional arthroscopic double-row rotator cuff repair - Comparable results at 2-year follow-up.

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    Ang, Benjamin Fu Hong; Chen, Jerry Yongqiang; Yeo, William; Lie, Denny Tijauw Tjoen; Chang, Paul Chee Cheng

    2018-01-01

    The aim of our study is to compare the improvement in clinical outcomes after conventional arthroscopic double-row rotator cuff repair and arthroscopic undersurface rotator cuff repair. A consecutive series of 120 patients who underwent arthroscopic rotator cuff repair was analysed. Sixty-one patients underwent conventional double-row rotator cuff repair and 59 patients underwent undersurface rotator cuff repair. Several clinical outcomes, including numerical pain rating scale (NPRS), constant shoulder score (CSS), Oxford shoulder score (OSS) and University of California Los Angeles shoulder score (UCLASS), were prospectively recorded by a trained healthcare professional preoperatively and at 3, 6, 12 and 24 months after surgery. Comparing both groups, there were no differences in age, gender and preoperative NPRS, CSS, OSS and UCLASS. However, the tear size was 0.7 ± 0.2 (95% confidence interval (CI) 0.3-1.1) cm larger in the conventional group ( p = 0.002). There was no difference in the improvement of NPRS, CSS, OSS and UCLASS at all time points of follow-up, that is, at 3, 6, 12 and 24 months after surgery. The duration of operation was shorter by 35 ± 3 (95% CI 28-42) min in the undersurface group ( p rotator cuff repair and conventional arthroscopic double-row rotator cuff repair showed marked improvements in clinical scores when compared preoperatively, and there was no difference in improvements between both groups. Arthroscopic undersurface rotator cuff repair is a faster technique compared to the conventional arthroscopic double-row rotator cuff repair.

  4. Arthroscopic rotator cuff repair in elite rugby players

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    Tambe, Amol; Badge, Ravi; Funk, Lennard

    2009-01-01

    Background: Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. Aims: We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Materials and Methods: Eleven professional rugby players underwent arthroscopic ...

  5. Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair.

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    Zuke, William A; Leroux, Timothy S; Gregory, Bonnie P; Black, Austin; Forsythe, Brian; Romeo, Anthony A; Verma, Nikhil N

    2018-03-01

    As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Systematic review. A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1

  6. Pulmonary Embolism after Arthroscopic Rotator Cuff Repair: A Case Report

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    Tadashi Yamamoto

    2013-01-01

    Full Text Available Total hip/knee arthroplasty may cause venous thromboembolism (VTE as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively.

  7. Free Biceps Tendon Autograft to Augment Arthroscopic Rotator Cuff Repair

    OpenAIRE

    Obma, Padraic R.

    2013-01-01

    Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while...

  8. Cost-effectiveness of open versus arthroscopic rotator cuff repair.

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    Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

    2010-03-01

    Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  9. Open versus arthroscopic treatment of chronic rotator cuff impingement

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    Schröder, J.; van Dijk, C. N.; Wielinga, A.; Kerkhoffs, G. M.; Marti, R. K.

    2001-01-01

    We report the results of 238 consecutive patients who underwent in total 261 acromioplasties because of chronic rotator cuff impingement. The procedure was performed either in conventional open technique (80) or arthroscopically (181). Two years (1-10) after the operation 68% of the patients treated

  10. ARTHROSCOPIC TREATMENT OF CALCIFYING TENDINITIS OF THE ROTATOR CUFF.

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    Neto, Arnaldo Amado Ferreira; Trevizani, Cassio Silva; Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emílio Conforto; Bitar, Alexandre Carneiro; Neto, Francisco José Dos Santos

    2010-01-01

    To evaluate the clinical and radiographic results from arthroscopic surgical treatment of the rotator cuff in patients with calcifying tendinitis. A retrospective study was conducted on twenty patients who underwent arthroscopic treatment for calcifying tendinitis of the shoulder between March 1999 and November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) were male. The right side was affected in 10 cases (71%) and the left in four cases (29%). Nine cases (64%) had calcification in the supraspinatus tendon, two (14%) in the infraspinatus tendon, and three (21%) in both tendons. In all cases, resection of the calcium deposits was performed by means of a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) underwent subacromial decompression, and one (7%) underwent excision of the distal clavicle. A tendon-tendon suture was performed in three shoulders (21%). None of the patients underwent tendon-bone reinsertion. The mean score obtained on the UCLA scale was 33 points (26-35), thus indicating that a majority of patients had good results. In the final radiographic evaluation, none of the patients showed signs of calcification. Arthroscopic treatment of calcifying tendinitis of the shoulder safely allows excision of the calcification, leading to good results in relation to shoulder pain and function.

  11. Functional outcomes after bilateral arthroscopic rotator cuff repair.

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    Aleem, Alexander W; Syed, Usman Ali M; Wascher, Jocelyn; Zoga, Adam C; Close, Koby; Abboud, Joseph A; Cohen, Steven B

    2016-10-01

    Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

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    Ko, Sang Hun; Cho, Sung Do; Lee, Chae Chil; Choi, Jang Kyu; Kim, Han Wook; Park, Seon Jae; Bae, Mun Hee; Cha, Jae Ryong

    2017-01-01

    Background The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. Methods Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to...

  13. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis.

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    Maier, Dirk; Jaeger, Martin; Izadpanah, Kaywan; Bornebusch, Lutz; Suedkamp, Norbert Paul; Ogon, Peter

    2013-05-01

    We sought to evaluate (1) clinical and radiologic results after arthroscopic calcific deposit (CD) removal and (2) the relevance of remnant calcifications (RCs). The study included 102 patients undergoing arthroscopic CD removal, preserving integrity of the rotator cuff. Postoperatively, we divided patients into 2 groups according to the extent of CD removal achieved. Group 1 consisted of patients with complete CD removal. Group 2 included patients showing minor RCs. Ninety-three patients (99 shoulders) completed follow-up. The mean patient age was 50.6 years (31 to 68 years), and the mean follow-up period was 37.3 months (24 to 83 months). We obtained anteroposterior (AP) and outlet radiographs before surgery, postoperatively, and at follow-up. We used the absolute and age- and sex-related Constant scores (CSabs, CSrel) as outcome measures. We compared both groups statistically (Mann-Whitney U test; P rotator cuff yielded good to excellent results in 90% of patients and avoided iatrogenic tendon defects in all patients. Minor RCs did not impair clinical outcome and spontaneously resolved at follow-up. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Arthroscopic rotator cuff repair in elite rugby players.

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    Tambe, Amol; Badge, Ravi; Funk, Lennard

    2009-01-01

    Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans. There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360 degrees labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6-31 months) post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed. We conclude that full-thickness rotator cuff tears in the contact athlete can be addressed successfully by arthroscopic repair, with a rapid return to

  15. Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?

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    Alberto Naoki Miyazaki

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate whether the good and excellent functional results from arthroscopic repair of massive rotator cuff tears are maintained over the long term. METHODS: From the sample of the study conducted by our group in 2006, in which we evaluated the functional results from arthroscopic repair of massive rotator cuff tears, 35 patients were reassessed, 8 years after the first evaluation. The inclusion criteria were that these patients with massive rotator cuff tears operated by means of an arthroscopic technique, who participated in the previous study and achieved good or excellent outcomes according to the UCLA criteria. Patients whose results were not good or excellent in the first evaluation according to the UCLA criteria were excluded. RESULTS: Among the 35 patients reassessed, 91% of them continued to present good and excellent results (40% excellent and 51% good, while 3% presented fair results and 6% poor results. The time interval between the first and second evaluations was 8 years and the minimum length of follow-up since the immediate postoperative period was 9 years (range: 9-17 years, with an average of 11.4 years. CONCLUSION: The good and excellent results from arthroscopic repair of massive rotator cuff tears were mostly maintained (91%, with the same level of function and satisfaction, even though 8 years had passed since the first assessment, with a follow-up period averaging 11.4 years.

  16. Result from arthroscopic surgical treatment of renewed tearing of the rotator cuff of the shoulder

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    Glaydson Gomes Godinho

    2015-02-01

    Full Text Available OBJECTIVES: To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series and compare this with function in patients without recurrence (control group; and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm.METHODS: This was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair.RESULTS: The size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure.CONCLUSION: Arthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury.

  17. Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review.

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    Saridakis, Paul; Jones, Grant

    2010-03-01

    Arthroscopic rotator cuff repair is a common procedure that is gaining wide acceptance among orthopaedic surgeons because it is less invasive than open repair techniques. However, there is little consensus on whether to employ single-row or double-row fixation. The purpose of the present study was to systematically review the English-language literature to see if there is a difference between single-row and double-row fixation techniques in terms of clinical outcomes and radiographic healing. PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were reviewed with the terms "arthroscopic rotator cuff," "single row repair," and "double row repair." The inclusion criteria were a level of evidence of III (or better), an in vivo human clinical study on arthroscopic rotator cuff repair, and direct comparison of single-row and double-row fixation. Excluded were technique reports, review articles, biomechanical studies, and studies with no direct comparison of arthroscopic rotator cuff repair techniques. On the basis of these criteria, ten articles were found, and a review of the full-text articles identified six articles for final review. Data regarding demographic characteristics, rotator cuff pathology, surgical techniques, biases, sample sizes, postoperative rehabilitation regimens, American Shoulder and Elbow Surgeons scores, University of California at Los Angeles scores, Constant scores, and the prevalence of recurrent defects noted on radiographic studies were extracted. Confidence intervals were then calculated for the American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Constant scores. Quality appraisal was performed by the two authors to identify biases. There was no significant difference between the single-row and double-row groups within each study in terms of postoperative clinical outcomes. However, one study divided each of the groups into patients with small-to-medium tears ( or = 3 cm in length), and the

  18. Arthroscopic rotator cuff repair for the elderly (over 75-years)

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    Ikeda, Rintaro; Furukawa, Keizo; Kajiyama, Shiro; Sakimura, Toshiyuki; Shindo, Hiroyuki; Eto, Masao

    2010-01-01

    The purpose of this study was to evaluate the surgical results of arthroscopic rotator cuff repair (ARCR) and investigate the interoperative complications for elderly people (over 75-years). We evaluated nine patients 75 and over who underwent rotator cuff repair, followed up for more than 12 months, and underwent MRI six months or more after the operation which was performed between December 2004 to July 2008. Their average age was 77.3 years. The control patients were 61 patients less than 75 who underwent ARCR during same term. Their average age was 59.9 years. Clinical outcome was evaluated based on interoperative complications, the Japanese Orthopaedic Association score (JOA score), and cuff integrity using MRI Sugaya's classification. In the over 75 patients, anchors came out from the tuberosity in three patients. Postoperative complications were not seen in both groups. No differences were observed in JOA score and cuff integrity using MRI Sugaya's classification compared with patients under 75. The surgical outcome of ARCR for elderly people (over 75-years) was satisfactory, and ARCR for elderly people (over 75-years) shoud be performed with caution because of the coming out of anchors. (author)

  19. Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis.

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    Shen, Chong; Tang, Zhi-Hong; Hu, Jun-Zu; Zou, Guo-Yao; Xiao, Rong-Chi; Yan, Dong-Xue

    2014-09-01

    To determine whether immobilization after arthroscopic rotator cuff repair improved tendon healing compared with early passive motion. A systematic electronic literature search was conducted to identify randomized controlled trials (RCTs) comparing early passive motion with immobilization after arthroscopic rotator cuff repair. The primary outcome assessed was tendon healing in the repaired cuff. Secondary outcome measures were range of motion (ROM) and American Shoulder and Elbow Surgeons (ASES) shoulder scale, Simple Shoulder Test (SST), Constant, and visual analog scale (VAS) for pain scores. Pooled analyses were performed using a random effects model to obtain summary estimates of treatment effect with 95% confidence intervals. Heterogeneity among included studies was quantified. Three RCTs examining 265 patients were included. Meta-analysis revealed no significant difference in tendon healing in the repaired cuff between the early-motion and immobilization groups. A significant difference in external rotation at 6 months postoperatively favored early motion over immobilization, but no significant difference was observed at 1 year postoperatively. In one study, Constant scores were slightly higher in the early-motion group than in the immobilization group. Two studies found no significant difference in ASES, SST, or VAS score between groups. We found no evidence that immobilization after arthroscopic rotator cuff repair was superior to early-motion rehabilitation in terms of tendon healing or clinical outcome. Patients in the early-motion group may recover ROM more rapidly. Level II; systematic review of levels I and II studies.

  20. Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

    OpenAIRE

    Dilisio, Matthew F.; Miller, Lindsay R.; Higgins, Laurence D.

    2014-01-01

    Arthroscopic transtendinous techniques for the arthroscopic repair of partial-thickness, articular-surface rotator cuff tears offer the advantage of minimizing the disruption of the patient's remaining rotator cuff tendon fibers. In addition, double-row fixation of full-thickness rotator cuff tears has shown biomechanical advantages. We present a novel method combining these 2 techniques for transtendon, double-row, transosseous-equivalent arthroscopic repair of partial-thickness, articular-s...

  1. Arthroscopic proximal versus open subpectoral biceps tenodesis with arthroscopic repair of small- or medium-sized rotator cuff tears.

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    Yi, Young; Lee, Jong-Myoung; Kwon, Seok Hyun; Kim, Jeong-Woo

    2016-12-01

    The study was aimed to compare arthroscopic proximal biceps tenodesis and open subpectoral biceps tenodesis in repair of small or medium rotator cuff tears. Eighty-five patients underwent biceps tenodesis with arthroscopic repair of a rotator cuff tear, and 66 patients were followed for median of 26.8 (18-42) months with ultrasonography were reviewed. The arthroscopic biceps tenodesis group included 34 cases, and the open subpectoral biceps group included 32 cases. Patients were evaluated using visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant scores. Rotator cuff repair and fixation of the biceps tendon were assessed by ultrasonography. Fixation failure and degree of deformity were evaluated by the pain in the bicipital groove and biceps apex distance (BAD). VAS score and tenderness at the bicipital groove decreased significantly in the open subpectoral group at 3 months postoperative. In both groups, the range of motion, ASES score, and constant score increased significantly (P tendinitis and using intra-bicipital groove tenodesis technique. III.

  2. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block following arthroscopic rotator-cuff repair

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    Yamakado K

    2014-05-01

    Full Text Available Kotaro YamakadoDepartment of Orthopaedics, Fukui General Hospital, Fukui, JapanBackground: Rotator-cuff surgery is well recognized to be a painful procedure.Objectives: The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB] following arthroscopic rotator-cuff repair (ARCR.Materials and methods: This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB. The visual analog scale (at 6 hours and on the first, second, and third postoperative days and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated.Results: The respective visual analog scale scores (mm obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73 before surgery, 9.1 and 19.4 (P=0.12 at 6 hours after surgery, 24.4 and 44.6 (P=0.019 on the first postoperative day, 19.4 and 40.4 (P=0.0060 on the second postoperative day, and 18.5 and 27.8 (P=0.21 on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020, respectively.Conclusion: ca-SSNB was highly effective in controlling postoperative pain after ARCR.Keywords: shoulder, rotator cuff tear, postoperative pain control, continuous suprascapular nerve block, arthroscopic rotator cuff repair

  3. Alterations of the Deltoid Muscle After Open Versus Arthroscopic Rotator Cuff Repair.

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    Cho, Nam Su; Cha, Sang Won; Rhee, Yong Girl

    2015-12-01

    Open repair can be more useful than arthroscopic repair for immobile and severely retracted, large to massive rotator cuff tears. However, it is not known whether the deltoid muscle is altered after open repair or to what extent the deltoid origin remains detached after surgery. To compare postoperative alterations of the deltoid muscle in open versus arthroscopic repair for severely retracted, large to massive rotator cuff tears. Case-control study; Level of evidence, 3. Enrolled in this study were 135 patients who underwent surgical repair for severely retracted, large to massive rotator cuff tears and who had routine follow-up MRIs at least 6 months after surgery. Open repairs were performed in 56 cases and arthroscopic repairs in 79 cases. The detachment and thickness of the deltoid muscle at its proximal origin were recorded in 5 zones on MRI. The alterations of the deltoid muscle and postoperative integrity of the repaired rotator cuff were evaluated. Partial detachment of the deltoid occurred in 1 patient (1.8%) in the open group and in 2 patients (2.5%) in the arthroscopic group (P = .80). All the partial detachments occurred in zones 2 and 3. Attenuation of the proximal origin of the deltoid was found in 3 patients (5.4%) in the open group and in 4 patients (5.1%) in the arthroscopic group (P = .87). Atrophy of the deltoid muscle was shown in 3 patients (5.4%) in the open group and 4 patients (5.1%) in the arthroscopic group (P = .61). The retear rate of the repaired cuff was 30.4% (17/56) in the open group and 38.0% (30/79) in the arthroscopic group (P = .74). Between open and arthroscopic repair for severely retracted, large to massive rotator cuff tears, there was no significant difference in detachment of the deltoid origin and alterations of the deltoid muscle after repair. Postoperative alterations of the deltoid occurred in arthroscopic surgery as well as in open surgery. For immobile massive rotator cuff tear, open repair is an acceptable technique

  4. Clinical results of arthroscopic polyglycolic acid sheet patch graft for irreparable rotator cuff tears

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    Yu Mochizuki

    2015-01-01

    Full Text Available The high retear rates after surgery for irreparable rotator cuff tears can be explained by the healing capacity potential of tendons and the native rotator cuff enthesis characterised by complex morphological structures, called direct insertion. Many experimental researches have focused on biologically augmenting the rotator cuff reconstruction and improving tendon–bone healing of the rotator cuff. The results of the experimental study showed that the polyglycolic acid sheet scaffold material allows for the regeneration of not only tendon-to-tendon, but also tendon-to-bone interface in an animal model. We performed a clinical study of the arthroscopic polyglycolic acid sheet patch graft used for the repair of irreparable rotator cuff tears. One-year clinical results of the repair of irreparable rotator cuff tears by arthroscopic patch graft with a polyglycolic acid sheet demonstrated improved shoulder function and a significantly lower retear rate, compared with patients treated with a fascia lata patch.

  5. The Burden of Craft in Arthroscopic Rotator Cuff Repair: Where Have We Been and Where We Are Going.

    Science.gov (United States)

    Burkhart, Stephen S

    2015-08-01

    The rather turbulent history of arthroscopic rotator cuff repair went through stages of innovation, conflict, disruption, assimilation, and transformation that might be anticipated when a new and advanced technology (arthroscopic cuff repair) displaces an entrenched but outdated discipline (open cuff repair). The transition from open to arthroscopic rotator cuff repair has been a major paradigm shift that has greatly benefited patients. However, this technical evolution/revolution has also imposed a higher "burden of craft" on the practitioners of arthroscopic rotator cuff repair. Technological advancements in surgery demand that surgeons accept this burden of craft and master the advanced technology for the benefit of their patients. This article outlines the author's involvement in the development of arthroscopic rotator cuff repair, and it also explores the surgeon's obligation to accept the burden of craft that is imposed by this discipline.

  6. The temporal outcomes of open versus arthroscopic knotted and knotless rotator cuff repair over 5 years

    Science.gov (United States)

    Lucena, Thomas R; Lam, Patrick H; Millar, Neal L

    2015-01-01

    Background The present study aimed to determine how repair technique influenced structural and clinical outcomes at 5 years post-surgery. Methods Three cohorts of patients had repair of a symptomatic rotator cuff tear using (i) an open double-row mattress repair technique (n = 25); (ii) arthroscopic single-row simple suture knotted technique (n = 25); or (iii) arthroscopic single-row inverted mattress knotless technique (n = 36) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained pre-operatively and postoperatively with a validated protocol, ultrasound were also performed at the same time. Results Retear occurred more often after open repair (48%) at 5 years than after arthroscopic knotted (33%) and arthroscopic knotless (26%) repair. Retear was associated with increasing age, pre-operative tear size and weaker pre-operative and 5 years postoperative cuff strength. Between 2 years and 5 years, the open repair group experienced an increase in the frequency of pain during activity, as well as in the difficulty experienced and the severity of pain during overhead activities (p repair group. Conclusions At 5-year follow-up, arthroscopic rotator cuff repair techniques resulted in fewer retears and better outcomes compared to an open double-row technique. PMID:27582985

  7. Difference between early versus delayed postoperative physical rehabilitation protocol following arthroscopic rotator cuff repair

    Directory of Open Access Journals (Sweden)

    Samar M Fawzy

    2016-01-01

    Conclusion Significant improvement in pain, ROM, and function after arthroscopic rotator cuff repair was seen at 1 year postoperatively, regardless of early or delayed postoperative rehabilitation protocols. However, early motion increases pain scores and may increase the possibility of rotator cuff retear but with early regain of ROM. A delayed rehabilitation protocol with immobilization for 6 weeks would be better for tendon healing without risk for retear or joint stiffness and easily convalescence with less postoperative pain.

  8. Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report

    Directory of Open Access Journals (Sweden)

    Rambani Rohit

    2009-06-01

    Full Text Available Abstract Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery. Conclusion Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome.

  9. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors.

    Science.gov (United States)

    Chung, Seok Won; Oh, Joo Han; Gong, Hyun Sik; Kim, Joon Yub; Kim, Sae Hoon

    2011-10-01

    The prognostic factors associated with structural outcome after arthroscopic rotator cuff repair have not yet been fully determined. The hypothesis of this study was that bone mineral density (BMD) is an important prognostic factor affecting rotator cuff healing after arthroscopic cuff repair. Cohort study; Level of evidence, 3. Among 408 patients who underwent arthroscopic repair for full-thickness rotator cuff tear between January 2004 and July 2008, 272 patients were included whose postoperative cuff integrity was verified by computed tomography arthrography (CTA) or ultrasonography (USG) and simultaneously who were evaluated by various functional outcome instruments. The mean age at the time of operation was 59.5 ± 7.9 years. Postoperative CTA or USG was performed at a mean 13.0 ± 5.1 months after surgery, and the mean follow-up period was 37.2 ± 10.0 months (range, 24-65 months). The clinical, structural, and surgery-related factors affecting cuff integrity including BMD were analyzed using both univariate and multivariate analysis. Evaluation of postoperative cuff integrity was performed by musculoskeletal radiologists who were unaware of the present study. The failure rate of rotator cuff healing was 22.8% (62 of 272). The failure rate was significantly higher in patients with lower BMD (P cuff healing failure following arthroscopic rotator cuff repair. Bone mineral density, as well as FI of the infraspinatus and amount of retraction, was an independent determining factor affecting postoperative rotator cuff healing. Further studies with prospective, randomized, and controlled design are needed to confirm the relationship between BMD and postoperative rotator cuff healing.

  10. [Clinical research of arthroscopic separate double-layer suture bridge technique for delaminated rotator cuff tear].

    Science.gov (United States)

    Ren, Jiangtao; Xu, Cong; Liu, Xianglin; Wang, Jiansong; Li, Zhihuai; Lü, Yongming

    2017-10-01

    To explore the effectiveness of the arthroscopic separate double-layer suture bridge technique in treatment of the delaminated rotator cuff tear. Between May 2013 and May 2015, 54 patients with the delaminated rotator cuff tears were recruited in the study. They were randomly allocated into 2 groups to receive repair either using arthroscopic separate double-layer suture bridge technique (trial group, n =28) or using arthroscopic whole-layer suture bridge technique (control group, n =26). There was no significant difference in gender, age, injured side, tear type, and preoperative visual analogue scale (VAS) score, Constants score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and the range of motion of shoulder joint between 2 groups ( P >0.05). Postoperative functional scores, range of motion, and recurrence rate of tear in 2 groups were observed and compared. The operation time was significant longer in trial group than in control group ( t =8.383, P =0.000). All incisions healed at stage Ⅰ without postoperative complication. All the patients were followed up 12 months. At 12 months postoperatively, the UCLA score, ASES score, VAS score, Constant score, and the range of motion were significantly improved when compared with the preoperative values in 2 groups ( P 0.05). Four cases (14.3%) of rotator cuff tear recurred in trial group while 5 cases (19.2%) in control group, showing no significant difference ( χ 2 =0.237, P =0.626). Compared with the arthroscopic whole-layer suture bridge technique, arthroscopic separate double-layer suture bridge technique presents no significant difference in the shoulder function score, the range of motion, and recurrence of rotator cuff tear, while having a longer operation time.

  11. No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial.

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    Bayle, Xavier; Pham, Thuy-Trang; Faruch, Marie; Gobet, Aurelie; Mansat, Pierre; Bonnevialle, Nicolas

    2017-12-01

    Arthroscopic techniques tend to become the gold standard in rotator cuff repair. However, little data are reported in the literature regarding the improvement of postoperative outcomes and re-tear rate relative to conventional open surgery. The aim of this study was to compare clinical outcomes and cuff integrity after arthroscopic versus open cuff repair. We prospectively assessed clinical outcomes and cuff integrity after an arthroscopic or open rotator cuff repair with a minimum follow-up of 12 months. Clinical evaluation was based on Constant score, Simple Shoulder Value (SSV) and American Shoulder and Elbow Score (ASES). Rotator cuff healing was explored with ultrasound. 44 patients in arthroscopic group A (mean age 56-year-old) and 43 in open group O (mean age 61-year-old) fulfilled the inclusion criteria. Tendons were repaired with a single row technique associated with biceps tenodesis and subacromial decompression. All objective clinical scores significantly improved postoperatively in both groups. No statistical difference was identified between group A and O regarding, respectively, Constant score (72 vs 75 points; p = 0.3), ASES score (88 vs 91 points; p = 0.3), and SSV (81 vs 85%). The overall rate of re-tear (Sugaya type IV or V) reached 7 and 9%, respectively, in group A and O (p = 0.8). This study did not prove any difference of arthroscopic over open surgery in case of rotator cuff repair regarding clinical outcome and cuff integrity at 1-year follow-up. Prospective comparative study.

  12. Arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears.

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    Jung, Sung-Weon; Kim, Dong-Hee; Kang, Seung-Hoon; Lee, Ji-Heon

    2017-07-01

    While a conventional single- or double-row repair technique could be applied for repair of C-shaped tears, a different surgical strategy should be considered for repair of U- or L-shaped tears because they typically have complex patterns with anterior, posterior, or both mobile leaves. This study was performed to examine the outcomes of the modified Mason-Allen technique for footprint restoration in the treatment of large U- or L-shaped rotator cuff tears. Thirty-two patients who underwent an arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears between January 2012 and December 2013 were included in this study. Margin convergence was first performed to reduce the tear gap and tension, and then, an arthroscopic Mason-Allen technique was performed to restore the rotator cuff footprint in a side-to-end repair fashion. All patients were evaluated preoperatively and for a minimum of 2 years of follow-up with a visual analog scale (VAS) for pain, Constant score, and ultrasonography. There was significant improvement in all VAS and Constant scores compared with the preoperative values (P rotator cuff in our data. Overall satisfactory results were achieved in most patients, with the exception of those with severe fatty degeneration. An arthroscopic modified Mason-Allen technique could be an effective and reliable alternative for patients with large U- or L-shaped rotator cuff tears. Case Series, Therapeutic Level IV.

  13. Reversibility of Supraspinatus Muscle Atrophy in Tendon-Bone Healing After Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Park, Yong Bok; Ryu, Ho Young; Hong, Jin Ho; Ko, Young Hoo; Yoo, Jae Chul

    2016-04-01

    To date, there are few reports of the definite reversibility of rotator cuff muscle atrophy after repair. To evaluate the reversibility of rotator cuff muscle atrophy after successful arthroscopic repair. Case series; Level of evidence, 4. Included in this study were 47 patients (mean age, 61.2 ± 7.3 years; range, 49-73 years) who underwent arthroscopic rotator cuff repair as well as magnetic resonance imaging (MRI) preoperatively and at 6-month and last follow-up. Patients who had confirmed rotator cuff healing (grades 1-3 according to the Sugaya classification) on both series of postoperative MRI were enrolled in the study. The mean time from the onset of symptoms to surgery was 24.7 ± 25.6 months (range, 3-120 months). The minimum follow-up was 2 years, and the mean follow-up duration was 41.8 ± 14.4 months. Serial changes in the supraspinatus muscle area on the most matching MRI scans (sagittal-oblique view) were evaluated. The area was measured by 2 independent observers. Both independent observers reported no significant difference in the area of the supraspinatus muscle between the preoperative time point and 6-month follow-up (observer 1: P = .135; observer 2: P = .189). However, there was a significant difference between the 6-month and last follow-up (mean, 41.8 months; observers 1 and 2: P .999) or from 6-month to final follow-up (P = .077). After successful arthroscopic rotator cuff repair, there was a slight (11.3%-13.9%) increase in muscle volume from preoperatively to final follow-up, as seen on serial MRI. Fatty infiltration according to the Goutallier grade was not reversed (P = .077). Some reversibility of supraspinatus muscle atrophy may exist in tendon-bone healing after arthroscopic rotator cuff repair; further follow-up is needed to better elucidate this result. © 2016 The Author(s).

  14. Evaluation of Repair Tension in Arthroscopic Rotator Cuff Repair: Does It Really Matter to the Integrity of the Rotator Cuff?

    Science.gov (United States)

    Kim, Do Hoon; Jang, Young Hoon; Choi, Young Eun; Lee, Hwa-Ryeong; Kim, Sae Hoon

    2016-11-01

    Repair tension of a torn rotator cuff can affect healing after repair. However, a measurement of the actual tension during arthroscopic rotator cuff repair is not feasible. The relationship between repair tension and healing of a rotator cuff repair remains unclear. The purpose of this study was to evaluate the effect of repair tension on healing at the repair site. The hypothesis was that repair tension would be a major factor in determining the anatomic outcome of rotator cuff repair. Cohort study; Level of evidence, 2. Arthroscopic rotator cuff repairs (132 patients) for full-thickness rotator cuff tears were analyzed. An intraoperative model was designed for the estimation of repair tension using a tensiometer. Magnetic resonance imaging (MRI) was performed approximately 1 year (mean [±SD], 12.7 ± 3.2 months) postoperatively for the evaluation of healing at the repair site. Multivariable analysis was performed for tear size, amount of retraction, and fatty degeneration (FD) of rotator cuff muscles. The mean repair tension measured during the arthroscopic procedure was 28.5 ± 23.1 N. There was a statistically significant correlation between tension and tear size (Pearson correlation coefficient [PCC], 0.529; P repair tension also showed a significant inverse correlation with healing at the repair site (SCC, 0.195; P = .025). However, when sex, age, tear size, amount of retraction, tendon quality, and FD of rotator cuff muscles were included for multivariable logistic regression analysis, only FD of the infraspinatus showed an association with the anatomic outcome of repair (Exp(B) = 0.596; P = .010). Our intraoperative model for the estimation of rotator cuff repair tension showed an inverse correlation of repair tension with healing at the repair site, suggesting that complete healing is less likely with high-tension repairs. A significant association was observed on MRI between a high level of FD of the infraspinatus and repaired tendon integrity. © 2016

  15. Early versus delayed rehabilitation following arthroscopic rotator cuff repair: A systematic review.

    Science.gov (United States)

    Gallagher, Brian P; Bishop, Meghan E; Tjoumakaris, Fotios P; Freedman, Kevin B

    2015-05-01

    Early passive range of motion (ROM) following arthroscopic cuff repair is thought to decrease postoperative stiffness and improve functionality. However, early aggressive rehabilitation may compromise repair integrity. Our purpose was to perform a systematic review to determine if there are differences between early and delayed rehabilitation after arthroscopic rotator cuff repair in terms of clinical outcomes and healing. We performed a literature search with the terms 'arthroscopic rotator cuff', 'immobilization', 'early', 'delayed', 'late', and 'rehabilitation' using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Selection criteria included: level I/II evidence ≤ 6 months in duration, comparing early versus delayed rehabilitation following arthroscopic repair. Data regarding demographics, sample sizes, duration, cuff pathology, surgery, rehabilitation, functional outcomes, pain, ROM and anatomic assessment of healing were analyzed. PRIMSA criteria were followed. We identified six articles matching our criteria. Three reported significantly increased functional scores within the first 3-6 months with early rehabilitation compared to the delayed group, only one of which continued to observe a difference at a final follow-up of 15 months. Four articles showed improved ROM in the first 3-6 months post-operatively with early rehabilitation. One noted transient differences in pain scores. Only one study noted significant differences in ROM at final follow-up. No study reported any significant difference in rates of rotator cuff re-tear. However, two studies noted a trend towards increased re-tear with early rehabilitation that did not reach significance. This was more pronounced in studies including medium-large tears. Early rehabilitation after arthroscopic cuff repair is associated with some initial improvements in ROM and function. Ultimately, similar clinical and anatomical outcomes between groups existed at 1 year. While there was no

  16. Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

    Science.gov (United States)

    Ko, Sang Hun; Cho, Sung Do; Lee, Chae Chil; Choi, Jang Kyu; Kim, Han Wook; Park, Seon Jae; Bae, Mun Hee; Cha, Jae Ryong

    2017-09-01

    The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

  17. Functional evaluation of patient after arthroscopic repair of rotator cuff tear.

    Science.gov (United States)

    Kumar, Rohit; Jadhav, Umesh

    2014-06-01

    Rotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population. Twenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented. The mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients. The mean UCLA improved from a score of 15.84 to 30.28 with a p value advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results.

  18. Editorial Commentary: The Wake of the Dragon: Will the Orthopaedic Community Adopt the Shoulder Arthroscopic Latarjet Procedure as We Adopted the Arthroscopic Rotator Cuff Repair?

    Science.gov (United States)

    Boileau, Pascal; Saliken, David

    2017-12-01

    The Latarjet procedure is a complex and difficult operation when performed both with an open approach and arthroscopically. The difficulties come from the fact that it is a combined intra- and extra-articular procedure, and that working close to the brachial plexus may be frightening for surgeons. Because of the high complication and reoperation rates reported in the literature, this procedure is, at the moment, rejected by a large part of the orthopaedic community, specifically in North America. The Chinese experience shows, after the European one, that arthroscopic Latarjet is an efficient and irreplaceable option for the treatment of recurrent anterior shoulder instability in the context of capsular and/or glenoid deficiency. A recent study shows that the arthroscopic procedure provides accurate bone block positioning and high rates of healing, excellent clinical results (no recurrence of instability at 2-year follow-up), and low rates of complications (no neurovascular injury). Although the arthroscopic Latarjet should be approached with caution, the learning curve should not be thought of as prohibitive. To learn how to perform an arthroscopic Latarjet, surgeons should visit an experienced surgeon and take a course to practice on cadavers first. Although it will take time and effort to learn and perform this operation correctly, we should command our Chinese colleagues to encourage us to follow their path. There is no reason that in the near future the orthopaedic community does not adopt the arthroscopic Latarjet procedure, as we adopted the arthroscopic rotator cuff repair and other complex surgical procedures. Among the strongest reasons to perform the Latarjet procedure arthroscopically are the accuracy of graft placement, the safety for neurovascular structures provided by direct visualization and magnification, and the excellent clinical results allowing young people to go back to sport, including high-risk (contact, overhead) sports. Copyright © 2017

  19. Arthroscopic treatment of secondary rotator cuff damage after shoulder hemiarthroplasty (case report

    Directory of Open Access Journals (Sweden)

    S. Y. Dokolin

    2015-01-01

    Full Text Available Anatomical shoulder arthroplasty is an effective treatment for patients with primary deforming arthritis, rheumatoid arthritis and aseptic necrosis of the humeral head. However this kind of surgery is associated with high risk of complications, and within five-year follow-up the incidence of complications increases. The authors described a clinical case illustrating one of these complications - secondary rotator cuff damage after shoulder hemiarthroplasty. The tear was verified using radiological methods and arthroscopy. They performed arthroscopic rotator cuff repair using suture anchors in order to alleviate pain and preserve shoulder functions. If there are no signs of endoprosthetic instability and coracoacromial ligament is preserved, arthroscopic treatment of such damages extends the time of limb function preserving the endoprosthesis. Patients should not raise their arms above the horizontal level.

  20. Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Gwak, Heui-Chul; Kim, Chang-Wan; Kim, Jung-Han; Choo, Hye-Jeung; Sagong, Seung-Yeob; Shin, John

    2015-05-01

    The purpose of this study was to evaluate the extension of delamination and the cuff integrity after arthroscopic repair of delaminated rotator cuff tears. Sixty-five patients with delaminated rotator cuff tears were retrospectively reviewed. The delaminated tears were divided into full-thickness delaminated tears and partial-thickness delaminated tears. To evaluate the medial extension, we calculated the coronal size of the delaminated portion. To evaluate the posterior extension, we checked the tendon involved. Cuff integrity was evaluated by computed tomography arthrography. The mean medial extension in the full-thickness and partial-thickness delaminated tears was 18.1 ± 6.0 mm and 22.7 ± 6.3 mm, respectively (P = .0084). The posterior extension into the supraspinatus and the infraspinatus was 36.9% and 32.3%, respectively, in the full-thickness delaminated tears, and it was 27.7% and 3.1%, respectively, in the partial-thickness delaminated tears (P = .0043). With regard to cuff integrity, 35 cases of anatomic healing, 10 cases of partial healing defects, and 17 cases of retear were detected. Among the patients with retear and partial healing of the defect, all the partially healed defects showed delamination. Three retear patients showed delamination, and 14 retear patients did not show delamination; the difference was statistically significant (P = .0001). The full-thickness delaminated tears showed less medial extension and more posterior extension than the partial-thickness delaminated tears. Delamination did not develop in retear patients, but delamination was common in the patients with partially healed defects. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair.

    Science.gov (United States)

    Barnes, L A Fink; Kim, H M; Caldwell, J-M; Buza, J; Ahmad, C S; Bigliani, L U; Levine, W N

    2017-02-01

    Advances in arthroscopic techniques for rotator cuff repair have made the mini-open approach less popular. However, the mini-open approach remains an important technique for repair for many surgeons. The aims of this study were to compare the integrity of the repair, the function of the shoulder and satisfaction post-operatively using these two techniques in patients aged > 50 years. We identified 22 patients treated with mini-open and 128 patients treated with arthroscopic rotator cuff repair of July 2007 and June 2011. The mean follow-up was two years (1 to 5). Outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores, and satisfaction. The integrity of the repair was assessed using ultrasonography. A power analysis ensured sufficient enrolment. There was no statistically significant difference between the age, function, satisfaction, or pain scores (p > 0.05) of the two groups. The integrity of the repair and the mean SST scores were significantly better in the mini-open group (91% of mini-open repairs were intact versus 60% of arthroscopic repairs, p = 0.023; mean SST score 10.9 (standard deviation (sd) 1.3) in the mini-open group; 8.9 (sd 3.5) in arthroscopic group; p = 0.003). The ASES scores were also higher in the mini-open group (mean ASES score 91.0 (sd 10.5) in mini-open group; mean 82.70 (sd 19.8) in the arthroscopic group; p = 0.048). The integrity of the repair and function of the shoulder were better after a mini-open repair than after arthroscopic repair of a rotator cuff tear in these patients. The functional difference did not translate into a difference in satisfaction. Mini-open rotator cuff repair remains a useful technique despite advances in arthroscopy. Cite this article: Bone Joint J 2017;99-B:245-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

  2. Early postoperative fluoroquinolone use is associated with an increased revision rate after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Young, Chris; Werner, Brian C

    2017-07-01

    To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair. An insurance database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0-2, 2-4, and 4-6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair. Rates of failure requiring revision rotator cuff repair were compared within 2 years. A total of 1292 patients were prescribed fluoroquinolones within 6 months after rotator cuff repair, including 442 within 2 months, 433 within 2 to 4 months, and 417 within 4 to 6 months, and were compared to 5225 matched negative controls and 1597 matched positive controls. The rate of revision rotator cuff repair was significantly higher in patients prescribed fluoroquinolones within 2 months (6.1 %) compared to matched negative (2.2 %, P = 0.0009) and positive controls (2.4 %, P = 0.0026). There were no significant differences in the rate of revision rotator cuff repair when fluoroquinolones were prescribed >2 months after rotator cuff repair. Early use of fluoroquinolones following rotator cuff repair was independently associated with significantly increased rates of failure requiring revision rotator cuff repair. This is the first clinical study examining the association of postoperative fluoroquinolone use with failure following arthroscopic rotator cuff repair. III.

  3. The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair

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    Bryan G. Vopat

    2014-05-01

    Full Text Available Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthro- scopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001. This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

  4. Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Randelli, Pietro; Stoppani, Carlo Alberto; Zaolino, Carlo; Menon, Alessandra; Randelli, Filippo; Cabitza, Paolo

    2017-07-01

    Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Randomized controlled trial; Level of evidence, 1. Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).

  5. Use of a shoulder abduction brace after arthroscopic rotator cuff repair: A study on gait performance and falls.

    Science.gov (United States)

    Sonoda, Yuma; Nishioka, Takashi; Nakajima, Ryo; Imai, Shinji; Vigers, Piers; Kawasaki, Taku

    2018-04-01

    Fall prevention is essential in patients after arthroscopic rotator cuff repair because of the high risk of re-rupture. However, there are no reports related to falls that occur during the early postoperative period, while the affected limb is immobilized. This study assessed gait performance and falls in patients using a shoulder abduction brace after arthroscopic rotator cuff repair. Prospective cohort and postoperative repeated measures. This study included 29 patients (mean age, 67.1 ± 7.4 years) who underwent arthroscopic rotator cuff repair followed by rehabilitation. The timed up and go test, Geriatric Depression Scale, and Falls Efficacy Scale were measured, and the numbers of falls were compared between those shoulder abduction brace users and patients who had undergone total hip or knee arthroplasty. In arthroscopic rotator cuff repair patients, there were significant improvements in timed up and go test and Geriatric Depression Scale, but no significant differences in Falls Efficacy Scale, between the second and fifth postoperative weeks ( p rotator cuff repair patients fell more often than patients with total hip arthroplasty or total knee arthroplasty during the same period. The findings suggest that rehabilitation in arthroscopic rotator cuff repair patients is beneficial, but decreased gait performance due to the immobilizing shoulder abduction brace can lead to falls. Clinical relevance Although rehabilitation helps motor function and mental health after arthroscopic rotator cuff repair, shoulder abduction brace use is associated with impaired gait performance, high Falls Efficacy Scale scores, and risk of falls, so awareness of risk factors including medications and lower limb dysfunctions is especially important after arthroscopic rotator cuff repair.

  6. Recovery of Muscle Strength After Intact Arthroscopic Rotator Cuff Repair According to Preoperative Rotator Cuff Tear Size.

    Science.gov (United States)

    Shin, Sang-Jin; Chung, Jaeyoon; Lee, Juyeob; Ko, Young-Won

    2016-04-01

    The recovery of muscle strength after arthroscopic rotator cuff repair based on the preoperative tear size has not yet been well described. The purpose of this study was to evaluate the recovery period of muscle strength by a serial assessment of isometric strength after arthroscopic rotator cuff repair based on the preoperative tear size. The hypothesis was that muscle strength in patients with small and medium tears would recover faster than that in those with large-to-massive tears. Cohort study; Level of evidence, 3. A total of 164 patients who underwent arthroscopic rotator cuff repair were included. Isometric strength in forward flexion (FF), internal rotation (IR), and external rotation (ER) was evaluated preoperatively and at 6, 12, 18, and 24 months after surgery. Preoperative magnetic resonance imaging scans were assessed to evaluate the quality of the rotator cuff muscle, including fatty infiltration, occupation ratio, and tangent sign. Patient satisfaction as well as visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores were assessed at every follow-up. Muscle strength demonstrated the slowest recovery in pain relief and the restoration of shoulder function. To reach the strength of the uninjured contralateral shoulder in all 3 planes of motion, recovery took 6 months in patients with small tears and 18 months in patients with medium tears. Patients with large-to-massive tears showed continuous improvement in strength up to 18 months; however, they did not reach the strength of the contralateral shoulder at final follow-up. At final follow-up, mean strength in FF, IR, and ER was 113.0%, 118.0%, and 112.6% of the contralateral shoulder in patients with small tears, respectively; 105.0%, 112.1%, and 102.6% in patients with medium tears, respectively; and 87.6%, 89.5%, and 85.2% in patients with large-to-massive tears, respectively. Muscle strength in any direction did not significantly correlate with

  7. Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

    Science.gov (United States)

    Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

    2016-09-01

    To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these

  8. Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique.

    Science.gov (United States)

    Mook, William R; Greenspoon, Joshua A; Millett, Peter J

    2016-01-01

    Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

  9. Transtendon, double-row, transosseous-equivalent arthroscopic repair of partial-thickness, articular-surface rotator cuff tears.

    Science.gov (United States)

    Dilisio, Matthew F; Miller, Lindsay R; Higgins, Laurence D

    2014-10-01

    Arthroscopic transtendinous techniques for the arthroscopic repair of partial-thickness, articular-surface rotator cuff tears offer the advantage of minimizing the disruption of the patient's remaining rotator cuff tendon fibers. In addition, double-row fixation of full-thickness rotator cuff tears has shown biomechanical advantages. We present a novel method combining these 2 techniques for transtendon, double-row, transosseous-equivalent arthroscopic repair of partial-thickness, articular-surface rotator cuff tears. Direct visualization of the reduction of the retracted articular tendon layer to its insertion on the greater tuberosity is the key to the procedure. Linking the medial-row anchors and using a double-row construct provide a stable repair that allows early shoulder motion to minimize the risk of postoperative stiffness.

  10. Factors affecting healing rates after arthroscopic double-row rotator cuff repair.

    Science.gov (United States)

    Tashjian, Robert Z; Hollins, Anthony M; Kim, Hyun-Min; Teefey, Sharlene A; Middleton, William D; Steger-May, Karen; Galatz, Leesa M; Yamaguchi, Ken

    2010-12-01

    Double-row arthroscopic rotator cuff repairs were developed to improve initial biomechanical strength of repairs to improve healing rates. Despite biomechanical improvements, failure of healing remains a clinical problem. To evaluate the anatomical results after double-row arthroscopic rotator cuff repair with ultrasound to determine postoperative repair integrity and the effect of various factors on tendon healing. Case series; Level of evidence, 4. Forty-eight patients (49 shoulders) who had a complete arthroscopic rotator cuff repair (double-row technique) were evaluated with ultrasound at a minimum of 6 months after surgery. Outcome was evaluated at a minimum of 1-year follow-up with standardized history and physical examination, visual analog scale for pain, active forward elevation, and preoperative and postoperative shoulder scores according to the system of the American Shoulder and Elbow Surgeons and the Simple Shoulder Test. Quantitative strength was measured postoperatively. Ultrasound and physical examinations were performed at a minimum of 6 months after surgery (mean, 16 months; range, 6 to 36 months) and outcome questionnaire evaluations at a minimum of 12 months after surgery (mean, 29 months; range, 12 to 55 months). Of 49 repairs, 25 (51%) were healed. Healing rates were 67% in single-tendon tears (16 of 24 shoulders) and 36% in multitendon tears (9 of 25 shoulders). Older age and longer duration of follow-up were correlated with poorer tendon healing (P repair (P rotator cuff repair. The biological limitation at the repair site, as reflected by the effects of age on healing, appears to be the most important factor influencing tendon healing, even after maximizing repair biomechanical strength with a double-row construct.

  11. The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs.

    Science.gov (United States)

    Yeo, Daniel Y T; Walton, Judie R; Lam, Patrick; Murrell, George A C

    2017-03-01

    Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Cohort study; Level of evidence, 3. A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L'Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P 8 cm 2 . There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and

  12. Functional evaluation of arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis,

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    Alberto Naoki Miyazaki

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the functional result from arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis, defined as incapacity to actively raise the arm above 90◦ , while complete passive elevation was possible.METHODS: we reevaluated 38 patients with a mean follow-up of 51 months (minimum of 24. We analyzed the pseudoparalysis reversion rate and the functional result obtained.RESULTS: according to the assessment criteria of the University of California in Los Angeles (UCLA, 31 (82% patients had good and excellent results, two (5% had fair results and five (13% had poor results. The mean active elevation went from 39◦ before the operation to 139◦ after the operation (p < 0.05; the mean active lateral rotation went from 30◦ to 48◦ (p < 0.05 and the mean active medial rotation went from level L3 to T12 (p < 0.05.CONCLUSION: arthroscopic repair of rotator cuff injuries produced good and excellent results in 82% of the cases and a statistically significant improvement of active range of motion, with reversion of the pseudoparalysis in 97.4% of the cases. It is therefore a good treatment option.

  13. Factors affecting healing after arthroscopic rotator cuff repair

    Science.gov (United States)

    Abtahi, Amir M; Granger, Erin K; Tashjian, Robert Z

    2015-01-01

    Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. PMID:25793161

  14. The Relationship Between Shoulder Stiffness and Rotator Cuff Healing: A Study of 1,533 Consecutive Arthroscopic Rotator Cuff Repairs.

    Science.gov (United States)

    McNamara, William J; Lam, Patrick H; Murrell, George A C

    2016-11-16

    Retear and stiffness are not uncommon outcomes of rotator cuff repair. The purpose of this study was to evaluate the relationship between rotator cuff repair healing and shoulder stiffness. A total of 1,533 consecutive shoulders had an arthroscopic rotator cuff repair by a single surgeon. Patients assessed their shoulder stiffness using a Likert scale preoperatively and at 1, 6, 12, and 24 weeks (6 months) postoperatively, and examiners evaluated passive range of motion preoperatively and at 6, 12, and 24 weeks postoperatively. Repair integrity was determined by ultrasound evaluation at 6 months. After rotator cuff repair, there was an overall significant loss of patient-ranked and examiner-assessed shoulder motion at 6 weeks compared with preoperative measurements (p rotator cuff integrity at 6 months postoperatively (r = 0.11 to 0.18; p rotation at 6 weeks postoperatively was 7%, while the retear rate of patients with >20° of external rotation at 6 weeks was 15% (p rotator cuff repair was more likely to heal. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  15. Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population.

    Science.gov (United States)

    Jensen, Andrew R; Cha, Peter S; Devana, Sai K; Ishmael, Chad; Di Pauli von Treuheim, Theo; D'Oro, Anthony; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

    2017-10-01

    Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Cohort study; Level of evidence, 3. All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.

  16. ARTHROSCOPIC REPAIR OF LARGE AND MASSIVE ROTATOR CUFF TEARS: CLINICAL OUTCOMES AND POSTOPERATIVE MRI FINDINGS

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    S. Yu. Dokolin

    2017-01-01

    Full Text Available Purpose of the study – to identify incidence rate of recurrent rotator cuff (RC tears, to evaluate outcomes of arthroscopic bone-tendon anchor suture, to determine the factors influencing arthroscopic treatment outcomes.Materials and methods. Medical history data, pre-operative x-rays and MRI of shoulder joints of 305 patients (main group who underwent arthroscopic bone-tendon anchor suture repair of large or massive RC tears during 2010-2016 were included in the study. Follow up period ranged from 1 to 6 years postoperatively with mean value of 25,6±4,5 months. Telephone survey of patients was conducted after the surgery as well as a single examination of patients with evaluation by functional scales – UCLA, ASES, CS, VAS, DN4. Preoperative standard x-rays in AP and axial views were done in all patients. Arthropathy severity was evaluated by K.Hamada classification. Comparison of patient specific data, features of RC lesions and surgical treatment was made by Kruskal-Wallis test.Results. Good outcomes by ASES, CS and UCLA functional scales were obtained in 15 (5% of patients, satisfactory – in 213 (69.8%, poor – in 77 (25.2%. Postoperative MRI data provided the following sub-distribution of patients: 49 (41.1% patients with complete repair of RC tendons lesions, 38 (31.9% patients with partial repair and 33 (27.0% patients with recurrent tear of reconstructed tendon. Correlation analysis allowed to establish the limits for achieving good outcomes of arthroscopic bone-tendon anchor suturing for significant association with infraspinatus muscle atrophy (not exceeding 40% and fatty infiltration of supraspinatus muscle (not exceeding 23.5%. 

  17. Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player

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    Tomoyuki Muto

    2015-01-01

    Full Text Available In 2013, a 16-year-old baseball pitcher visited Nobuhara Hospital complaining of shoulder pain and limited range of motion in his throwing shoulder. High signal intensity in the rotator interval (RI area (ball sign, injured subscapularis tendon, and damage to both the superior and middle glenohumeral ligaments were identified using magnetic resonance imaging (MRI. Repair of the RI lesion and partially damaged subscapularis tendon was performed in this pitcher. During surgery, an opened RI and dropping of the subscapularis tendon were observed. The RI was closed in a 90° externally rotated and abducted position. To reconfirm the exact repaired state of the patient, arthroscopic examination was performed from behind. However, suture points were not visible in the >30° externally rotated position, which indicates that the RI could not be correctly repaired with the arthroscopic procedure. One year after surgery, the patient obtained full function of the shoulder and returned to play at a national convention. Surgical repair of the RI lesion should be performed in exactly the correct position of the upper extremity.

  18. Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears.

    Science.gov (United States)

    Ji, Jong-Hun; Shafi, Mohamed; Kim, Weon-Yoo; Kim, Young-Yul

    2010-07-01

    There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

  19. Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Ji Jong-Hun

    2010-01-01

    Full Text Available Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I and 25 patients who underwent double row repair (group II from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES. Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

  20. Prognostic Factors Affecting Rotator Cuff Healing After Arthroscopic Repair in Small to Medium-sized Tears.

    Science.gov (United States)

    Park, Ji Soon; Park, Hyung Jun; Kim, Sae Hoon; Oh, Joo Han

    2015-10-01

    Small and medium-sized rotator cuff tears usually have good clinical and anatomic outcomes. However, healing failure still occurs in some cases. To evaluate prognostic factors for rotator cuff healing in patients with only small to medium-sized rotator cuff tears. Case-control study; Level of evidence, 3. Data were prospectively collected from 339 patients with small to medium-sized rotator cuff tears who underwent arthroscopic repair by a single surgeon between March 2004 and August 2012 and who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery. The mean age of the patients was 59.8 years (range, 39-80 years), and the mean follow-up time was 20.8 months (range, 12-66 months). The functional evaluation included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons score, Constant-Murley score, and Simple Shoulder Test. Postoperative VAS for pain and functional scores improved significantly compared with preoperative values (P rotator cuff healing (P 2 cm in size (34.2%) compared with patients with a tear ≤2 cm (10.6%) (P rotator cuff tears, grade II fatty degeneration of the infraspinatus muscle according to the Goutallier classification could be a reference point for successful healing, and anatomic outcomes might be better if repair is performed before the patient is 69 years old and the tear size exceeds 2 cm. © 2015 The Author(s).

  1. Evaluation of the functional results after rotator cuff arthroscopic repair with the suture bridge technique

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    Alberto Naoki Miyazaki

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI that involved the supra and infraspinatus muscles using the suture bridge (SB technique. METHODS: Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45-75. The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases. The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew(r fibertape(r or fiberwire(r at the articular margin, associated with lateral fixation without stitch using PushLocks(r or SwiveLocks(r. RESULTS: The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA, 35 (94% patients had excellent and good results; one (2.7%, fair; and one (2.7%, poor. CONCLUSION: Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.

  2. Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity.

    Science.gov (United States)

    Cheon, Sang Jin; Lee, Hyo Yeol; Jeon, Woong Ki

    2018-04-20

    This study aimed to evaluate the clinical outcomes and structural integrity of arthroscopic repair of intratendinous rotator cuff tear. Patients who were diagnosed with an intratendinous tear but in whom conservative treatment failed were selected and underwent arthroscopic repair. Between 2008 and 2014, a total of 30 patients (6 men, 24 women; mean age, 59 ± 3.7 years) met the inclusion criteria and were followed up. The mean follow-up period was 26.3 ± 0.7 months. The results were evaluated using the University of California at Los Angeles (UCLA) score, the Society of the American Shoulder and Elbow Surgeons rating scale (ASES) questionnaire, and the visual analog scale (VAS) and range of motion (ROM) were measured preoperatively and at final follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 6.7 ± 0.2 months postoperatively. Postoperative MRI was performed on 27 out of 30 patients and analysed using the Sugaya classification. Corresponding to the preoperative MRI findings, arthroscopic findings of intratendinous tears were observed in all 30 patients. The mean active forward elevation ROM was 137.3° ± 15.4° before surgery and 168.8° ± 15.2° at the final follow-up. The internal and external rotations at abduction were 31.7° ± 5.1° and 63.0° ± 11.6° before surgery, respectively, and 60.5° ± 8.0° and 75.2° ± 10.8° after surgery, respectively. The UCLA score improved from of 20.1 ± 7.4 points preoperative to 28.4 ± 5.5 points at the final follow-up. The ASES score improved from 55.7 ± 15.3 points preoperative to 82.6 ± 9.7 points postoperatively. The VAS for pain score decreased from 6.4 ± 1.2 points preoperative to 1.6 ± 0.9 points postoperative. Satisfactory outcomes (excellent/good) in terms of UCLA and ASES scores were observed in 29 of 30 patients. Based on Sugaya classification, grades I, II, and III structural integrities were observed in 9

  3. Can arthroscopic rotator cuff repair prevent proximal migration of the humeral head?

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    Pablo Sanz-Ruiz

    2015-12-01

    Full Text Available Introduction: Shoulder arthroscopy has become increasingly used in recent years, especially in rotator cuff repair. The purpose of this study was to determine whether arthroscopic rotator cuff repair could prevent proximal migration of the humeral head. Material and Methods: We performed a retrospective study of 56 patients suffering from shoulder pain. They were divided into two groups, one comprising patients with impingement syndrome who underwent acromioplasty only and another comprising patients with rotator cuff tear who underwent acromioplasty combined with rotator cuff repair. The pre-operative Hirooka angle and the results of the simple shoulder test (SST were compared after 1 year. Results: We found no differences between the groups for the Hirooka angle or SST results. We did find a significant difference (P<0.05 between pre-operative and post-operative SST results. Conclusions: Rotator cuff repair using arthroscopy is a minimally invasive procedure that improves function and prevents proximal migration of the humeral head after 1 year of follow-up. [Arch Clin Exp Surg 2015; 4(4.000: 190-195

  4. HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

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    Vishnumurthy H. Y

    2016-09-01

    Full Text Available INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS Thirty patients clinically suspected to have rotator cuff tear who underwent ultrasonography and arthroscopy of shoulder were included in the study. Duration of study was for two years. All ultrasonography examinations were conducted in ultrasound machine using GE Voluson 730 PRO high frequency (10-12 MHz linear array transducer done by two experienced radiologists. Arthroscopies were done by two experienced shoulder arthroscopic surgeons. RESULTS Age of the patients with rotator cuff tears ranged from 40 to 80 years. 57% were females and 43% were males among the patients who had rotator cuff tears. 71.43% of the rotator cuff tears were found in the dominant arm. 64.28% of patients with rotator cuff tear had given history of fall or trauma to the corresponding shoulder within 6 months prior to presentation. 39.28% of patients who had rotator cuff tears were known diabetics. Supraspinatus tendon was the most commonly affected tendon, followed by infraspinatus and subscapularis tendons. For overall detection of rotator cuff tears, ultrasonography in comparison with the arthroscopy has sensitivity and specificity of 92.85% and 100%. For detection of full thickness rotator cuff tear, its sensitivity and specificity was 94.73% and 100% and for partial thickness rotator cuff tears 76.92% and 100%. Ultrasonography has 100% sensitivity and specificity for detection of supraspinatus full thickness tear. For supraspinatus partial thickness tear, sensitivity and specificity was 88

  5. Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

    International Nuclear Information System (INIS)

    Chun, Kyung Ah; Kim, Min Sung; Kim, Young Joo

    2010-01-01

    To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal- sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and

  6. Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Kyung Ah; Kim, Min Sung; Kim, Young Joo [Catholic University of Korea Uijeongbu St.Mary' s Hospital, Uijeongbu (Korea, Republic of)

    2010-10-15

    To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal- sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and

  7. Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.

    Science.gov (United States)

    Abrams, Geoffrey D; Gupta, Anil K; Hussey, Kristen E; Tetteh, Elizabeth S; Karas, Vasili; Bach, Bernard R; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2014-06-01

    Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated. To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty. Randomized controlled trial; Level of evidence, 2. Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California-Los Angeles (UCLA) score, and Short Form-12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperative imaging was reviewed to classify the acromial morphologic type, acromial angle, and lateral acromial angulation. A total of 114 patients were initially enrolled in the study, and 95 (83%; 43 nonacromioplasty, 52 acromioplasty) were available for a minimum 2-year follow-up. There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Within groups, there was a significant (P < .001) improvement in all functional outcome scores from preoperatively to all follow-up time points, including 2 years, for the nonacromioplasty and acromioplasty groups (ASES score: 55.1-91.5, 48.8-89.0; Constant score: 48.3-75.0, 51.9-78.7, respectively). There were no significant differences in functional outcomes between nonacromioplasty and acromioplasty groups or between subjects with different acromial features at any time point. The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair

  8. Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation.

    Science.gov (United States)

    Ma, C Benjamin; Comerford, Lyn; Wilson, Joseph; Puttlitz, Christian M

    2006-02-01

    Recent studies have shown that arthroscopic rotator cuff repairs can have higher rates of failure than do open repairs. Current methods of rotator cuff repair have been limited to single-row fixation of simple and horizontal stitches, which is very different from open repairs. The objective of this study was to compare the initial cyclic loading and load-to-failure properties of double-row fixation with those of three commonly used single-row techniques. Ten paired human supraspinatus tendons were split in half, yielding four tendons per cadaver. The bone mineral content at the greater tuberosity was assessed. Four stitch configurations (two-simple, massive cuff, arthroscopic Mason-Allen, and double-row fixation) were randomized and tested on each set of tendons. Specimens were cyclically loaded between 5 and 100 N at 0.25 Hz for fifty cycles and then loaded to failure under displacement control at 1 mm/sec. Conditioning elongation, peak-to-peak elongation, ultimate tensile load, and stiffness were measured with use of a three-dimensional tracking system and compared, and the failure type (suture or anchor pull-out) was recorded. No significant differences were found among the stitches with respect to conditioning elongation. The mean peak-to-peak elongation (and standard error of the mean) was significantly lower for the massive cuff (1.1 +/- 0.1 mm) and double-row stitches (1.1 +/- 0.1 mm) than for the arthroscopic Mason-Allen stitch (1.5 +/- 0.2 mm) (p row fixation (287 +/- 24 N) than for all of the single-row fixations (p row fixation had a significantly higher ultimate tensile load than the three types of single-row fixation stitches. Of the single-row fixations, the massive cuff stitch had cyclic and load-to-failure characteristics similar to the double-row fixation. Anterior repairs of the supraspinatus tendon had significantly stronger biomechanical behavior than posterior repairs.

  9. Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability.

    Science.gov (United States)

    Itoigawa, Yoshiaki; Itoi, Eiji

    2016-02-01

    The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.

  10. The cost-effectiveness of single-row compared with double-row arthroscopic rotator cuff repair.

    Science.gov (United States)

    Genuario, James W; Donegan, Ryan P; Hamman, Daniel; Bell, John-Erik; Boublik, Martin; Schlegel, Theodore; Tosteson, Anna N A

    2012-08-01

    Interest in double-row techniques for arthroscopic rotator cuff repair has increased over the last several years, presumably because of a combination of literature demonstrating superior biomechanical characteristics and recent improvements in instrumentation and technique. As a result of the increasing focus on value-based health-care delivery, orthopaedic surgeons must understand the cost implications of this practice. The purpose of this study was to examine the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with traditional single-row repair. A decision-analytic model was constructed to assess the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with single-row repair on the basis of the cost per quality-adjusted life year gained. Two cohorts of patients (one with a tear of row compared with single-row arthroscopic rotator cuff repair was $571,500 for rotator cuff tears of row repair was less than $287 for small or moderate tears and less than $352 for large or massive tears compared with the cost of single-row repair, then double-row repair would represent a cost-effective surgical alternative. On the basis of currently available data, double-row rotator cuff repair is not cost-effective for any size rotator cuff tears. However, variability in the values for costs and probability of retear can have a profound effect on the results of the model and may create an environment in which double-row repair becomes the more cost-effective surgical option. The identification of the threshold values in this study may help surgeons to determine the most cost-effective treatment.

  11. MRI of the rotator interval of the shoulder

    International Nuclear Information System (INIS)

    Lee, J.C.; Guy, S.; Connell, D.; Saifuddin, A.; Lambert, S.

    2007-01-01

    The rotator interval of the shoulder joint is located between the distal edges of the supraspinatus and subscapularis tendons and contains the insertions of the coracohumeral and superior glenohumeral ligaments. These structures form a complex pulley system that stabilizes the long head of the biceps tendon as it enters the bicipital groove of the humeral head. The rotator interval is the site of a variety of pathological processes including biceps tendon lesions, adhesive capsulitis and anterosuperior internal impingement. This article describes the anatomy, function and pathology of the rotator interval using magnetic resonance imaging (MRI)

  12. Critical period and risk factors for retear following arthroscopic repair of the rotator cuff

    NARCIS (Netherlands)

    Barth, J.; Andrieu, K.; Fotiadis, E.; Hannink, G.J.; Barthelemy, R.; Saffarini, M.

    2017-01-01

    PURPOSE: The incidence of retear following rotator cuff repair remains a major concern, and the cause and timing of retear remain unclear. The aim of this study was to prospectively investigate the timing of retears following rotator cuff repair at multiple time intervals. The hypothesis was that

  13. Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

    Science.gov (United States)

    Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

    2013-11-01

    Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  14. Preliminary Results of a Consecutive Series of Large & Massive Rotator Cuff Tears Treated with Arthroscopic Rotator Cuff Repairs Augmented with Extracellular Matrix

    Directory of Open Access Journals (Sweden)

    Paolo Consigliere

    2017-01-01

    Full Text Available Background: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.Methods: Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.Results: Mean Constant score improved from 53 (SD=4 pre-operatively to 75 (SD=11 at final follow up. Mean Oxford score also increased from 30 (SD=8 pre-operatively to 47 (SD=10 at the final follow up. The visual analogue scale (VAS improved from seven out of 10 (SD=2 preoperatively to 0.6 (SD=0.8 at final follow up. Additionally, there was significant improvement at three months mark in Constant score. Conclusion: Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome.

  15. Retear rate in the late postoperative period after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Kim, Jae Hwa; Hong, In Tae; Ryu, Keun Jung; Bong, Sun Tae; Lee, Yoon Seok; Kim, Jang Hwan

    2014-11-01

    Few clinical studies have evaluated the integrity of repaired tendons and identified the timing of retears through the use of serial imaging. Retears after arthroscopic rotator cuff repair are uncommon in the late postoperative period (after 3 months). Case series; Level of evidence, 4. Among 221 arthroscopic rotator cuff repairs that were performed at a single hospital between May 2010 and February 2012, 61 were involved in this study. Rotator cuff tears consisted of 12 small, 31 medium, 8 large, and 6 massive rotator cuff tears. Additionally, 4 isolated subscapularis tears were included. For clinical evaluation, all patients were assessed both preoperatively and postoperatively by use of the University of California-Los Angeles Shoulder Rating Scale, absolute and relative Constant scores, and American Shoulder and Elbow Surgeons score; active range of motion was assessed as well. For radiological evaluation, all 61 patients had a magnetic resonance imaging (MRI) evaluation at 3 months postoperatively. Among them, 23 patients were evaluated for repaired tendon integrity on postoperative MRI at a minimum of 1 year after surgery (mean, 14.1 months; range, 12-19 months), and results were classified according to the Sugaya classification: type I, sufficient thickness with homogeneously low intensity on each image; type II, sufficient thickness, partial high-intensity area; type III, less than half the thickness without discontinuity; type IV, minor discontinuity; and type V, major discontinuity. The remaining 38 patients, who refused to undergo MRI again for financial reasons, were evaluated through ultrasound. Statistically significant clinical improvements were observed after surgery. The MRI conducted at 3 months postoperatively identified 9 patients with Sugaya type I, 28 patients with type II, and 24 patients with type III repairs. No patients showed Sugaya type IV or V repairs at postoperative 3 months. Thirty-seven patients who had shown Sugaya type I or II

  16. Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation.

    Science.gov (United States)

    Hohn, Eric A; Gillette, Blake P; Burns, Joseph P

    2018-05-01

    The purpose was to assess the minimum 2-year patient-reported outcomes and failure rate of patients who underwent revision arthroscopic rotator cuff repair augmented with acellular human dermal matrix (AHDM) allograft for repairable retears. From 2008-2014, patients who underwent revision rotator cuff repair augmented with AHDM with greater than 2 years' follow-up by a single surgeon were retrospectively reviewed. Data regarding surgical history, demographic characteristics, and medical comorbidities were collected. Outcome data included American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, as well as rotator cuff healing on magnetic resonance imaging or ultrasound. Retears and subsequent surgical procedures were characterized. A total of 28 patients met our inclusion criteria, and 23 (82%) were available for follow-up at 2 years. The mean age was 60.1 ± 9.3 years (range, 43-79 years), with a mean follow-up period of 48 ± 23 months. All patients had at least 1 prior rotator cuff repair. Of the 23 patients, 13 (56%) underwent postoperative imaging, and 4 of these 13 (31%) had a retear. A reoperation was performed in 3 of 23 patients (13%). Among the 6 patients with both preoperative and postoperative outcome scores, we saw improvement in the ASES score from 56 to 85 (P = .03) and in the SANE score from 42 to 76 (P = .03). The full cohort's mean postoperative ASES and SANE scores were 77 and 69, respectively. AHDM allograft augmentation is a safe and effective treatment method for patients with full-thickness rotator cuff retears. Further research is needed with larger studies to confirm these findings from our small cohort of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

    International Nuclear Information System (INIS)

    Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K.; Imhoff, A.B.

    2007-01-01

    We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

  18. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

    2007-02-15

    We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

  19. Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder.

    Science.gov (United States)

    Hashiguchi, Hiroshi; Iwashita, Satoshi; Okubo, Atsushi; Takai, Shinro

    2017-01-01

    The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder. Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34-61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. The mean follow-up duration was 30.4 (range, 13-72) months. The mean shoulder score significantly improved from 69.7 (range, 58-80) points before surgery to 97.8 (range, 89-100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3

  20. Biomechanical comparison of single-row arthroscopic rotator cuff repair technique versus transosseous repair technique.

    Science.gov (United States)

    Tocci, Stephen L; Tashjian, Robert Z; Leventhal, Evan; Spenciner, David B; Green, Andrew; Fleming, Braden C

    2008-01-01

    This study determined the effect of tear size on gap formation of single-row simple-suture arthroscopic rotator cuff repair (ARCR) vs transosseous Mason-Allen suture open RCR (ORCR) in 13 pairs of human cadaveric shoulders. A massive tear was created in 6 pairs and a large tear in 7. Repairs were cyclically tested in low-load and high-load conditions, with no significant difference in gap formation. Under low-load, gapping was greater in massive tears. Under high-load, there was a trend toward increased gap with ARCR for large tears. All repairs of massive tears failed in high-load. Gapping was greater posteriorly in massive tears for both techniques. Gap formation of a modeled RCR depends upon the tear size. ARCR of larger tears may have higher failure rates than ORCR, and the posterior aspect appears to be the site of maximum gapping. Specific attention should be directed toward maximizing initial fixation of larger rotator cuff tears, especially at the posterior aspect.

  1. Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

    Science.gov (United States)

    Cho, Nam Su; Moon, Seong Cheol; Hong, Se Jung; Bae, Seong Hae; Rhee, Yong Girl

    2017-09-01

    The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Cohort study; Level of evidence, 3. One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

  2. Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

    Science.gov (United States)

    Jensen, Andrew R.; Cha, Peter S.; Devana, Sai K.; Ishmael, Chad; Di Pauli von Treuheim, Theo; D’Oro, Anthony; Wang, Jeffrey C.; McAllister, David R.; Petrigliano, Frank A.

    2017-01-01

    Background: Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. Purpose: To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Study Design: Cohort study; Level of evidence, 3. Methods: All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. Results: In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P repairs increased (from 4.5 to 7.8 per 10,000 patients, P rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs. PMID:29051905

  3. A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair.

    Science.gov (United States)

    Smith, Christopher D; Alexander, Susan; Hill, Adam M; Huijsmans, Pol E; Bull, Anthony M J; Amis, Andrew A; De Beer, Joe F; Wallace, Andrew L

    2006-11-01

    The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading. A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed. Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 +/- 1.2 mm compared with 3.8 +/- 1.4 mm; p row repairs failed at a mean of 320 +/- 96.9 N whereas the single-row repairs failed at a mean of 224 +/- 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred. Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique. A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.

  4. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    2016-04-01

    Full Text Available OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A or greater than or equal to 3.0 cm (group B. All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743. Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416. CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation.

  5. Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2015-02-01

    Full Text Available OBJECTIVE: To analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia.METHOD: 138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16; those with osteopenia, group 2 (n = 33; and normal individuals, group 3 (n = 55.RESULTS: In analyzing the University of California at Los Angeles (UCLA scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070. Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027.CONCLUSION: The results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry.

  6. Arthroscopic suture bridge rotator cuff repair: functional outcome, repair integrity, and preoperative factors related to postoperative outcome.

    Science.gov (United States)

    Rimmke, Nathan; Maerz, Tristan; Cooper, Ross; Yadavalli, Sailaja; Anderson, Kyle

    2016-01-01

    To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair. Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography. Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41-79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs. 2.05 cm ± 0.48, P rotation ROM (P = 0.002), and internal rotation strength (P = 0.004). Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes. IV, Case Series.

  7. [Evolution of the technique of arthroscopic reinsertion of the rotator cuff. Our experience from the years 1998 to 2008].

    Science.gov (United States)

    Holibka, R; Neoral, P; Kalina, R; Radová, L; Gallo, J

    2012-01-01

    A rotator cuff tear is a relatively frequent cause of pain and restricted motion of the shoulder. Some orthopaedists believe that any attempt at rotator cuff reconstruction will fail. The aim of this paper is to present our experience with arthroscopic reconstruction of rotator cuff tears. Between January 1998 and December 2008, 319 patients with an early diagnosis of rotator cuff rupture were treated. The group included 67 women and 252 men, with an average age of 37 years (range, 24 to 71 years) at the time of surgery. The patients indicated for arthroscopic reconstruction had to show free motion of the shoulder, had a full thickness tear up to 3 cm in size in the sagittal plane and a Patte stage 2 tear in the frontal plane at the maximum. The outcome of surgery was evaluated at one year of follow-up and included the patient's self-assessment, modified UCLA score and incidence of complications. The probability of failure was calculated as an odds ratio of an implant failure to failure of the other implants and the probability of repeat surgery in a given implant was calculated as a relative risk in relation to the other implants. The average operative time was 52 minutes (range, 25 to 85); the average UCLA score increased from 10 to 31 points (pRC anchors had the odds ratio for mechanical failure equal to 0.55 (95 % CI, 0.25 to 1.24) and the relative risk of repeat surgery equal to 0.41 (95% CI, 0.12 to 1.43). In addition, 18 complications were recorded. The frequency of deep wound infection was 0.7% (2/319). Six patients (2.1%) required repeat surgery for symptomatic bursitis and adhesive capsulitis. A recent meta-analysis has found no significant difference between the results of surgical rotator cuff reconstruction and its conservative treatment. We do not support this view but present here evidence that, when certain conditions are fulfilled, arthroscopic reconstruction can produce a very good clinical outcome. The arthroscopic reconstruction of a rotator

  8. The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up

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    Ibrahim Khalid A

    2007-12-01

    Full Text Available Abstract Background To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears. Methods Fifty-two patients underwent "mini-open" or all arthroscopic repair of a full thickness tear of the rotator cuff. Patients who complained of shoulder pain and/or weakness and who had failed a minimum of 6 weeks of physical therapy and had at least one sub-acromial injection were surgical candidates. Pre and post-operative clinical evaluations included the following: 1 demographics; 2 Simple Shoulder Test (SST; 3 University of California, Los Angeles (UCLA rating scale; 4 visual analog pain assessment (VAS; and 5 pre-op SF12 assessment. Descriptive analysis was performed for patient demographics and for all variables. Pre and post outcome scores, range of motion and pain scale were compared using paired t-tests. Analysis of variance (ANOVA was used to evaluate any effect between dependent and independent variables. Significance was set at p is less than or equal to 0.05. Results There were 31 females and 21 males. The average follow-up was 50.6 months (27 – 84 months. The average age was similar between the two groups [arthroscopic x = 55 years/mini-open x = 58 years, p = 0.7]. Twenty-seven patients underwent arthroscopic repair and 25 underwent repair with a mini-open incision. The average rotator cuff tear size was 3.1 cm (range: 1–5 centimeters. There was no significant difference in tear size between the two groups (arthroscopic group = 2.9 cm/mini-open group = 3.2 cm, p = 0.3. Overall, there was a significant improvement from pre-operative status in shoulder pain, shoulder function as measured on the Simple Shoulder test and UCLA Shoulder Form. Visual analog pain improved, on average, 4.4 points and the most recent Short Shoulder Form and UCLA scores were 8 and 26 respectively. Both active and passive glenohumeral joint range of motion improved

  9. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair.

    Science.gov (United States)

    Thigpen, Charles A; Shaffer, Michael A; Gaunt, Bryce W; Leggin, Brian G; Williams, Gerald R; Wilcox, Reg B

    2016-04-01

    This is a consensus statement on rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The purpose of this statement is to aid clinical decision making during the rehabilitation of patients after arthroscopic rotator cuff repair. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. This statement describes a rehabilitation framework that includes a 2-week period of strict immobilization and a staged introduction of protected, passive range of motion during weeks 2-6 postoperatively, followed by restoration of active range of motion, and then progressive strengthening beginning at postoperative week 12. When appropriate, rehabilitation continues with a functional progression for return to athletic or demanding work activities. This document represents the first consensus rehabilitation statement developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients after arthroscopic rotator cuff repair. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Long-term Correction in Sleep Disturbance Is Sustained After Arthroscopic Rotator Cuff Repair.

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    Horneff, John G; Tjoumakaris, Fotios; Wowkanech, Charles; Pepe, Matthew; Tucker, Bradford; Austin, Luke

    2017-06-01

    Sleep disturbance is a major complaint of patients with rotator cuff disease that often leads them to seek treatment. The authors previously reported a prospective analysis of patients who underwent rotator cuff repair and found that sleep disturbance significantly improved at 3 months after surgery. That improvement in sleep was maintained at 6 months. In the current study, the authors sought to gain medium-term data on this same population at greater than 2 years. The hypotheses were that improvement in sleep disturbance after arthroscopic rotator cuff repair is maintained at 2-year follow-up and that the continued use of narcotic pain medication has a negative effect on sleep quality at 2-year follow-up. Case series; Level of evidence, 4. The original cohort of patients was contacted at a minimum of 24 months after their surgery. Thirty-seven of the 56 patients (66%) involved in the original study were available. Patient outcomes were scored using the Pittsburgh Sleep Quality Index (PSQI), Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Single Assessment Numeric Evaluation (SANE). The newly obtained scores were compared with prior scores, which ranged from preoperatively to 6 months postoperatively. The statistically significant improvement of the PSQI score demonstrated in our prior analysis at 6 months postoperatively was maintained, with a mean PSQI score of 5.5 for the 37 patients followed beyond 24 months. Of those patients, 41% still had a PSQI score >5, indicative of sleep disturbance. However, even those patients in our study with a PSQI score >5, indicative of sleep disturbance, had an improved mean score of 9.3 at greater than 24 months compared with those patients with a PSQI score >5 at 6 months, who had a mean PSQI score of 11.5 ( P = .13). Both the SST and VAS scores displayed continued improvement at greater than 24 months, with both displaying moderate strength correlation to the PSQI score (VAS: Spearman rho = 0.479, P < .001

  11. Critical Shoulder Angle and Acromial Index Do Not Influence 24-Month Functional Outcome After Arthroscopic Rotator Cuff Repair.

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    Lee, Merrill; Chen, Jerry Yongqian; Liow, Ming Han Lincoln; Chong, Hwei Chi; Chang, Paul; Lie, Denny

    2017-11-01

    Recent studies have shown a correlation between scapular geometry and the development of atraumatic rotator cuff tears. However, a paucity of literature is available on the effects of critical shoulder angle (CSA) and acromial index (AI) on functional outcomes after arthroscopic rotator cuff repair. Hypothesis/Purpose: The purpose was to investigate the influence of CSA and AI on 24-month functional outcomes after arthroscopic rotator cuff repair. The hypothesis was that a larger CSA or AI would result in poorer postoperative outcomes. Cohort study; Level of evidence, 3. The study included 147 patients who underwent arthroscopic double-row rotator cuff repair for radiologically documented full-thickness supraspinatus tears. An independent reviewer measured the CSA and AI on preoperative radiographs. These patients were prospectively enrolled and were evaluated preoperatively as well as at 3, 6, 12, and 24 months postoperatively. Functional outcome was assessed with the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and University of California at Los Angeles (UCLA) Shoulder Rating Scale. The patients were first divided based on CSA: (1) ≤35° (control CSA) and (2) >35° (increased CSA); and then based on AI: (1) ≤0.7 and (2) >0.7. The Student unpaired t test, Pearson chi-square test, and Pearson correlation were performed to examine the influence of CSA and AI on postoperative functional outcome scores. At 6 months of follow-up, the CSS, OSS, and UCLA Shoulder Rating Scale were 10 ± 1, 4 ± 2, and 3 ± 1 points poorer in the increased CSA group compared with the control CSA group ( P = .005, P = .030, and P = .035, respectively). These scores were not significantly different between both AI groups. By 24 months of follow-up, all outcome scores were comparable between both CSA groups as well as between both AI groups. No significant correlation was found between either CSA or AI when compared with CSS, OSS, or UCLA Shoulder Rating Scale at 24

  12. Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears: Preoperative Factors Associated With Outcome Deterioration Over 2 Years.

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    Shon, Min Soo; Koh, Kyoung Hwan; Lim, Tae Kang; Kim, Won Ju; Kim, Kyung Cheon; Yoo, Jae Chul

    2015-08-01

    Arthroscopic partial repair is a treatment option in irreparable large-to-massive rotator cuff tears without arthritic changes. However, there are indications that arthroscopic partial repair does not yield satisfactory outcomes. To report the clinical and radiographic results of arthroscopic partial repairs in patients with irreparable large-to-massive cuff tears. In addition, an analysis was performed regarding preoperative factors that may influence patient outcomes and patient-rated satisfaction over time. Case series; Level of evidence, 4. From 2005 to 2011, a total of 31 patients who underwent arthroscopic partial repair for irreparable large-to-massive cuff tears were retrospectively evaluated. Partial repair was defined as posterior cuff tissue repair with or without subscapularis tendon repair to restore the transverse force couple of the cuff. Pain visual analog scale (PVAS), questionnaire results (American Shoulder and Elbow Surgeons [ASES] and Simple Shoulder Test [SST]), and radiographic changes (acromiohumeral distance and degenerative change) were assessed preoperatively, at first follow-up (roughly 1 year postoperatively), and at final follow-up (>2 years postoperatively). Patients rated their satisfaction level at each postoperative follow-up as well. Preoperative factors that might influence outcomes, such as patient demographics, tear size, and fatty infiltration, were investigated. The preoperative, first follow-up, and final follow-up results for mean PVAS (5.13, 2.13, and 3.16, respectively) and questionnaires (ASES: 41.97, 76.37, and 73.78; SST: 3.61, 6.33, and 6.07, respectively) improved significantly (all P .05) from the first to the final follow-up. Among preoperative factors, fatty infiltration of the teres minor was identified as the only statistically significant factor affecting patient-rated satisfaction (P = .007). This study showed that arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year

  13. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results

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    Imam Mohamed Abdelnabi

    2016-01-01

    Full Text Available Background: The transosseous-equivalent cross bridge double row (TESBDR rotator cuff (RC repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. Methods: Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS, the University of California, Los Angeles (UCLA score, the Constant-Murley (CM Score and Range of motion (ROM. Secondary outcome measures included a Visual Analogue Scale (VAS for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D for quality of life assessment. Results: At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. Conclusion: Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up.

  14. Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review.

    Science.gov (United States)

    Merolla, Giovanni; Dave, Arpit C; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2015-03-01

    Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed.

  15. Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial.

    Science.gov (United States)

    Murphy, J; Gray, A; Cooper, C; Cooper, D; Ramsay, C; Carr, A

    2016-12-01

    A trial-based comparison of the use of resources, costs and quality of life outcomes of arthroscopic and open surgical management for rotator cuff tears in the United Kingdom NHS was performed using data from the United Kingdom Rotator Cuff Study (UKUFF) randomised controlled trial. Using data from 273 patients, healthcare-related use of resources, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. There were no significant differences between the arthroscopic and open groups in terms of total mean use and cost of resources or QALYs at any time post-operatively. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared with open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%. There was no significant overall difference in the use or cost of resources or quality of life between arthroscopic and open management in the trial. There was uncertainty about which strategy was most cost-effective. Cite this article: Bone Joint J 2016;98-B:1648-55. ©2016 Gray et al.

  16. Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears?

    Science.gov (United States)

    Charousset, Christophe; Zaoui, Amine; Bellaïche, Laurence; Piterman, Michel

    2014-04-01

    To evaluate the clinical and magnetic resonance imaging (MRI) outcome of arthroscopic rotator cuff repair with the use of leukocyte-platelet-rich plasma (L-PRP) in patients with large or massive rotator cuff tears. A comparative cohort of patients with large or massive rotator cuff tears undergoing arthroscopic repair was studied. Two consecutive groups of patients were included: rotator cuff repairs with L-PRP injection (group 1, n = 35) and rotator cuff repairs without L-PRP injection (group 2, n = 35). A double-row cross-suture cuff repair was performed by a single surgeon with the same rehabilitation protocol. Patients were clinically evaluated with the Constant score; Simple Shoulder Test score; University of California, Los Angeles (UCLA) score; and strength measurements by use of a handheld dynamometer. Rotator cuff healing was evaluated by postoperative MRI using the Sugaya classification (type 1 to type 5). We prospectively evaluated the 2 groups at a minimum 2-year follow-up. The results did not show differences in cuff healing between the 2 groups (P = .16). The size of recurrent tears (type 4 v type 5), however, was significantly smaller in group 1 (P = .008). There was no statistically significant difference in the recurrent tear rate (types 4 and 5) between the 2 groups (P = .65). There was no significant difference between group 1 and group 2 in terms of University of California, Los Angeles score (29.1 and 30.3, respectively; P = .90); Simple Shoulder Test score (9.9 and 10.2, respectively; P = .94); Constant score (77.3 and 78.1, respectively; P = .82); and strength (7.5 and 7.0, respectively; P = .51). In our study the use of autologous L-PRP did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation. The only significant advantage was that the L-PRP patients had smaller iterative tears. However, the functional outcome was similar in

  17. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device.

    Science.gov (United States)

    Proctor, Christopher S

    2014-10-01

    Rotator cuff repair is a procedure with varying outcomes, and there has been subsequent interest in devices that reinforce the repair and enhance structural and functional outcomes. The objective of this study was to determine these outcomes for arthroscopic repair of large and massive rotator cuff tears augmented with a synthetic absorbable mesh designed specifically for reinforcement of tendon repair by imaging and clinical assessments. Consecutive arthroscopic repairs were performed on 18 patients with large to massive rotator cuff tears by use of a poly-l-lactic acid synthetic patch as a reinforcement device and fixation with 4 sutures. Patients were assessed preoperatively and at 6 months, 12 months, and a mean of 42 months after surgery by the American Shoulder and Elbow Surgeons (ASES) shoulder score to evaluate clinical performance and at 12 months by ultrasound to assess structural repair. Ultrasound showed that 15 of 18 patients had intact rotator cuff repair at 12 months; at 42 months, an additional patient had a failed repair. Patients showed improvement in the ASES shoulder score from 25 preoperatively to 71 at 12 months and 70 at 42 months after surgery. Patients with intact rotator cuff (n = 14) at 42 months had an ASES shoulder score of 82. The poly-l-lactic acid bioabsorbable patch designed specifically to reinforce the surgical repair of tendons supported successful repair of large to massive rotator cuff tears in 83% of patients at 12 months after surgery and 78% of patients at 42 months after surgery, with substantial functional improvement. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. High Rate of Return to High-Intensity Interval Training After Arthroscopic Management of Femoroacetabular Impingement Syndrome.

    Science.gov (United States)

    Riff, Andrew J; Ukwuani, Gift; Clapp, Ian; Movassaghi, Kamran; Kelly, D Michael; Nho, Shane J

    2018-06-01

    Since the inception of CrossFit in 2000, the popularity of high-intensity interval training (HIIT) in the United States has risen dramatically. While HIIT is a highly efficient exercise for weight loss and improved conditioning, some literature reports injuries in up to 34% of HIIT participants. We sought to evaluate the functional and sports-specific results of hip arthroscopic surgery in recreational HIIT participants. To evaluate patients' ability to return to HIIT after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Case series; Level of evidence, 4. Consecutive patients with FAIS who had identified themselves as participating in HIIT and had undergone hip arthroscopic surgery for the treatment of FAIS by a single fellowship-trained surgeon between 2012 and 2015 were reviewed. Demographic data; preoperative physical examination findings; preoperative imaging results; preoperative patient-reported outcome (PRO) scores including the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and postoperative examination and PRO scores at a minimum 2 years after surgery, including a HIIT-specific questionnaire, were assessed for all patients. Thirty-two patients (13 male, 19 female) with a mean age of 34.7 ± 6.9 years (range, 21-49 years) were identified with a minimum 24-month follow-up. Among these, 22 participated in CrossFit, 4 in Shred415, 3 in Orangetheory, and 3 in self-directed cross-training including plyometrics. Preoperatively, 14 patients had discontinued HIIT because of activity-related hip complaints, 17 patients had scaled back involvement in HIIT, and 1 patient maintained her baseline routine. Postoperatively, 28 of 32 patients (88%) returned to HIIT at a mean of 9.8 ± 5.7 months after surgery (range, 3-24 months); 96% returned to HIIT at the same level as or better than before the injury. Fear

  19. Arthroscopic repair of large U-shaped rotator cuff tears without margin convergence versus repair of crescent- or L-shaped tears.

    Science.gov (United States)

    Park, Jin-Young; Jung, Seok Won; Jeon, Seung-Hyub; Cho, Hyoung-Weon; Choi, Jin-Ho; Oh, Kyung-Soo

    2014-01-01

    For large-sized tears of the rotator cuff, data according to the tear shape have not yet been reported for repair methodology, configuration, and subsequent integrity. The retear rate after the repair of large mobile tears, such as crescent- or L-shaped tears, is believed to be lower compared with retear rates after the repair of large U-shaped tears that are accompanied by anterior or posterior leaves of the rotator cuff. Cohort study; Level of evidence, 3. Data were collected and analyzed from 95 consecutive patients with a large-sized rotator cuff tear who underwent arthroscopic suture-bridge repair. Patients were divided into 2 groups: those having crescent- or L-shaped tears (mobile tear group, 53 patients) and those having U-shaped tears (U-shaped tear group, 42 patients). The integrity of the repaired constructs was determined by ultrasonography at 4.5, 12, and 24 months. Moreover, clinical evaluations were performed by using the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and muscle strength at intervals of 3, 6, 12, and 24 months postoperatively. On ultrasonography at 4.5, 12, and 24 months, a retear was detected in 6, 2, and 1 patients in the mobile tear group and in 5, 2, and 1 patients in the U-shaped tear group, respectively. Significant differences in retear rates were not detected between the groups overall or at each time point. Moreover, clinical scores were similar between groups, except for the presence of a temporarily higher Constant score at 12 months in the mobile tear group. With regard to shoulder strength, between-group comparisons indicated no statistically significant difference, either in abduction or external rotation, except for the presence of temporarily higher external rotation strength at 3 months in the mobile tear group. Arthroscopic repair of large-sized rotator cuff tears yielded substantial improvements in shoulder function, regardless of tear retraction, during midterm follow-up. Moreover, the

  20. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

    Science.gov (United States)

    Cai, You-zhi; Zhang, Chi; Lin, Xiang-jin

    2015-12-01

    The use of platelet-rich plasma (PRP) is an innovative clinical therapy, especially in arthroscopic rotator cuff repair. The purpose of this study was to compare the clinical improvement and tendon-to-bone healing with and without PRP therapy in arthroscopic rotator cuff repair. A systematic search was done in the major medical databases to evaluate the studies using PRP therapy (PRP+) or with no PRP (PRP-) for the treatment of patients with rotator cuff tears. We reviewed clinical scores such as the Constant score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles (UCLA) Shoulder Rating Scale, the Simple Shoulder Test, and the failure-to-heal rate by magnetic resonance imaging between PRP+ and PRP- groups. Five studies included in this review were used for a meta-analysis based on data availability. There were no statistically significant differences between PRP+ and PRP- groups for overall outcome scores (P > .05). However, the PRP+ group exhibited better healing rates postoperatively than the PRP- group (P = .03) in small/moderate full-thickness tears. The use of PRP therapy in full-thickness rotator cuff repairs showed no statistically significant difference compared with no PRP therapy in clinical outcome scores, but the failure-to-heal rate was significantly decreased when PRP was used for treatment of small-to-moderately sized tears. PRP therapy may improve tendon-to-bone healing in patients with small or moderate rotator cuff tears. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Perioperative Serum Lipid Status and Statin Use Affect the Revision Surgery Rate After Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Werner, Brian C

    2017-11-01

    Recent animal studies have demonstrated that hyperlipidemia is associated with poor tendon-bone healing after rotator cuff repair; however, these findings have not been substantiated in human studies. To examine any association between hyperlipidemia and the failure of arthroscopic rotator cuff repair requiring revision surgery and to investigate whether the use of statin lipid-lowering agents had any influence on observed associations. Cohort study; Level of evidence, 3. From a national insurance database, patients who underwent arthroscopic rotator cuff repair with perioperative lipid levels (total cholesterol, low-density lipoprotein [LDL], and triglycerides) recorded were reviewed. For each lipid test, patients were stratified into normal, moderate, and high groups based on published standards. For the total cholesterol and LDL cohorts, a subgroup analysis of patients stratified by statin use was performed. The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair or debridement. A logistic regression analysis controlling for patient demographics and comorbidities was utilized for comparison. There were 30,638 patients included in the study. The rate of revision rotator cuff surgery was significantly increased in patients with moderate (odds ratio [OR], 1.20; 95% CI, 1.03-1.40; P = .022) and high total cholesterol levels (OR, 1.36; 95% CI, 1.10-1.55; P = .006) compared with patients with normal total cholesterol levels perioperatively. Within each of these groups, patients without statin use had significantly higher rates of revision surgery, while those with statin prescriptions did not. The absolute risk reduction for statin use ranged from 0.24% to 1.87% when stratified by the total cholesterol level, yielding a number needed to treat from 54 to 408 patients. The rate of revision surgery was significantly increased in patients with moderate (OR, 1.24; 95% CI, 1.10-1.41; P = .001) and high LDL levels (OR, 1.46; 95

  2. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol.

    Science.gov (United States)

    Cuff, Derek J; Pupello, Derek R

    2012-11-01

    This study evaluated patient outcomes and rotator cuff healing after arthroscopic rotator cuff repair using a postoperative physical therapy protocol with early passive motion compared with a delayed protocol that limited early passive motion. The study enrolled 68 patients (average age, 63.2 years) who met inclusion criteria. All patients had a full-thickness crescent-shaped tear of the supraspinatus that was repaired using a transosseous equivalent suture-bridge technique along with subacromial decompression. In the early group, 33 patients were randomized to passive elevation and rotation that began at postoperative day 2. In the delayed group, 35 patients began the same protocol at 6 weeks. Patients were monitored clinically for a minimum of 12 months, and rotator cuff healing was assessed using ultrasound imaging. Both groups had similar improvements in preoperative to postoperative American Shoulder and Elbow Surgeons scores (early group: 43.9 to 91.9, P rotator cuff healing, or range of motion between the early and delayed groups. Patients in the early group and delayed group both demonstrated very similar outcomes and range of motion at 1 year. There was a slightly higher rotator cuff healing rate in the delayed passive range of motion group compared with the early passive range of motion group (91% vs 85%). Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  3. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity.

    Science.gov (United States)

    Heuberer, Philipp R; Smolen, Daniel; Pauzenberger, Leo; Plachel, Fabian; Salem, Sylvia; Laky, Brenda; Kriegleder, Bernhard; Anderl, Werner

    2017-05-01

    The number of arthroscopic rotator cuff surgeries is consistently increasing. Although generally considered successful, the reported number of retears after rotator cuff repair is substantial. Short-term clinical outcomes are reported to be rarely impaired by tendon retears, whereas to our knowledge, there is no study documenting long-term clinical outcomes and tendon integrity after arthroscopic rotator cuff repair. To investigate longitudinal long-term repair integrity and clinical outcomes after arthroscopic rotator cuff reconstruction. Case series; Level of evidence, 4. Thirty patients who underwent arthroscopic rotator cuff repair with suture anchors for a full-tendon full-thickness tear of the supraspinatus or a partial-tendon full-thickness tear of the infraspinatus were included. Two and 10 years after initial arthroscopic surgery, tendon integrity was analyzed using magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) score and Constant score as well as subjective questions regarding satisfaction with the procedure and return to normal activity were used to evaluate short- and long-term outcomes. At the early MRI follow-up, 42% of patients showed a full-thickness rerupture, while 25% had a partial rerupture, and 33% of tendons remained intact. The 10-year MRI follow-up (129 ± 11 months) showed 50% with a total rerupture, while the other half of the tendons were partially reruptured (25%) or intact (25%). The UCLA and Constant scores significantly improved from preoperatively (UCLA total: 50.6% ± 20.2%; Constant total: 44.7 ± 10.5 points) to 2 years (UCLA total: 91.4% ± 16.0% [ P rotator cuff repair showed good clinical long-term results despite a high rate of retears. Nonetheless, intact tendons provided significantly superior clinical long-term outcomes, making the improvement of tendon healing and repair integrity important goals of future research efforts.

  4. Arthroscopic evaluation of patellofemoral congruence with rotation of the knee joint and electrical stimulation of the quadriceps.

    Science.gov (United States)

    Suganuma, Jun; Mochizuki, Ryuta; Inoue, Yutaka; Kitamura, Kazuya; Honda, Akio

    2014-02-01

    The aim of this study was to investigate the pathoanatomic features of patellar instability by arthroscopically comparing patellofemoral congruence with rotation of the knee joint and/or electrical stimulation of the quadriceps (ESQ) between knees with and without patellar instability. We retrospectively examined 83 knee joints in 83 patients. The joints were classified into 2 groups: group 1 comprised those without a history of patellar dislocation and included 59 patients (25 male and 34 female patients), and group 2 comprised those with a history of patellar dislocation and included 24 patients (9 male and 15 female patients). Evaluation of patellofemoral congruence at 30° of flexion of the knee joint was conducted based on an axial radiograph and arthroscopic findings. The congruence angle was measured on the radiograph. The position of the patellar central ridge (PPCR) on the trochlear groove during arthroscopy was measured using still video frames of knee joints with rotational stress and/or ESQ. Statistical differences in the measurements between the 2 groups were assessed with the unpaired t test and the area under the receiver operating characteristic curve of each measurement. There were significant differences (P congruence angle on radiographs and PPCR in knee joints with rotational stress and/or ESQ on arthroscopy. External and internal rotation of the knee joint caused lateral and medial patellar shift, respectively, in both groups, but the shift was significantly larger in group 2. ESQ in addition to rotation caused further patellar shift in group 2 but reduced patellar shift in group 1. Measurement of PPCR with external rotation of the knee and ESQ was the only method to show an area under the receiver operating characteristic curve of 1. There were significant differences in the effects of rotation of the knee joint and/or ESQ on patellofemoral congruence at 30° of flexion of the knee joint on arthroscopy between knees with and without patellar

  5. Does Additional Biceps Augmentation Improve Rotator Cuff Healing and Clinical Outcomes in Anterior L-Shaped Rotator Cuff Tears? Clinical Comparisons With Arthroscopic Partial Repair.

    Science.gov (United States)

    Jeon, Yoon Sang; Lee, Juyeob; Kim, Rag Gyu; Ko, Young-Won; Shin, Sang-Jin

    2017-11-01

    The repair of anterior L-shaped tears is usually difficult because of the lack of anterior rotator cuff tendon to cover the footprint. The biceps tendon is usually exposed from the retracted anterolateral corner of the torn tendon and can be easily used to augment rotator cuff repair. Hypothesis/Purpose: This study compared the clinical outcomes of the biceps augmentation technique with those of partial tendon repair for the arthroscopic treatment of large anterior L-shaped rotator cuff tears to evaluate the role of additional biceps augmentation in tendon healing. We hypothesized that the biceps augmentation technique would lead to a lower rotator cuff tendon retear rate and provide satisfactory functional outcomes. Cohort study; Level of evidence, 3. This study included 64 patients with anterior L-shaped rotator cuff tears who underwent arthroscopic repair. Patients were divided into 2 groups: group A (31 patients) underwent repair of an anterior L-shaped tear combined with biceps augmentation, and group B (33 patients) had a partially repaired tendon whose footprint was exposed after repair without undue tension on the retracted tendon. Clinical evaluations were performed using the American Shoulder and Elbow Surgeons (ASES) score, Constant score, muscle strength, visual analog scale for pain, and patient satisfaction. Magnetic resonance imaging (MRI) was performed for tendon integrity at 6 months postoperatively. The mean period of follow-up was 29.1 ± 3.5 months (range, 24-40 months). The mean ASES and Constant scores significantly improved from 52.8 ± 10.6 and 43.2 ± 9.9 preoperatively to 88.2 ± 6.9 and 86.8 ± 6.2 at final follow-up in group A ( P rotation [ER]: 57.5 ± 9.9 to 86.8 ± 9.3; internal rotation [IR]: 68.1 ± 10.8 to 88.1 ± 8.4; P rotator cuff tendon on postoperative MRI. The retear rate between the 2 groups showed no significant difference ( P = .552). Regarding clinical outcomes, both groups had no significant difference in the ASES score

  6. Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

    Directory of Open Access Journals (Sweden)

    Ignacio Carbonel

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI, and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001. Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001. MRI studies showed 24 cases of tear after repair (29%. Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

  7. Evaluation of the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2015-06-01

    Full Text Available OBJECTIVES: To evaluate the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over.METHODS: Between 1998 and 2009, 168 patients underwent operations. Five cases were excluded. The remaining 163 patients were stratified according to their age group: 65-69 years (49.1%, 70-74 (26.4% and 75 years and over (24.5%. Their mean age was 71 years (range: 65-83. There were 63 male patients (38.7%. The mean length of time with pain, from the onset of symptoms to the surgery, was 23 months (range: 2 days to 240 months. Sixty-two patients (38% reported histories of trauma and 26 (16% reported that their pain worsened through exertion.RESULTS: From the UCLA criteria, 80.4% of the results were excellent, 16% good, 1.8% fair and 1.8% poor. Complications occurred in 11%. The final clinical result did not show any correlation with age progression, injury size or tendons affected. However, there was a significant association (p < 0.001 between the presence of trauma and larger injuries. The length of time between the onset of symptoms and the surgical procedure had a significant relationship (p < 0.027 with the postoperative results: the longer this time was, the worse the results were.CONCLUSION: Arthroscopic treatment of rotator cuff injuries in patients aged 65 years and over presented excellent and good results in 96.4% of the cases, according to the UCLA assessment, with a low complication rate. Advanced age did not show any influence on the postoperative clinical evolution, but the earlier the surgical treatment was instituted, the better the results were.

  8. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

    Science.gov (United States)

    Shin, Sang-Jin; Jeong, Jae-Hoon; Jeon, Yoon Sang; Kim, Rag Gyu

    2016-12-01

    The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50 % of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50 % of the tendon's thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6 months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0 ± 10.3 to postoperative 92.6 ± 8.0), Constant score (61.2 ± 8.5-88.0 ± 5.3), VAS for pain (4.9 ± 2.6-0.6 ± 0.7) improved significantly after arthroscopic transtendon anatomic repair (p rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

  9. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

    Science.gov (United States)

    Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

    2017-07-01

    The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

  10. Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears.

    Science.gov (United States)

    Aydin, Nuri; Kocaoglu, Baris; Guven, Osman

    2010-07-01

    Double-row rotator cuff repair leads to superior cuff integrity and clinical results compared with single-row repair. The study enrolled 68 patients with a full-thickness rotator cuff tear who were divided into 2 groups of 34 patients according to repair technique. The patients were followed-up for at least 2 years. The results were evaluated by Constant score. Despite the biomechanical studies and cadaver studies that proved the superiority of double-row fixation over single-row fixation, our clinical results show no difference in functional outcome between the two methods. It is evident that double-row repair is more technically demanding, expensive, and time-consuming than single-row repair, without providing a significant improvement in clinical results. Comparison between groups did not show significant differences. At the final follow-up, the Constant score was 82.2 in the single-row group and 78.8 in the double-row group. Functional outcome was improved in both groups after surgery, but the difference between the 2 groups was not significant. At long-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair in small to medium tears. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  11. Arthroscopic Removal and Rotator Cuff Repair Without Acromioplasty for the Treatment of Symptomatic Calcifying Tendinitis of the Supraspinatus Tendon.

    Science.gov (United States)

    Ranalletta, Maximiliano; Rossi, Luciano Andrés; Bongiovanni, Santiago Luis; Tanoira, Ignacio; Piuzzi, Nicolas; Maignon, Gastón

    2015-04-01

    Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. Although most patients respond well to conservative treatment, some eventually require surgical treatment. To evaluate the clinical outcome with arthroscopic removal of calcific deposit and rotator cuff repair without acromioplasty for the treatment of calcific tendinitis of the supraspinatus tendon. Case series; Level of evidence, 4. This study retrospectively evaluated 30 consecutive patients with a mean age of 49.2 years. The mean follow-up was 35 months (range, 24-88 months). Pre- and postoperative functional assessment was performed using the Constant score, University of California Los Angeles (UCLA) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH). Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. Significant improvement was obtained for pain (mean VAS, 8.7 before surgery to 0.8 after; P rotator cuff repair without acromioplasty can lead to good results in patients with symptomatic calcifying tendonitis of the supraspinatus tendon.

  12. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation

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    Kang, Yusuhn; Lee, Joon Woo; Ahn, Joong Mo; Lee, Eugene; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of)

    2017-10-15

    To evaluate the diagnostic value of MR arthrography (MRA) in diagnosing instability of the LHBT in patients with rotator cuff tendon tear. The MR arthrograms of 101 patients were retrospectively reviewed and correlated with arthroscopic findings as the standard reference. Images were evaluated for (1) the integrity of the LHBT, (2) the position of the LHBT (subluxation/dislocation on axial images, inferior displacement on oblique sagittal image) and (3) the integrity of the biceps pulley (SGHL, supraspinatus and subscapularis tendon adjacent to the rotator interval). The integrity of the LHBT was correctly classified in 74.3% (75/101) and 66.3% (67/101) by readers 1 and 2, respectively. The diagnosis of LHBT instability could be made on axial images with a sensitivity of 82.6% and 73.9% and specificity of 69.9% and 87.7%, whereas the displacement sign on sagittal images had a sensitivity of 73.9% and 78.3% and a specificity of 64.4% and 61.6%, respectively. Assessing the integrity of the SGHL had a sensitivity of 60.9 and 93.3% and a specificity of 70.4 and 75.0%, respectively. By combining the different image findings, the accuracy in assessing LHBT instability was 80.9 and 90.5% with a sensitivity of 60.9 and 86.7% and specificity of 83.1 and 91.8%, respectively. Individual image findings may have a limited role in diagnosing LHBT instability in patients with rotator cuff tendon tear. The accuracy of MRA may be improved by assessing the integrity of the biceps pulley structures along with the position of the LHBT on both axial and sagittal images. (orig.)

  13. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

    Science.gov (United States)

    2013-01-01

    Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no

  14. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial.

    Science.gov (United States)

    Jo, Chris Hyunchul; Shin, Ji Sun; Shin, Won Hyoung; Lee, Seung Yeon; Yoon, Kang Sup; Shin, Sue

    2015-09-01

    Two main questions about the use of platelet-rich plasma (PRP) for regeneration purposes are its effect on the speed of healing and the quality of healing. Despite recent numerous studies, evidence is still lacking in this area, especially in a representative patient population with medium to large rotator cuff tears. To assess the efficacy of PRP augmentation on the speed and quality of healing in patients undergoing arthroscopic repair for medium to large rotator cuff tears. Randomized controlled trial; Level of evidence, 1. A total of 74 patients scheduled for arthroscopic repair of medium to large rotator cuff tears were randomly assigned to undergo either PRP-augmented repair (PRP group) or conventional repair (conventional group). In the PRP group, 3 PRP gels (3 × 3 mL) were applied to each patient between the torn end and the greater tuberosity. The primary outcome was the Constant score at 3 months after surgery. Secondary outcome measures included the visual analog scale (VAS) for pain, range of motion (ROM), muscle strength, overall satisfaction and function, functional scores, retear rate, and change in the cross-sectional area (CSA) of the supraspinatus muscle. There was no difference between the 2 groups in the Constant score at 3 months (P > .05). The 2 groups had similar results on the VAS for pain, ROM, muscle strength, overall satisfaction and function, and other functional scores (all P > .05) except for the VAS for worst pain (P = .043). The retear rate of the PRP group (3.0%) was significantly lower than that of the conventional group (20.0%) (P = .032). The change in 1-year postoperative and immediately postoperative CSAs was significantly different between the 2 groups: -36.76 ± 45.31 mm(2) in the PRP group versus -67.47 ± 47.26 mm(2) in the conventional group (P = .014). Compared with repairs without PRP augmentation, the current PRP preparation and application methods for medium to large rotator cuff repairs significantly improved the

  15. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

    Directory of Open Access Journals (Sweden)

    Tudisco Cosimo

    2013-01-01

    Full Text Available Abstract Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA, showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS, the Simple Shoulder Test (SST scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant

  16. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results.

    Science.gov (United States)

    Tudisco, Cosimo; Bisicchia, Salvatore; Savarese, Eugenio; Fiori, Roberto; Bartolucci, Dario A; Masala, Salvatore; Simonetti, Giovanni

    2013-01-27

    Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that

  17. HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

    OpenAIRE

    Vishnumurthy H. Y; Jagdeesh K. S; Anand K; Ranoji Mane; Sanath G. Kamte; Fathima Zohra; Banerji B. H; Sathish Servegar

    2016-01-01

    INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS...

  18. Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears.

    Science.gov (United States)

    Choi, Sungwook; Kim, Myung Ku; Kim, Gyeong Min; Roh, Young-Ho; Hwang, Im Kyung; Kang, Hyunseong

    2014-11-01

    This study was conducted to evaluate clinical outcomes, maintenance of repair integrity, and retear rate after arthroscopic rotator cuff repair by a suture bridge technique among patients with medium, large, and massive rotator cuff tears. We evaluated 147 patients who had undergone arthroscopic rotator cuff repair. Clinical and functional evaluations were performed with the Constant and University of California-Los Angeles scores. All patients were confirmed to have magnetic resonance imaging evidence of tendon healing at least 12 months postoperatively. The average postoperative time to follow-up magnetic resonance imaging was 23.4 months (range, 12-48 months). A total of 25 (17.0%) retears were observed. All clinical outcome scores were improved significantly at follow-up. Larger intraoperative tear sizes were correlated with higher retear rates. The incidence of retear was also higher in cases in which the preoperative fatty degeneration grade was higher. The incidence of retear increased with age and in the heavy worker group (e.g., farmers, carriers, car mechanics) but was not statistically significant. Arthroscopic rotator cuff repair by a suture bridge technique yields improvements in clinical outcome measures and a relatively high degree of patient satisfaction despite the fact that repair integrity is not maintained in many cases. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Arthroscopic-Assisted Repair in Full-Thickness Rotator Cuff Ruptures: Functional and Radiologic Results of Five-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Meriç Uğurlar

    2016-06-01

    Full Text Available Objective: In our study, we evaluated the post-operative 5-year clinical and radiological results and the ratio of re­current ruptures under magnetic resonance imaging of the patients diagnosed as wide and massive, full-thick­ness rotator cuff rupture and arthroscopic-assisted mini-open rotator cuff repair is applied. Methods: We evaluated the pre-operative and post-op­erative clinical and radiological results of 38 patients with wide and massive, full-thickness rotator cuff rupture and arthroscopic-assisted rotator cuff repair is applied after failure of conservative treatment. Results: Mean post-operative follow-up period was 60.4 months. According to UCLA scoring there were excellent results in 26 patients, good results in 10, and moderate results in 2 patients. According to Constant scoring there were excellent results in 24 patients, good results in 12, and moderate results in 2 patients. 34 of the 38 patients indicated that they were satisfied with the results. The continuity of the rotator cuffs are evaluated with magnetic resonance imaging at the last visits of the patients and there was recurrent ruptures at the 8 patients. Conclusion: Although recurrent rotator cuff rupture rates varies depending on the age of the patients, moderate clinical results are obtained in elder patients. Neverthe­less, despite the rupture rates in the treatment of wide and massive, full-thickness ruptures, satisfactory clinical results can be obtained with arthroscopic-assisted mini-open rotator cuff repair.

  20. The intraoperative use of ultrasound facilitates significantly the arthroscopic debridement of calcific rotator cuff tendinitis.

    Science.gov (United States)

    Sabeti, M; Schmidt, M; Ziai, P; Graf, A; Nemecek, E; Schueller-Weidekamm, C

    2014-05-01

    During arthroscopy, the localization of calcific deposit in patients suffering from calcifying tendinitis can be demanding and time consuming, frequently using ionizing radiation. Intraoperative ultrasound has been recently promoted, facilitating deposit localization and reducing radiation dose. In this prospective, randomized, controlled and clinical observer-blinded pilot trial, 20 patients with calcific tendinitis were operated. In group I, the deposit was localized conventionally. In group II, the deposit was localized using intraoperative ultrasound. The needle punctures to detect the deposit and operation times were noted. Patients were postoperatively evaluated after 2 and 6 weeks and 9 months. In group II, the needle punctures to detect the deposit were significantly lower than in group I (p < 0.0001). Operation time to localize the deposit was also significantly less in group II (p < 0.033). In both groups, patients improved significantly with increased shoulder function (p < 0.0001) and decreased pain (p < 0.0001) 2 weeks and 9 months (p < 0.001) after surgery. The difference between the groups was not significant. Excellent radiological findings were obtained in both groups after 9 months. Intraoperative US significantly facilitates the detection of calcific deposits during arthroscopic debridement by speeding up surgery and reducing the number of needle punctures. Hence, we have changed our method of detecting calcific deposits intraoperatively from fluoroscopy to ultrasound.

  1. Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

    OpenAIRE

    Mook, William R.; Greenspoon, Joshua A.; Millett, Peter J.

    2016-01-01

    Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construc...

  2. Large Critical Shoulder Angle Has Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Li, Hong; Chen, Yuzhou; Chen, Jiwu; Hua, Yinghui; Chen, Shiyi

    2018-05-01

    The critical shoulder angle (CSA) is the angle created between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion. A few studies recently investigated the relation between CSA and functional outcomes after rotator cuff repair. However, there is a lack of research investigating the effect of CSA on postoperative tendon integrity after rotator cuff repair. To assess the effects of the CSA on postoperative tendon integrity after rotator cuff repair. Cohort study; Level of evidence, 3. All patients who underwent rotator cuff repair for full-thickness supraspinatus tears by 1 senior surgeon between January 2010 and January 2014 were included in this study. All patients had standardized anteroposterior shoulder radiographs the day before surgery. CSA and acromial index (AI) were measured. AI was derived by measuring the distance from the glenoid plane to the lateral border of the acromion and dividing it by the distance from the glenoid plane to the lateral aspect of the humeral head. Functional scores-including American Shoulder and Elbow Surgeons shoulder evaluation form, modified University of California at Los Angeles score, Constant-Murley score, and visual analog scale for pain-were used to evaluate shoulder function at a minimum follow-up of 2 years. Meanwhile, magnetic resonance imaging examinations were performed to evaluate rotator cuff integrity according to the Sugaya method and the signal/noise quotient (SNQ) of the rotator cuff tendon. A total of 90 patients were included in this study: 42 patients with a single-row repair and 48 with a double-row repair. There was a significant positive correlation between CSA or AI and tendon SNQ. On the basis of CSA, the patients were divided into 2 groups: large CSA (>38°) and control (CSA ≤38°). At final follow-up, the large CSA group and the control CSA group demonstrated no significant differences in American Shoulder and Elbow Surgeons, University of California at

  3. Effect of preemptive intra-articular morphine and ketamine on pain after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled study.

    Science.gov (United States)

    Khashan, M; Dolkart, O; Amar, E; Chechik, O; Sharfman, Z; Mozes, G; Maman, E; Weinbroum, A A

    2016-02-01

    Rotator cuff tear is a leading etiology of shoulder pain and disability. Surgical treatment is indicated in patients with persistent pain who fail a trial of non-surgical treatment. Pain reduction following rotator cuff repair, particularly within the first 24-48 h, is a major concern to both doctors and patients. This study aimed to compare the postoperative antinociceptive additive effects of pre-incisional intra-articular (IA) ketamine when combined with morphine with two times the dose of morphine or saline. In this prospective, randomized, double blind, controlled trial patients undergoing arthroscopic rotator cuff tear repair (ARCR) under general anesthesia were enrolled. Patients were randomly assigned to one of the three intervention groups. Twenty minutes prior to incision, morphine (20 mg/10 ml), ketamine (50 mg + morphine 10 mg/10 ml), or saline (0.9 % 10 ml) (n = 15/group), were administered to all patients. First 24 h postoperative analgesia consisted of intravenous patient controlled analgesia (IV-PCA) morphine and oral rescue paracetamol 1000 mg or oxycodone 5 mg. 24-h, 2-week and 3-month patient rated pain numeric rating scale (NRS) and analgesics consumption were documented. Patients' demographic and perioperative data were similar among all groups. The 24-h and the 2-week NRSs were significantly (p pain in the first 2 weeks after arthroscopic rotator cuff repair. Further research is warranted to elucidate the optimal timing and dosing of IA ketamine and morphine for postoperative analgesic effects.

  4. Resultados do tratamento artroscópico das rupturas do manguito rotador Outcomes of arthroscopic treatment for rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Ramos

    2010-01-01

    Full Text Available OBJETIVO: Analisar os resultados do reparo artroscópico das rupturas do manguito rotador. MÉTODOS: Realizado estudo retrospectivo com avaliação dos resultados da técnica em 42 pacientes operados entre 2002 e 2006. O seguimento médio foi de 31 meses e a média de idade foi de 57 anos, sendo o lado dominante operado em 73,8% dos casos. Para avaliação foram usadas escalas de UCLA e Escala Visual Analógica da dor no pós-operatório. RESULTADOS: Os resultados foram satisfatórios em 85,7% (59,5% excelentes e 26,2% bons respectivamente e insatisfatórios em 14,3% dos pacientes. Nos casos com lesões associadas, a mais frequente foi no tendão da porção longa do bíceps (57,1%. Associação com outras lesões não comprometeu o resultado. O mesmo aconteceu com relação a idade e tempo de acompanhamento pós-cirurgia. Quanto ao tamanho da lesão, diferença significativa ocorreu nos casos de lesões grandes e maciças demonstrando resultados inferiores em relação às pequenas e médias. A função foi inferior principalmente nos casos de lesão maciça. CONCLUSÃO: A reparação artroscópica das lesões do manguito rotador (MR proporciona baixa morbidade cirúrgica e possibilita diagnóstico de lesões articulares associadas. O benefício do procedimento foi confirmado principalmente pela melhora significativa da dor, mesmo nos casos de lesões maiores.OBJECTIVE: To evaluate the results of arthroscopic treatment for rotator cuff tears. METHODS: A retrospective study was carried out demonstrating the results of this technique in 42 patients operated between 2002 and 2006. The mean follow-up was 31 months and average age was 57 years. The dominant limb was operated in 73.8% of cases. Function and pain were evaluated using criteria of UCLA Score System and Visual Analogic Scale respectively. RESULTS: The results were satisfactory in 85.7% (59.5% excellent and 26.2% good, with 14.3% unsatisfactory. The most frequent associated lesion was the

  5. Patient Preference Before and After Arthroscopic Rotator Cuff Repair: Which Is More Important, Pain Relief or Strength Return?

    Science.gov (United States)

    Virk, Mandeep S; Levy, David M; Kuhns, Benjamin D; Krecher, James S; Parsley, Billy K; Burkhart, Stephen S; Romeo, Anthony A; Verma, Nikhil N; Cole, Brian J

    Our understanding of patients' desired outcomes and expectations of arthroscopic rotator cuff repair (ARCR) is limited, particularly regarding the importance of pain relief and strength return relative to each other. We conducted a study of patient's ratings of the importance of pain relief and strength return after ARCR. Before undergoing surgery, 60 patients completed a shoulder questionnaire on which they assessed severity of symptoms and rated, on a 10-point scale, the importance of postoperative improvements in pain relief and strength return. After surgery, they completed the same questionnaire, again rating the importance of pain relief and strength return. About 50% of the patients valued pain relief and strength return equally before and after ARCR. However, overall patient ratings were higher for strength return over pain relief, both before surgery, mean (SD), 9.2 (2.1) vs 8.6 (2.3) (P = .02), and afterward, at a follow-up of 5.2 (0.2) years, 8.9 (1.9) vs 8.2 (3.1) (P = .03). This significant preference for strength return held irrespective of sex, age, active sports involvement, preoperative self-assessed pain score, and subjective shoulder weakness. Before surgery, increasing age was associated with a stronger preference for pain relief (r = 0.33, P = .01), and retirees preferred pain relief over strength return. These results show the patterns of patient preference for pain relief and strength return after ARCR. Improved understanding of these patients' expectations will allow meaningful changes in patient satisfaction.

  6. Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears.

    Science.gov (United States)

    Ide, Junji; Karasugi, Tatsuki; Okamoto, Nobukazu; Taniwaki, Takuya; Oka, Kiyoshi; Mizuta, Hiroshi

    2015-10-01

    We compared the outcomes of knotless double-row suture bridge and single-row repairs in patients undergoing arthroscopic repair for anterosuperior rotator cuff tears. We included 61 full-thickness anterosuperior rotator cuff tears treated by arthroscopic repair, namely, single-row repair (group 1: 25 shoulders; mean patient age, 64 years) and the knotless double-row suture bridge repair (group 2: 36 shoulders; mean patient age, 62 years). Preoperative and postoperative magnetic resonance imaging was performed for all shoulders. Clinical outcomes were evaluated for mean follow-up periods of 81 months (range, 72-96 months) in group 1 and 34 months (range, 24-42 months) in group 2, using the University of California, Los Angeles and Japanese Orthopaedic Association assessments. At the final follow-up, both groups showed improvement in the average University of California, Los Angeles and Japanese Orthopaedic Association scores and range of motion, although no intergroup differences were observed. Both groups showed improved abduction strength, and the average score was higher in group 2 (P = .0112). The lift-off and belly-press test results were improved in both groups. Postoperatively, the incidence of positive lift-off tests tended to be lower (P = .075) and that of positive belly-press tests was lower in group 2, P = .049). The repair failure rate tended to be lower in group 2 (14% [5 of 36]) than in group 1 (32% [8 of 25]; P = .0839). Arthroscopic knotless double-row suture bridge repair of anterosuperior rotator cuff tears yielded functional outcomes equivalent to those of single-row repair and may be useful for improving subscapularis function, abduction strength, and tendon healing. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Return to driving after arthroscopic rotator cuff repair: patient-reported safety and maneuverability.

    Science.gov (United States)

    Gholson, J Joseph; Lin, Albert; McGlaston, Timothy; DeAngelis, Joseph; Ramappa, Arun

    2015-01-01

    This survey investigated patients' return to driving after rotator cuff surgery, to determine whether pain, weakness, sling use, and narcotics correlate with self-assessed safety and maneuvering. Fifty-four patients (80.6% of those eligible) were surveyed 4 months after surgery. Return to driving ranged widely from same day to 4 months, with two not driving at 4 months; 12% reported narcotics use and 33% reported sling use. Drivers reporting weakness were more likely to feel unsafe (p = .02) and more likely to report difficulty maneuvering (p driving does not correspond to perceived safety; pain and weakness correspond with feeling unsafe and difficulty maneuvering. Although subjective, clinicians may find these self-assessments predictive when counseling patients on return to driving.

  8. Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial.

    Science.gov (United States)

    Lee, Jae Jun; Hwang, Jung-Taek; Kim, Do-Young; Lee, Sang-Soo; Hwang, Sung Mi; Lee, Na Rea; Kwak, Byung-Chan

    2017-07-01

    The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7  6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p  4.0, p = 0.001). Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.

  9. Factors impacting arthroscopic rotator cuff repair operational throughput time at an ambulatory care center

    Directory of Open Access Journals (Sweden)

    Emily J. Curry

    2018-03-01

    Full Text Available Identifying patient factors influencing operational throughput time is becoming more imperative due to an increasing focus on value and cost savings in healthcare. The primary objective of this study was to determine patient factors influencing throughput time for primary rotator cuff repairs. Demographic information, medical history and operative reports of 318 patients from one ambulatory care center were retrospectively reviewed. Operating room set up, incision to closure and recovery room time were collected from anesthesia records. Univariate analysis was performed for both continuous and categorical variables. A stepwise, multivariable regression analysis was performed to determine factors associated with operating room time (incision to closure and recovery room time. Of the 318 patients, the mean age was 54.4±10.0 and 197 (61% were male. Male patients had a significantly longer OR time than females (115.5 vs. 100.8 minutes; P<0.001. Furthermore, patients set up in the beach chair position had a significantly longer OR time than patients positioned lateral decubitus (115.8 vs. 89.6 mins, P<0.0001. Number of tendons involved, and inclusion of distal clavicle excision, biceps tenodesis and labral debridement also added significant OR time. Type and number of support staff present also significantly affected OR time. Recovery room time was significantly longer patients who had surgery in the beach chair position (+9.61 minutes and for those who had a cardiac-related medical comorbidity (+11.7 minutes. Our study found that patients positioned in a beach chair spent significantly more time in the operating and recovery rooms. While ease of set up has been a stated advantage ofbeach chair position, we found the perceived ease of set up does not result in more efficient OR throughput.

  10. Meta-analysis of Clinical and Radiographic Outcomes After Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair.

    Science.gov (United States)

    Perser, Karen; Godfrey, David; Bisson, Leslie

    2011-05-01

    Double-row rotator cuff repair methods have improved biomechanical performance when compared with single-row repairs. To review clinical outcomes of single-row versus double-row rotator cuff repair with the hypothesis that double-row rotator cuff repair will result in better clinical and radiographic outcomes. Published literature from January 1980 to April 2010. Key terms included rotator cuff, prospective studies, outcomes, and suture techniques. The literature was systematically searched, and 5 level I and II studies were found comparing clinical outcomes of single-row and double-row rotator cuff repair. Coleman methodology scores were calculated for each article. Meta-analysis was performed, with treatment effect between single row and double row for clinical outcomes and with odds ratios for radiographic results. The sample size necessary to detect a given difference in clinical outcome between the 2 methods was calculated. Three level I studies had Coleman scores of 80, 74, and 81, and two level II studies had scores of 78 and 73. There were 156 patients with single-row repairs and 147 patients with double-row repairs, both with an average follow-up of 23 months (range, 12-40 months). Double-row repairs resulted in a greater treatment effect for each validated outcome measure in 4 studies, but the differences were not clinically or statistically significant (range, 0.4-2.2 points; 95% confidence interval, -0.19, 4.68 points). Double-row repairs had better radiographic results, but the differences were also not statistically significant (P = 0.13). Two studies had adequate power to detect a 10-point difference between repair methods using the Constant score, and 1 study had power to detect a 5-point difference using the UCLA (University of California, Los Angeles) score. Double-row rotator cuff repair does not show a statistically significant improvement in clinical outcome or radiographic healing with short-term follow-up.

  11. Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Tan, Martin; Lam, Patrick H; Le, Brian T N; Murrell, George A C

    2016-01-01

    Patients with rotator cuff tears often recall a specific initiating event (traumatic), whereas many cannot (nontraumatic). It is unclear how important a history of trauma is to the outcomes of rotator cuff repair. This question was addressed in a study cohort of 1300 consecutive patients who completed a preoperative questionnaire regarding their shoulder injury and had a systematic evaluation of shoulder range of motion and strength, a primary arthroscopic rotator cuff repair performed by a single surgeon, an ultrasound scan, and the same subjective and objective measurements made of their shoulder 6 months after surgery. Post hoc, this cohort was separated into 2 groups: those who reported no history of trauma on presentation (n = 489) and those with a history of traumatic injury (n = 811). The retear rate in the group with no history of trauma was 12%, whereas that of the group with a history of trauma was 14% (P = .36). Those patients with a history of shoulder trauma who waited longer than 24 months had higher retear rates (20%) than those who had their surgery earlier (13%) (P = .040). Recollection of a traumatic initiating event had little effect on the outcome of arthroscopic rotator cuff repair. Duration of symptoms was important in predicting retears if patients recalled a specific initiating event but not in patients who did not recall any specific initiating event. Patients with a history of trauma should be encouraged to have their rotator cuff tear repaired within 2 years. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Arthroscopic repair of the rotator cuff: prospective study of tendon healing after 70 years of age in 145 patients.

    Science.gov (United States)

    Flurin, P-H; Hardy, P; Abadie, P; Boileau, P; Collin, P; Deranlot, J; Desmoineaux, P; Duport, M; Essig, J; Godenèche, A; Joudet, T; Kany, J; Sommaire, C; Thelu, C-E; Valenti, P

    2013-12-01

    The level of activity of patients older than 70 years is tending to increase, as are their expectations in terms of joint function recuperation. It has not been proven that rotator cuff repair healing is satisfactory in the elderly. The main hypothesis of this study was: repair of supraspinous lesions in patients older than 70 years is reliable in terms of both clinical results and healing. The secondary hypothesis was: tendon healing is significantly correlated with the Constant, ASES, and SST scores as well as with age, tendon retraction, and fatty infiltration. Multicenter prospective study on 145 patients older than 70 years, with 135 patients reviewed at 1 year (93%). The mean age was 73.9 years. Full-thickness tears of the supraspinatus extended at most to the upper third of the infraspinatus and retraction limited to Patte stages 1 and 2 were included. Clinical assessment was carried out in accordance with the Constant, ASES, and SST scores. Healing was evaluated with ultrasound. A significant improvement was noted in the Constant (44/76)+31.5 (P0.0001) scores at 1 year of follow-up. The healing rate was 89% with 15 re-tears, nine of which were stage 1 and six stage 2. The clinical result was not correlated with patient age (Constant, P=0.24; ASES, P=0.38; SST, P=0.83) nor with the retraction stage (Constant, P=0.71; ASES, P=0.35; SST, P=0.69) or the stage of fatty infiltration (P>0.7). Healing was correlated with the quality of the clinical result (Constant, P=0.02; ASES, P=0.03) and age (P=0.01) but was not correlated with retraction or the fatty infiltration stage (P>0.3). Arthroscopic repair significantly improves the clinical results, even in patients older than 70 years. The clinical results are not correlated with age (but deterioration of the result was not noted after 75 years) or frontal retraction (but the study only included retractions limited to stages 1 and 2). The healing rate is satisfactory, but this study is limited to small ruptures of

  13. Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique.

    Science.gov (United States)

    Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Ma, Chang Hyun; Choy, Won Sik

    2018-05-23

    This retrospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the suture-bridge and double-row modified Mason-Allen techniques. From January 2012 to May 2013, 76 consecutive cases of full-thickness rotator cuff tear, 1 to 4 cm in the sagittal plane, for which arthroscopic rotator cuff repair was performed, were included. The suture-bridge technique was used in 37 consecutive shoulders; and the double-row modified Mason-Allen technique, in 39 consecutive shoulders. Clinical outcomes at a minimum of 2 years (mean, 35.7 months) were evaluated postoperatively using the visual analog scale; University of California, Los Angeles Shoulder Scale; American Shoulder and Elbow Surgeons Subjective Shoulder Scale; and Constant score. Postoperative cuff integrity was evaluated at a mean of 17.7 months by magnetic resonance imaging. At the final follow-up, the clinical outcomes improved in both groups (all P  .05). The retear rate was 18.9% in the shoulders subjected to suture-bridge repair and 12.8% in the double-row modified Mason-Allen group; the difference was not significant (P = .361). Despite the presence of fewer suture anchors, the patients who underwent double-row modified Mason-Allen repair had comparable shoulder functional outcomes and a comparable retear rate with those who underwent suture-bridge repair. Therefore, the double-row modified Mason-Allen repair technique can be considered an effective treatment for patients with medium- to large-sized full-thickness rotator cuff tears. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. A comparison of functional outcomes in patients undergoing revision arthroscopic repair of massive rotator cuff tears with and without arthroscopic suprascapular nerve release

    Directory of Open Access Journals (Sweden)

    Savoie III FH

    2016-10-01

    Full Text Available Felix H Savoie III,1 Mark Zunkiewicz,2 Larry D Field,2 William H Replogle,3 Michael J O’Brien1 1Tulane Institute of Sports Medicine, Tulane University School of Medicine, New Orleans, LA, USA; 2Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS, USA; 3Department of Family Medicine, University of Mississippi Medical Center, Jackson, MS, USA Purpose: This study was designed to compare functional outcomes in patients undergoing revision repair of massive rotator cuff tears (retracted medial to the glenoid with Goutallier Grade 4 atrophy and concomitant release of the suprascapular nerve to a similar group of patients with Grade 3 atrophy undergoing revision rotator cuff repair (RTCR without nerve release. We hypothesized that patients undergoing nerve release would have more favorable functional outcomes as measured by the Modified University of California at Los Angeles shoulder rating scale (UCLA. Patients and methods: Twenty-two patients underwent revision repair of massive rotator cuff tears with release of the suprascapular nerve at the suprascapular notch. We compared total preoperative, postoperative, and change in UCLA score in these patients to a similar group of 22 patients undergoing revision RTCR without suprascapular nerve release. Additionally, UCLA subscores between the two groups were compared preoperatively and at final follow-up. Results: The average preoperative UCLA score in the nerve-release group was 7.91, and final follow-up average was 27.86; average 3.05 grades of strength were recovered. In the comparison group, average preoperative UCLA score was 11.77, and final follow-up average was 29.09; average 1.32 grades of strength were recovered. The average preoperative UCLA score was significantly worse in the nerve-release group (P=0.007. The average postoperative UCLA score was not significantly different (P=0.590 between the groups, indicating a better improvement in the nerve-release group with significantly

  15. Magnetic resonance imaging findings associated with surgically proven rotator interval lesions

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    Vinson, Emily N.; Major, Nancy M. [Duke University Medical Center, Department of Radiology, P.O. Box 3808, Durham, NC (United States); Higgins, Laurence D. [Brigham and Women' s Hospital, Department of Orthopedic Surgery, Boston, MA (United States)

    2007-05-15

    To identify shoulder magnetic resonance imaging (MRI) findings associated with surgically proven rotator interval abnormalities. The preoperative MRI examinations of five patients with surgically proven rotator interval (RI) lesions requiring closure were retrospectively evaluated by three musculoskeletal-trained radiologists in consensus. We assessed the structures in the RI, including the coracohumeral ligament, superior glenohumeral ligament, fat tissue, biceps tendon, and capsule for variations in size and signal alteration. In addition, we noted associated findings of rotator cuff and labral pathology. Three of three of the MR arthrogram studies demonstrated extension of gadolinium to the cortex of the undersurface of the coracoid process compared with the control images, seen best on the sagittal oblique images. Four of five of the studies demonstrated subjective thickening of the coracohumeral ligament, and three of five of the studies demonstrated subjective thickening of the superior glenohumeral ligament. Five of five of the studies demonstrated a labral tear. The MRI arthrogram finding of gadolinium extending to the cortex of the undersurface of the coracoid process was noted on the studies of those patients with rotator interval lesions at surgery in this series. Noting this finding - especially in the presence of a labral tear and/or thickening of the coracohumeral ligament or superior glenohumeral ligament - may be helpful in the preoperative diagnosis of rotator interval lesions. (orig.)

  16. Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents.

    Science.gov (United States)

    Dierckman, Brian D; Ni, Jake J; Karzel, Ronald P; Getelman, Mark H

    2018-01-01

    This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair. This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist. Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. IV.

  17. Meta-analysis of Clinical and Radiographic Outcomes After Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair

    OpenAIRE

    Perser, Karen; Godfrey, David; Bisson, Leslie

    2011-01-01

    Context: Double-row rotator cuff repair methods have improved biomechanical performance when compared with single-row repairs. Objective: To review clinical outcomes of single-row versus double-row rotator cuff repair with the hypothesis that double-row rotator cuff repair will result in better clinical and radiographic outcomes. Data Sources: Published literature from January 1980 to April 2010. Key terms included rotator cuff, prospective studies, outcomes, and suture techniques. Study Sele...

  18. Effect of Preoperative Fatty Degeneration of the Rotator Cuff Muscles on the Clinical Outcome of Patients With Intact Tendons After Arthroscopic Rotator Cuff Repair of Large/Massive Cuff Tears.

    Science.gov (United States)

    Ohzono, Hiroki; Gotoh, Masafumi; Nakamura, Hidehiro; Honda, Hirokazu; Mitsui, Yasuhiro; Kakuma, Tatsuyuki; Okawa, Takahiro; Shiba, Naoto

    2017-11-01

    Fatty degeneration of the rotator cuff muscles is associated not only with postoperative retear but also with postoperative muscle weakness; therefore, fatty changes in the muscles may affect the clinical outcome even in patients with these tears who have intact tendons after arthroscopic rotator cuff repair (ARCR). To evaluate the effect of fatty infiltration on the clinical outcome in patients with intact tendons after arthroscopic repair of large/massive cuff tears. Case-control study; Level of evidence, 3. One hundred fifty-five consecutive patients with large/massive rotator cuff tears underwent ARCR. Of these, 55 patients (mean ± SD age, 64.4 ± 9.1 years) in whom intact tendons after surgery were confirmed with magnetic resonance imaging at final follow-up (mean ± SD, 2.5 ± 1.4 years) were included in this study. Depending on their University of California Los Angeles (UCLA) score at the final follow-up, they were assigned to either the unsatisfactory group (score ≤27; n = 12) or the satisfactory group (score >27; n = 43). Various clinical parameters affecting the clinical outcome were examined through univariate and multivariate analyses. The UCLA score of all patients significantly improved from 18.1 ± 4.4 points preoperatively to 29.8 ± 4.5 points postoperatively ( P muscles, with area under the curve values of 0.79 (sensitivity 91% and specificity 51%) and 0.84 (sensitivity 100% and specificity 54%) in the infraspinatus and subscapularis, respectively. Preoperative fatty degeneration of the infraspinatus and/or subscapularis with Goutallier stage 2 or higher was significantly associated with worse outcome in patients with large/massive tears who had intact tendons after ARCR.

  19. The relationship between quality of sleep and night shift rotation interval.

    Science.gov (United States)

    Kim, Jae Youn; Chae, Chang Ho; Kim, Young Ouk; Son, Jun Seok; Kim, Ja Hyun; Kim, Chan Woo; Park, Hyoung Ouk; Lee, Jun Ho; Kwon, Soon Il; Kwon, Sun Il

    2015-01-01

    Shift work is closely related with workers' health. In particular, sleep is thought to be affected by shift work. In addition, shift work has been reported to be associated with the type or direction of shift rotation, number of consecutive night shifts, and number of off-duty days. We aimed to analyze the association between the night shift rotation interval and the quality of sleep reported by Korean female shift workers. In total, 2,818 female shift workers from the manufacturing industry who received an employee physical examination at a single university hospital from January to August in 2014 were included. Subjects were classified into three groups (A, B, and C) by their night shift rotation interval. The quality of sleep was measured using the Korean version of the Pittsburgh Sleep Quality Index (PSQI). Descriptive analysis, univariate logistic regression, and multivariate logistic regression were performed. With group A as the reference, the odds ratio (OR) for having a seriously low quality of sleep was 1.456 (95% CI 1.171-1.811) and 2.348 (95% CI 1.852-2.977) for groups B and C, respectively. Thus, group C with the shortest night shift rotation interval was most likely to have a low quality of sleep. After adjustment for age, obesity, smoking status, alcohol consumption, exercise, being allowed to sleep during night shifts, work experience, and shift work experience, groups B and C had ORs of 1.419 (95% CI 1.134-1.777) and 2.238 (95% CI 1.737-2.882), respectively, compared to group A. Our data suggest that a shorter night shift rotation interval does not provide enough recovery time to adjust the circadian rhythm, resulting in a low quality of sleep. Because shift work is influenced by many different factors, future studies should aim to determine the most optimal shift work model and collect accurate, prospective data.

  20. Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity.

    Science.gov (United States)

    Chung, Seok Won; Kim, Jae Yoon; Yoon, Jong Pil; Lyu, Seong Hwa; Rhee, Sung Min; Oh, Se Bong

    2015-03-01

    The healing failure rate is high for partial-thickness or small full-thickness rotator cuff tears. To retrospectively evaluate and compare outcomes after arthroscopic repair of high-grade partial-thickness and small full-thickness rotator cuff tears and factors affecting rotator cuff healing. Cohort study; Level of evidence, 3. Included in the study were 55 consecutive patients (mean age, 57.9 ± 7.2 years) who underwent arthroscopic repair for high-grade partial-thickness (n = 34) and small full-thickness (n = 21) rotator cuff tears. The study patients also underwent magnetic resonance imaging (MRI) preoperatively and computed tomography arthrography (CTA) at least 6 months postoperatively, and their functional outcomes were evaluated preoperatively and at the last follow-up (>24 months). All partial-thickness tears were repaired after being converted to full-thickness tears; thus, the repair process was almost the same as for small full-thickness tears. The tendinosis of the torn tendon was graded from the MRI images using a 4-point scale, and the reliabilities were assessed. The outcomes between high-grade partial-thickness tears that were converted to small full-thickness tears and initially small full-thickness tears were compared, and factors affecting outcomes were evaluated. The inter- and intraobserver reliabilities of the tendinosis grade were good (intraclass correlation coefficient, 0.706 and 0.777, respectively). Failure to heal as determined by CTA was observed in 12 patients with a high-grade partial-thickness tear (35.3%; complete failure in 4 and partial failure in 8) and in 3 patients with a small full-thickness tear (14.3%; complete failure in 1 and partial failure in 2). The patients with high-grade partial-thickness rotator cuff tears showed a higher tendinosis grade than did those with small full-thickness tears (P = .014), and the severity of the tendinosis was related to the failure to heal (P = .037). Tears with a higher tendinosis grade

  1. Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study.

    Science.gov (United States)

    Jeong, Jeung Yeol; Chung, Pill Ku; Yoo, Jae Chul

    2017-01-01

    Hyaluronate-based anti-adhesive agents are expected to enhance rotator cuff healing; however, their effect on the incidence and extent of postoperative complications such as stiffness and retears has not been investigated. From July 2012 to February 2013, 80 patients undergoing arthroscopic rotator cuff repair surgery were prospectively enrolled. Forty patients were assigned to the control group, while the other 40 were assigned to the injection group and received a Guardix-sol injection immediately after surgery. Passive range of motion, pain visual analog scale, and functional score were assessed at 8 weeks, 6 months, and 24 months postoperatively. Gliding motion between the deltoid muscle and the greater tuberosity of the proximal humerus was evaluated using ultrasonography at 2 and 8 weeks postoperatively, and tendon integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. We found no significant difference between the groups regarding gliding motion at 2 weeks postoperatively. However, at 8 weeks, the incidence of poor gliding motion was 2.5% and 15% for the injected patients and control group, respectively, which was statistically significant. At 6 months after surgery, the retear rate between the two groups was not statistically significant. We found no statistically significant difference between the two groups regarding retear rate and clinical score throughout the follow-up period. We noted no complications related to the use of Guardix-sol. Patients who received the Guardix-sol injection showed improved gliding motion between the deltoid muscle and the greater tuberosity in the early postoperative period.

  2. Tratamento artroscópico da tendinite calcária do manguito rotador Arthroscopic treatment of calcifying tendinitis of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Arnaldo Amado Ferreira Neto

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico por via artroscópica em pacientes com tendinite calcária do manguito rotador. MÉTODO: Foi realizado um estudo retrospectivo com análise de 20 pacientes que foram submetidos ao tratamento artroscópico da tendinite calcária do ombro, de março de 1999 a novembro de 2005. Seis pacientes foram excluídos devido à perda do seguimento. Com seguimento médio de 41,4 meses, oito pacientes (57% eram do sexo feminino e seis (43% do masculino; sendo o lado direito acometido em 10 (71% e o esquerdo em quatro (29%. Nove casos (64% apresentavam calcificação no tendão supraespinal, dois (14% no infraespinal e três (21% envolvendo os dois tendões. RESULTADOS: Em todos os casos, realizou-se a ressecção dos depósitos de cálcio através da perfuração com agulha (Jelco® nº 14 e curetagem (minicureta. Dois ombros (14% foram submetidos à descompressão subacromial; um, (7% à exérese distal da clavícula; e, em três, (21% houve a necessidade de se fazer sutura tendão-tendão. Nenhum paciente foi submetido à reinserção tendão-osso. Pela escala da UCLA, a média da pontuação foi de 33 pontos (26-35, indicando que a maioria teve resultados bons. Na avaliação final radiográfica, nenhum paciente apresentava sinais de calcificações. CONCLUSÃO: O tratamento artroscópico da tendinite calcária do ombro permite a exérese da calcificação com segurança, obtendo-se resultados bons com relação à dor e à função do ombro.OBJECTIVE: To evaluate the clinical and radiographic results of arthroscopic treatment of the rotator cuff in patients with Calcifying Tendinitis. METHOD: A retrospective study of twenty patients submitted to arthroscopic treatment for rotator cuff Calcifying Tendinitis from March 1999 to November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57% were female and

  3. Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases.

    Science.gov (United States)

    Cho, Seung Hyun; Yi, Jin Woong; Kwack, Yoon Ho; Park, Sung Wook; Kim, Mi Kyeong; Rhee, Yong Girl

    2010-03-01

    We routinely have performed arthroscopic shoulder surgery under general anesthesia in the beach chair position using epinephrine (0.33 mg/L) saline irrigation. At a 2-week interval, two patients, a 19-year-old man scheduled to undergo an arthroscopic Bankart repair for left traumatic anterior instability and a 49-year-old woman scheduled for an arthroscopic rotator cuff repair for a left rotator cuff tear, were resuscitated by chest compression and defibrillation due to a sudden developed cardiogenic shock following ventricular tachycardia at the time of arthroscopic shoulder surgery. They were transferred to the intensive care unit because their emergent echocardiogram showed significantly decreased cardiac functions. They were fully recovered and then discharged. Epinephrine was considered to be the cause of ventricular tachycardia because the two patients showed no anaphylactic reaction to drugs or symptoms of air embolism related to the beach chair position. In addition, according to our observation of epinephrine flow patterns, it was more likely that highly concentrated epinephrine was rapidly infused into the body. This complication is very rare. However, thorough understanding of the side effects and their development of epinephrine during arthroscopic shoulder surgery should neither be overemphasized nor disregarded.

  4. Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Qiang Zhang

    Full Text Available BACKGROUND: Platelet-rich products (PRP are widely used for rotator cuff tears. However, whether platelet-rich products produce superior clinical or radiological outcomes is controversial. This study aims to use meta-analysis to compare clinical and radiological outcomes between groups with or without platelet-rich products. METHODS: The Pubmed, Embase, and Cochrane library databases were searched for relevant studies published before April 20, 2013. Studies were selected that clearly reported a comparison between the use or not of platelet-rich products. The Constant, ASES, UCLA, and SST scale systems and the rotator cuff retear rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects model. RESULTS: Seven studies were enrolled in this meta-analysis. No significant differences were found for the Constant scale (0.73, 95% CI, -1.82 to 3.27, P=0.58, ASES scale (-2.89, 95% CI, -6.31 to 0.53, P=0.1, UCLA scale (-0.79, 95% CI, -2.20 to 0.63, P=0.28, SST scale (0.34, 95% CI, -0.01 to 0.69, P=0.05, and the overall rotator cuff retear rate (0.71, 95% CI, 0.48 to 1.05, P=0.08. Subgroup analysis according to the initial tear size showed a lower retear rate in small- and medium-sized tears (0.33, 95% CI, 0.12 to 0.91, P=0.03 after platelet-rich product application but no difference for large- and massive-sized tears (0.86, 95% CI, 0.60 to 1.23, P=0.42. CONCLUSION: In conclusion, the meta-analysis suggests that the platelet-rich products have no benefits on the overall clinical outcomes and retear rate for the arthroscopic repair of full-thickness rotator cuff tears. However, a decrease occurred in the rate of retears among patients treated with PRP for small- and medium-sized rotator cuff tears but not for large- and massive-sized tears. LEVEL OF EVIDENCE: Level II.

  5. Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.

    Science.gov (United States)

    Gartsman, Gary M; Drake, Gregory; Edwards, T Bradley; Elkousy, Hussein A; Hammerman, Steven M; O'Connor, Daniel P; Press, Cyrus M

    2013-11-01

    The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. The diabetic frozen shoulder: arthroscopic release.

    Science.gov (United States)

    Ogilvie-Harris, D J; Myerthall, S

    1997-02-01

    Seventeen patients who were diabetics developed frozen shoulders which failed to respond to conservative management. They had persistent pain, stiffness, and limited function. An arthroscopic release was performed by progressively releasing the anterior structures from superior to inferior. Starting from the interval area we progressed to the anterior superior glenohumeral ligament, the intra-articular portion of the subscapularis, the anterior capsule, and the inferior capsule. Postoperatively physiotherapy was carried out daily to maintain the range of movement. At a follow up of 1 to 5 years the patients were assessed using the American Shoulder Society scheme. In addition the patients were assessed preoperatively and postoperatively on four criteria; pain, external rotation, abduction, and function. We found that the patients were statistically significantly improved in all four categories. Thirteen of the 17 patients had no pain, full range of motion compared with the opposite side, and full function. There was one poor result with no improvement. The remaining three patients had improved but still had residual abnormalities. We consider arthroscopic release to be an effective treatment for the resistant diabetic frozen shoulder.

  7. Single-row modified mason-allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison.

    Science.gov (United States)

    Nelson, Cory O; Sileo, Michael J; Grossman, Mark G; Serra-Hsu, Frederick

    2008-08-01

    The purpose of this study was to compare the time-zero biomechanical strength and the surface area of repair between a single-row modified Mason-Allen rotator cuff repair and a double-row arthroscopic repair. Six matched pairs of sheep infraspinatus tendons were repaired by both techniques. Pressure-sensitive film was used to measure the surface area of repair for each configuration. Specimens were biomechanically tested with cyclic loading from 20 N to 30 N for 20 cycles and were loaded to failure at a rate of 1 mm/s. Failure was defined at 5 mm of gap formation. Double-row suture anchor fixation restored a mean surface area of 258.23 +/- 69.7 mm(2) versus 148.08 +/- 75.5 mm(2) for single-row fixation, a 74% increase (P = .025). Both repairs had statistically similar time-zero biomechanics. There was no statistical difference in peak-to-peak displacement or elongation during cyclic loading. Single-row fixation showed a higher mean load to failure (110.26 +/- 26.4 N) than double-row fixation (108.93 +/- 21.8 N). This was not statistically significant (P = .932). All specimens failed at the suture-tendon interface. Double-row suture anchor fixation restores a greater percentage of the anatomic footprint when compared with a single-row Mason-Allen technique. The time-zero biomechanical strength was not significantly different between the 2 study groups. This study suggests that the 2 factors are independent of each other. Surface area and biomechanical strength of fixation are 2 independent factors in the outcome of rotator cuff repair. Maximizing both factors may increase the likelihood of complete tendon-bone healing and ultimately improve clinical outcomes. For smaller tears, a single-row modified Mason-Allen suture technique may provide sufficient strength, but for large amenable tears, a double row can provide both strength and increased surface area for healing.

  8. Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques.

    Science.gov (United States)

    Kim, Sung-Jae; Jung, Min; Lee, Jae-Hoo; Kim, Chul; Chun, Yong-Min

    2014-12-17

    The purpose of this study was to compare the clinical outcomes and structural integrity after two techniques of arthroscopic anterosuperior rotator cuff repair: in continuity and disruption of the tear margin. This study included fifty-nine patients who underwent arthroscopic repair of an anterosuperior rotator cuff tear that was done either by disrupting the margin between the subscapularis and supraspinatus tears (Group A) or by performing the repair in continuity without disrupting the margin (Group B). Clinical outcomes were assessed on the basis of a visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion of the shoulder. Subscapularis strength was assessed with use of the modified belly-press test. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed at six months after surgery to assess the structural integrity of the repair. At the two-year follow-up evaluation, VAS pain scores, SSVs, ASES scores, UCLA shoulder scores, subscapularis strength, and active range of motion improved significantly in both groups compared with preoperatively (p tears of the rotator cuff, the technique of in-continuity repair did not produce better clinical outcomes or structural integrity than the technique involving disruption of the tear margin. If the muscle in an anterosuperior rotator cuff tear is of good quality, it does not appear to matter whether the tear margin between the subscapularis and supraspinatus is preserved or disrupted. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

  9. High-grade bursal-side partial rotator cuff tears: comparison of mid- and long-term results following arthroscopic repair after conversion to a full-thickness tear.

    Science.gov (United States)

    Aydin, Nuri; Karaismailoglu, Bedri

    2017-07-21

    Partial-thickness rotator cuff tears (PTRCTs) are one of the leading causes of shoulder dysfunction. Successful results have been reported with different treatment techniques, but the long-term consequences of these procedures are not yet clearly known. The purposes of this study were to evaluate and compare the mid- and long-term clinical outcomes of arthroscopically repaired bursal-side PTRCTs after conversion to full-thickness tears and identify the possible effects of age, gender, and hand dominance on clinical outcomes. Twenty-nine patients who had undergone arthroscopic repair of a significant bursal-side PTRCT were functionally evaluated. The repair was made after conversion to a full-thickness tear. The average patient age was 55.2 years (range 35-69 years, SD ±7.6 years). Clinical outcomes were evaluated at 2 and 5 years after surgery. Constant Shoulder Score (CSS) and Visual Analogue Scale for Pain (VAS pain) were used as outcome measures. The average CSS improved from 38.9 preoperatively to 89.2 and 87.8 at 2 and 5 years after surgery, respectively (p functional outcomes and VAS pain scores at 2 and 5 years after surgery compared with the preoperative period. The patients who underwent surgery from their non-dominant extremity showed a significantly higher CSS increase relative to those who underwent surgery on the dominant extremity (p = 0.022). Arthroscopic repair of high-grade bursal-side PTRCTs after conversion to full-thickness tears is a reliable surgical technique with good functional outcomes and pain relief both at mid- and long-term follow-ups. Surgery on the non-dominant side may be related to better functional outcomes.

  10. Arthroscopic surgery for degenerative knee

    DEFF Research Database (Denmark)

    Thorlund, J B; Juhl, C B; Roos, E M

    2015-01-01

    OBJECTIVE: To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURES: Pain and physical function....... RESULTS: The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

  11. Plasma rico em plaquetas no reparo artroscópico das roturas completas do manguito rotador Platelet-rich plasma in arthroscopic repairs of complete tears of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Eduardo Angeli Malavolta

    2012-01-01

    Full Text Available OBJETIVO: Avaliar os resultados funcionais e o índice de rerrotura do reparo do manguito rotador por via artroscópica associado ao uso do PRP. MÉTODOS: Série de casos prospectiva, avaliando os resultados do reparo artroscópico do manguito rotador em fileira simples associada ao uso do PRP. Foram incluídas apenas roturas isoladas do supraespinal, com retração inferior a 3cm. O PRP utilizado foi obtido pelo método de aférese, e aplicado em sua forma ativada, com a adição de trombina autóloga, na consistência líquida. A avaliação pós-operatória foi realizada de maneira padronizada, aos 12 meses de seguimento. Foram utilizadas as escalas de Constant-Murley, UCLA e EVA, além da análise da incidência de rerroturas através da ressonância magnética. RESULTADOS: Foram avaliados 14 pacientes (14 ombros. A escala de Constant-Murley evoluiu em média de 45,64 ± 12,29 no pré-operatório para 80,78 ± 13,22 no pós-operatório (p OBJECTIVE: To evaluate shoulder functional results and the re tear rate of arthroscopic repair of the rotator cuff augmented with platelet-rich plasma (PRP. METHODS: Prospective case series with single-row arthroscopic repair of the rotator cuff augmented with PRP. Only cases of isolated supraspinatus tears with retraction of less than 3 cm were included in this series. The PRP used was obtained by apheresis. It was applied on liquid consistency in its activated form, with the addition of autologous thrombin. Patients were evaluated after 12 months of the surgical procedure. The Constant-Murley, UCLA and VAS scales were used, and the retear rate was assessed using magnetic resonance imaging (MRI. RESULTS: Fourteen patients were evaluated (14 shoulders. The mean Constant-Murley score was 45.64 ± 12.29 before the operation and evolved to 80.78 ± 13.22 after the operation (p < 0.001. The UCLA score increased from 13.78 ± 5.66 to 31.43 ± 3.9 (p < 0.001. The patients' pain level decreased from a median of 7

  12. Avaliação funcional do reparo artroscópico das lesões completas do manguito rotador associado a acromioplastia Functional evaluation of arthroscopic repairs of complete rotator cuff tears associated to acromioplasty

    Directory of Open Access Journals (Sweden)

    Marco Antonio de Castro Veado

    2008-12-01

    Full Text Available OBJETIVO: Realizar avaliação funcional dos pacientes portadores de lesão completa do MR que foram submetidos ao reparo artroscópico associados à acromioplastia. MÉTODOS: Trata-se de um estudo retrospectivo realizado com pacientes submetidos a tratamento cirúrgico artroscópico para reparo da lesão do MR. Foram incluídos os pacientes operados entre junho/2000 e outubro/2004 nos Hospitais Mater Dei e Felício Rocho, em Belo Horizonte. Dos 102 pacientes submetidos à reconstrução, 11 foram retirados por não cumprirem os critérios de inclusão, sendo o número final igual a 91 ombros em 91 pacientes. A avaliação funcional foi realizada pela escala UCLA (Universidade da Califórnia em Los Angeles e pelo teste Simples. RESULTADOS: Na avaliação pós-operatória em 35 pacientes, os resultados foram considerados excelentes (38,4%; em 47, bons (51,6%; seis, regulares (6,6%; e três, ruins (3,3%. Desse modo, 82 (90,1% pacientes foram avaliados como tendo obtido resultado bom ou excelente e nove como regulares ou ruins, sendo estes insatisfatórios. CONCLUSÃO: O reparo artroscópico do manguito rotador, associado a acromioplastia, apresentou resultado funcional excelente ou bom, na maioria dos pacientes, quando avaliados pelo método funcional da UCLA.OBJECTIVE: To perform a function evaluation of patients with complete rotator cuff tears that were submitted to arthroscopic repair associated to acromioplasty. METHODS: This is a retrospective study made with patients submitted to arthroscopic surgical treatment to repair rotator cuff tears. Patients included were operated on from June 2000 to October 2004 at the Mater Dei and Felício Rocho Hospitals, in Belo Horizonte. Of the 102 patients submitted to reconstruction, 11 were removed from the study because they did not meet the inclusion criteria, and so the final number of the series was 91 shoulders of 91 patients. The functional evaluation scale was the UCLA scale and the simple test was

  13. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Zappia, Marcello [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Varelli Institute, Naples (Italy); Castagna, Alessandro [Humanitas Research Hospital, Rozzano, Milan (Italy); Barile, Antonio [University of L' Aquila, Applied Clinical Science and Biotechnology, L' Aquila (Italy); Chianca, Vito [University ' ' Federico II' ' , Department of Advanced Biomedical Sciences, Naples (Italy); Brunese, Luca [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Pouliart, Nicole [Vrije Universiteit Brussel (VUB), Basic Biomedical Sciences - Human Anatomy, Brussels (Belgium); Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology - Shoulder and Elbow Unit, Brussels (Belgium)

    2017-08-15

    The coracoglenoid ligament (CGL) forms part of the anterosuperior capsuloligamentous complex of the shoulder. Although it has received attention in the anatomical literature, it has not been investigated on imaging. The purpose of this study is to determine the percentage value and the interobserver agreement of identification and classification of the CGL on MR and MR arthrography (MRA) imaging. Retrospectively, 280 MR and 150 MRA examinations were evaluated for detection of the CGL by two musculoskeletal radiologists. On the MRA examinations the CGL configuration in relation to the superior glenohumeral (SGHL) and coracohumeral ligament (CHL) was classified into five types. Additionally, the percentage of intra-articular appearance of the CGL and its mean thickness value were calculated. Finally, a possible correlation between pathological condition and anatomical type was evaluated on MRA. The CGL could be identified in 56%/54% of MRI and in 76%/77% of MRA examinations. On MRA, the CGL was detected as distinct structures in 37%/35% of cases and it appeared fused (partially or totally) with the SGHL and/or CHL in 39%/42%; it was absent in 12%/12% and it appears undistinguishable in the remaining cases. The interobserver agreement was excellent (κ = 0.98 for detection on MRI; p = 0.927 for classification of anterosuperior anatomy on MRA; κ = 0.873 and 0.978 for identification on sagittal and axial external rotation MRA respectively; κ = 0.943 for classification as intra- or extra-articular on MRA). The CGL can be reliably identified on MRI and MRA. (orig.)

  14. Arthroscopic management of posterior instability: evolution of technique and results.

    Science.gov (United States)

    Savoie, Felix H; Holt, M Shaun; Field, Larry D; Ramsey, J Randall

    2008-04-01

    The purpose of this study was to evaluate the effectiveness of arthroscopic posterior shoulder reconstruction. We treated 136 shoulders in 131 patients with a diagnosis of primary posterior instability who failed 6 months of vigorous rehabilitation by operative stabilization between 1989 and 2001. Inclusion criterion was primary posterior instability that failed an extensive rehabilitative program with functional impairment and pain. Exclusion criterion was less than 12 months of follow-up and Suretac (Smith & Nephew, Andover, MA) or laser stabilization, leaving 92 shoulders in 90 patients available for the study (69 male, 21 female). Follow-up ranged from 12 to 132 months (average, 28 months). Each patient underwent diagnostic arthroscopy and surgical repair at the same time using one of several primary procedures. The procedure used was based on the pathologic entity noted at the time of surgery. At an average follow-up of 28 months, 97% of the shoulders were stable and considered a success based on the Neer-Foster rating scale. Posterior pathology varied, and a reverse Bankart lesion alone was found 51% of the time, a stretched posterior capsule 67% of the time, and a combination of a reverse Bankart lesion and capsular stretching 16% of the time. The rotator interval was obviously damaged in 61% of cases. Multiple accompanying lesions were found, including anterior-superior labral tears and SLAP tears (20%), superior glenohumeral ligament injury (7%), middle glenohumeral ligament injury (38%), anteroinferior glenohumaral ligament injury (37%), and an enlarged axillary pouch (20%). No essential lesion is present for posterior instability. Multiple varied pathologies will be present in a shoulder presenting with posterior instability. Arthroscopic surgery allows inspection of the joint and anatomic-specific repairs based on pathology. Careful attention to all the supporting structures of the shoulder, including the rotator interval, the anterior-superior labrum

  15. Arthroscopic Rotator Cuff Repair With Graft Augmentation of 3-Dimensional Biological Collagen for Moderate to Large Tears: A Randomized Controlled Study.

    Science.gov (United States)

    Cai, You-Zhi; Zhang, Chi; Jin, Ri-Long; Shen, Tong; Gu, Peng-Cheng; Lin, Xiang-Jin; Chen, Jian-De

    2018-05-01

    Due to the highly organized tissue and avascular nature of the rotator cuff, rotator cuff tears have limited ability to heal after the tendon is reinserted directly on the greater tubercle of the humerus. Consequently, retears are among the most common complications after rotator cuff repair. Augmentation of rotator cuff repairs with patches has been an active area of research in recent years to reduce retear rate. Graft augmentation with 3D collagen could prevent retears of the repaired tendon and improve tendon-bone healing in moderate to large rotator cuff tears. Randomized controlled study; Level of evidence, 2. A prospective, randomized controlled study was performed in a consecutive series of 112 patients age 50 to 85 years who underwent rotator cuff repair with the suture-bridge technique (58 patients, control group) or the suture-bridge technique augmented with 3-dimensional (3D) collagen (54 patients, study group). All patients were followed for 28.2 months (range, 24-36 months). Visual analog scale score for pain, University of California Los Angeles (UCLA) shoulder score, and Constant score were determined. Magnetic resonance imaging was performed pre- and postoperatively (at a minimum of 24 months) to evaluate the integrity of the rotator cuff and the retear rate of the repaired tendon. Three patients in each group had biopsies at nearly 24 months after surgery with histological assessment and transmission electron microscopy. A total of 104 patients completed the final follow-up. At the 12-month follow-up, the UCLA shoulder score was 28.1 ± 1.9 in the study group, which was significantly better than that in the control group (26.9 ± 2.1, P = .002). The Constant score was also significantly better in the study group (87.1 ± 3.2) than in the control group (84.9 ± 4.2, P = .003). However, at the final follow-up, no significant differences were found in the UCLA shoulder scores (29.4 ± 1.9 in the control group and 30.0 ± 1.6 in the study group, P

  16. The Impact of Re-tear on the Clinical Outcome after Rotator Cuff Repair Using Open or Arthroscopic Techniques – A Systematic Review

    Science.gov (United States)

    Galanopoulos, Ilias; Ilias, Aslanidis; Karliaftis, Konstantinos; Papadopoulos, Dimitrios; Ashwood, Neil

    2017-01-01

    Background: It is generally accepted that rotator cuff repair gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of structural failure or re-tear. The purpose of this review study is to assess whether failure of the repaired cuff to heal could negatively affect the functional outcome. Methods: This article includes an extensive Internet PubMed based research in the current English-language literature including level I to level V studies as well as systematic reviews. Results: According to this extended study research, the results are mixed; certain reports show that patients with a healed rotator cuff repair have improved function and strength compared to those with structural failure, whereas other studies support the generally perceived concept that tendon re-tear does not lead to inferior clinical outcome. Conclusion: Further high-level prospective studies with larger numbers of patients and longer follow up are needed to overcome the current debate over function between healed and failed rotator cuff repairs. PMID:28400878

  17. Arthroscopic anatomy of the subdeltoid space

    Directory of Open Access Journals (Sweden)

    Michael J. Salata

    2013-09-01

    Full Text Available From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears.

  18. Lesões extensas do manguito rotador: avaliação dos resultados do reparo artroscópico Extensive rotator cuff injuries: an evaluation of arthroscopic repair outcomes

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    Alberto Naoki Miyazaki

    2009-04-01

    showed excellent or good outcomes; no fair outcome in none of the patients; and seven (11% poor outcomes. A satisfaction rate of 92% was reported. Postoperative joint motion went from a mean lifting value of 93º to 141º, the mean lateral rotation went from 32º to 48º and the mean medial rotation went from L1 to T10. These differences were regarded as statistically significant. CONCLUSION: The arthroscopic repair of extensive rotator cuff injuries leads to satisfactory outcomes for most of the patients, with a high satisfaction degree.

  19. Arthroscopic partial medial meniscectomy

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    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  20. Avaliação dos resultados do reparo artroscópico de lesões do manguito rotador em pacientes com até 50 anos de idade Evaluation of the results from arthroscopic repair on rotator cuff injuries among patients under 50 years of age

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2011-01-01

    Full Text Available OBJETIVO: Avaliar o resultado do tratamento cirúrgico das lesões do manguito rotador (LMR por via artroscópica nos pacientes com até 50 anos de idade. MÉTODOS: Entre agosto de 1998 e dezembro de 2007 foram reavaliados 63 pacientes com LMR submetidos a este tratamento pelo Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médica da Santa Casa de São Paulo - "Pavilhão Fernandinho Simonsen". Foram incluídos no estudo todos os pacientes com LMR com idade até 50 anos e com seguimento mínimo pós-operatório de 24 meses. RESULTADOS: Pelos critérios de avaliação da UCLA, 59 (92% pacientes tiveram resultados excelentes e bons; cinco (8%, regulares; e nenhum ruim. A amplitude média dos movimentos na avaliação pós-operatória foi de 145˚ na elevação, 47˚ na rotação lateral e de T10 na rotação medial. Os resultados insatisfatórios estiveram associados com o tempo prolongado da lesão, demonstrando uma relação estatisticamente significante. CONCLUSÃO: O reparo artroscópico da LMR nos pacientes jovens traz resultados bons e excelentes na maioria dos pacientes.OBJECTIVE: To assess the results from arthroscopic surgical treatment of rotator cuff injuries among patients under 50 years of age. METHODS: Sixty-three patients with rotator cuff injuries who underwent arthroscopic surgical treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, in the Fernandinho Simonsen wing of Santa Casa Medical School, São Paulo, between August 1998 and December 2007, were reassessed. The study included all patients with rotator cuff injuries who were under 50 years of age and had been followed up postoperatively for at least 24 months. RESULTS: According to the UCLA evaluation criteria, 59 patients (92% showed excellent and good results; five (8% showed fair results; and none showed poor results. The postoperative evaluation showed that the mean range of

  1. Modified arthroscopic Brostrom procedure.

    Science.gov (United States)

    Lui, Tun Hing

    2015-09-01

    The open modified Brostrom anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. However, there is high incidence of intra-articular pathologies associated with chronic lateral ankle instability which may not be addressed by an isolated open Brostrom procedure. Arthroscopic Brostrom procedure with suture anchor has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. However, the complication rates seemed to be higher than open Brostrom procedure. Modification of the arthroscopic Brostrom procedure with the use of bone tunnel may reduce the risk of certain complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Rotator manşetin kalsifiye tendinitinin artroskopik tedavisi

    OpenAIRE

    Ozkoc, Gurkan; Akpinar, Sercan; Hersekli, Murat; Ozalay, Metin; Tandogan, Reha

    2004-01-01

    Objectives: We evaluated the effectiveness of arthroscopic treatment in patients with rotator cuff calcifying tendinitis unresponsive to conservative treatment.Methods: Arthroscopic treatment was performed in 10 patients (6 females, 4 males; mean age 46 years; range 34 to 53 years) in whom pain and functional disability persisted for more than a year despite conservative therapy for rotator cuff calcifying tendinitis. Arthroscopic bursectomy was also carried out. One patient underwent repair ...

  3. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

    Science.gov (United States)

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

    2015-12-01

    Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

  4. Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis

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    Alberto Naoki Miyazaki

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of arthroscopic releases performed in patients with adhesive capsulitis refractory to conservative treatment. METHODS: This was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29-73 years. The mean follow-up was 65 (12-168 months and the mean preoperative time was 8.9 (2-24 months. According to Zukermann's classification, 23 cases were considered primary and 33 secondary. With the patient in the lateral decubitus position, circumferential release of the joint capsule was performed: joint debridement; rotator interval opening; coracohumeral ligament release; anterior, posterior, inferior, and finally antero-inferior capsulotomy. A subscapularis tenotomy was performed when necessary. All patients underwent intense physical therapy in the immediate postoperative period. In 33 shoulders, an interscalene catheter was implanted for anesthetic infusion. Functional results were evaluated by the UCLA criteria. RESULTS: Improved range of motion was observed: mean increase of 45° of elevation, 41° of external rotation and eight vertebral levels of medial rotation. According to the UCLA score excellent results were obtained in 25 (45% patients; good, in 24 (45%; fair, in two (3%; and poor, in two (7%. Patients who had undergone inferior capsulotomy achieved better results. Only 8.8% of patients who used the anesthetic infusion catheter underwent postoperative manipulation. Seven patients had complications. CONCLUSION: There was improvement in pain and range of motion. Inferior capsulotomy leads to better results. The use of the interscalene infusion catheter reduces the number of re-approaches.

  5. Arthroscopic excision of ganglion cysts.

    Science.gov (United States)

    Bontempo, Nicholas A; Weiss, Arnold-Peter C

    2014-02-01

    Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Arthroscopic treatment of acromioclavicular dislocation

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    Mihai T. Gavrilă

    2017-11-01

    Full Text Available A thorough understanding of biomechanical function of both acromioclavicular (AC and coracoclavicular (CC ligaments, stimulated surgeons to repair high-grade AC dislocation using arthroscopic technique. This technique necessitates a clear understanding of shoulder anatomy, especially of the structures in proximity to the clavicle and coracoid process and experiences in arthroscopic surgery. The follow case describes an arthroscopic technique used to treat AC dislocation in young man 30 years old, who suffered an injury at right shoulder. Results were similar to those obtained using open surgery and this encouraged us to continue utilization of this method. As a conclusion, arthroscopic treatment of AC separation is one of the best options as surgical treatment. Early results suggested that immediate anatomic reduction of an acute AC separation usually provides satisfactory clinical results at intermediate-term follow-up.

  7. Avaliação funcional dos pacientes submetidos ao desbridamento artroscópico para tratamento das rupturas extensas e irreparáveis do manguito rotador Functional evaluation of patients who have undergone arthroscopic debridement to treat massive and irreparable tears of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados dos pacientes submetidos ao desbridamento artroscópico das lesões extensas e irreparáveis do manguito rotador. Métodos: Foram operados 27 pacientes no período de 2003 a 2007, sendo avaliados 22 desses. O procedimento cirúrgico consistiu de desbridamento artroscópico do coto dos tendões envolvidos, bursectomia, remoção do osteófito acromial e, eventualmente, tenotomia do bíceps e tuberoplastia. RESULTADOS: No pré-operatório todos apresentavam envolvimento dos tendões do supra e infraespinal. Na avaliação pós-operatória, 14 pacientes estavam com o redondo menor íntegro e três com ruptura parcial do subescapular. Houve melhora dos critérios da UCLA de 15 no pré-operatório para 31 no pós. Não houve melhora de força muscular, porém ocorreu redução da dor. Conclusão: Desbridamento artroscópico é um procedimento indicado para pacientes idosos com ruptura irreparável do manguito rotador, que tenham boa ADM, baixa demanda funcional e com o principal objetivo de reduzir a dor.OBJECTIVE: To evaluate the results in patients who have undergone arthroscopic debridement of massive and irreparable injury of the rotator cuff. METHODS: 27 patients were operated in the period from 2003 to 2007, during which 22 of them were evaluated. The procedure used consisted of arthroscopic debridement of the related tendons of the residual limb, bursectomy, acromial osteophyte removal, and eventually, biceps tenotomy and tuberoplasty. RESULTS: All patients showed involvement of the supraspinatus and infraspinatus tendons in the preoperative stage. In the postoperative evaluation, 14 patients had an teres minor muscle, and 3 had partial tears of the subscapularis tendon. There was an improvement in the UCLA criteria from 15 preoperatively to 31 postoperatively. There was no improvement in muscular strength, but there was a reduction in the pain. CONCLUSION: Arthroscopic debridement is a recommended procedure for

  8. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery.

    Science.gov (United States)

    Yeranosian, Michael G; Arshi, Armin; Terrell, Rodney D; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

    2014-02-01

    An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Case series; Level of evidence, 4. A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ(2) analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of

  9. Back to Sports After Arthroscopic Revision Bankart Repair.

    Science.gov (United States)

    Buckup, Johannes; Welsch, Frederic; Gramlich, Yves; Hoffmann, Reinhard; Roessler, Philip P; Schüttler, Karl F; Stein, Thomas

    2018-02-01

    Recurrent instability following primary arthroscopic stabilization of the shoulder is a common complication. Young, athletic patients are at the greatest risk of recurring instability. To date, the literature contains insufficient description regarding whether return to sports is possible after revision arthroscopic Bankart repair. Patients presenting with recurrent instability after primary arthroscopic stabilization should expect limitations in terms of their ability to partake in sporting activities after revision surgery. Case series; Level of evidence, 4. Twenty athletes who underwent arthroscopic revision stabilization of the shoulder after failed primary arthroscopic Bankart repair were included in the study after completing inclusion and exclusion criteria surveys. Athletic Shoulder Outcome Scoring System (ASOSS), Shoulder Sport Activity Score (SSAS), and the Subjective Patient Outcome for Return to Sports (SPORTS) scores were determined to assess the participants' ability to partake in sporting activities. Furthermore, sport type and sport level were classified and recorded. To assess function and stability, Rowe, American Shoulder and Elbow Surgeons, Constant-Murley, and Walch-Duplay scores were measured and recorded. Follow-up consultations were carried out after a mean of 28.7 months. The mean age at follow-up examination was 27.75 years. At the time of follow-up, 70% of the patients were able to return to their original sporting activities at the same level. However, 90% of patients described a limitation in their shoulder when participating in their sports. At 28.7 months after surgery, the mean ASOSS score was 76.8; the SSAS score decreased from 7.85 before first-time dislocation to 5.35 at follow-up ( P SPORTS score was 5.2 out of 10 at the follow-up consultation. Function- and instability-specific scores showed good to excellent results. The mean external rotational deficit for high external rotation was 9.25°, and for low external rotation it was

  10. Arthroscopic Resection of Wrist Ganglion Arising from the Lunotriquetral Joint

    OpenAIRE

    Mak, Michael C. K.; Ho, Pak-cheong; Tse, W. L.; Wong, Clara W. Y.

    2013-01-01

    The dorsal wrist ganglion is the most common wrist mass, and previous studies have shown that it arises from the scapholunate interval in the vast majority of cases. Treatment has traditionally been open excision, and more recently arthroscopic resection has been established as an effective and less invasive treatment method. However, application of this technique to ganglia in atypical locations has not been reported, where open excision is the usual practice. This report describes two cases...

  11. Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears.

    Science.gov (United States)

    Luchetti, R; Atzei, A

    2017-05-01

    We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. IV.

  12. SLAP repair with arthroscopic decompression of spinoglenoid cyst

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    Hashiguchi Hiroshi

    2016-01-01

    Full Text Available Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.

  13. Arthroscopic treatment for snapping scapula

    DEFF Research Database (Denmark)

    Blønd, Lars; Rechter, Simone

    2014-01-01

    of symptoms was 4 years (range 4 months-20 years). Seven previously had arthroscopic operations in the affected shoulder with acromioplasty, with or without acromioclavicular joint resection. The median preoperative WORC score was 35.0 (range 18-74) and significantly increased to 86.4 (range 33...

  14. Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

    Directory of Open Access Journals (Sweden)

    Roberto Yukio Ikemoto

    2013-04-01

    Full Text Available OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%. The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001. Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001, 3º of external rotation (p < 0.396 and two vertebral levels for internal rotation (p < 0.025. CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

  15. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder

    Directory of Open Access Journals (Sweden)

    Marcos Rassi Fernandes

    Full Text Available OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66, predominantly female (90%, six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40% and six secondary (60%. RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001. By the Constant Score (range of motion, there was an increase of 13.8 (average pre to 32 points (average post. CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years.

  16. Short Term Results of Arthroscopic Repair of Subscapularis Tendon Tear

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    Zohreh Zafarani

    2009-11-01

    Full Text Available Background:Despite being the largest rotator cuff tendon of the shoulder,the function and clinical relevance of subscapularis pathology has been largely ignored in the literature.Although many studies have focused on subscapularis tears recently,majority of them reported techniques for open repair. The advent of arthroscopy and   arthroscopic repair techniques has opened new frontiers in the diagnosis and repair of torn rotator cuff tendons, including the subscapularis.In this article,we review shortterm results of arthroscopic subscapularis repair. Method: Ten patients with subscapularis tendon tear of the rotator cuff were studied   prospectively including 8 men and 2 women with an average age of 49.7±12.8 years and an average delay in treatment of 23.3 months. Clinical outcomes, including the UCLAscore were assessed in all patients after 3 months of the surgery. Results: 6 patients were followed regularly for more than 6 months,while other 4 patients had a follow-up period of more than a year. The pain score improved from 1.75 to 9 and the UCLA score from 8.8 to 30.6.Conclusions: rthroscopic repair of subscapularis tendon tear results in significant subjective and objective improvement and high levels of patient satisfaction.  

  17. Multimodal pain management after arthroscopic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten

    Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...

  18. Estudo prospectivo e comparativo dos resultados funcionais após reparo aberto e artroscópico das lesões do manguito rotador Prospective and comparative study on functional outcomes after open and arthroscopic repair of rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2011-10-01

    Full Text Available OBJETIVO: Avaliar prospectivamente o resultado cirúrgico dos pacientes submetidos ao reparo das lesões do manguito rotador por via aberta e artroscópica, quanto ao aspecto funcional, clínico e por exame de ultrassonografia (US, além de comparar a ocorrência de reruptura. MÉTODOS: Foram operados 60 pacientes pelo mesmo cirurgião, sendo 29 pacientes por via aberta e 31 por via artroscópica para reparo das lesões completas do manguito rotador (MR, entre agosto de 2007 e fevereiro de 2009 no Hospital Governador Israel Pinheiro (HGIP e Hospital Mater Dei (HMD em Belo Horizonte, MG. Os pacientes foram avaliados funcionalmente através do escore da UCLA feito no pré e no pós-operatório e exames de ressonância magnética realizados no pré-operatório. Todos os pacientes foram reavaliados com um período mínimo de 12 meses de pós-operatório, quando foi realizado também exame de US. RESULTADOS: Dos 29 pacientes operados por via aberta, 27 (93,1% apresentaram resultados bons/excelentes, com UCLA médio de 32 no pós-operatório. O seguimento médio foi de 14 meses. Três pacientes apresentaram reruptura ao US, sendo que um deles permaneceu assintomático. Dos 31 pacientes operados por via artroscópica, 29 (93,5% apresentaram resultados bons/excelentes, com UCLA médio de 33 no pós-operatório. O seguimento médio foi de 19 meses. Dois pacientes apresentaram reruptura, sendo que um deles permaneceu assintomático, e um paciente evoluiu com soltura de âncora com resultado insatisfatório. CONCLUSÃO: O reparo das lesões do manguito rotador apresenta bons resultados tanto por via aberta como artroscópica, com resultados funcionais semelhantes entre os grupos, bem como a taxa de reruptura.OBJECTIVE: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to

  19. Focal uptake at the rotator interval or inferior capsule of shoulder on "1"8F-FDG PET/CT is associated with adhesive capsulitis

    International Nuclear Information System (INIS)

    Sridharan, Radhika; Engle, Mitchell Philip; Garg, Naveen; Wei, Wei; Amini, Behrang

    2017-01-01

    To determine if focal increased uptake at the rotator interval (RI) and/or inferior capsule (IC) on"1"8F-FDG PET/CT (''positive PET'') predicts the presence of adhesive capsulitis (AC). Three populations were retrospectively examined. Group 1 included 1,137 consecutive "1"8F-FDG PET/CT studies and was used to determine the prevalence of focal uptake at the RI or IC. Group 2 included 361 cases from a 10-year period with "1"8F-FDG PET/CT and MRI of shoulder performed within 45 days of each other and was used to enrich the study group. Group 3 included 109 randomly selected patients from the same time frame as groups 1 and 2 and was used to generate the control group. The study group consisted of 15 cases from the three groups, which had positive PET findings. PET/CT images were assessed in consensus by two musculoskeletal radiologists. The reference standard for a diagnosis of AC was clinical and was made by review of the medical record by a pain medicine physician. The prevalence of focal activity at either the RI or IC (''positive PET'') was 0.53%. Nine patients had a clinical diagnosis of AC and 15 patients had a positive PET. The sensitivity and specificity of PET for detection of AC was 56% and 87%, respectively. PET/CT had a positive likelihood ratio for AC of 6.3 (95% CI: 2.8-14.6). Increased uptake at the RI or IC on PET/CT confers a moderate increase in the likelihood of AC. (orig.)

  20. Focal uptake at the rotator interval or inferior capsule of shoulder on {sup 18}F-FDG PET/CT is associated with adhesive capsulitis

    Energy Technology Data Exchange (ETDEWEB)

    Sridharan, Radhika [Universiti Kebangsaan Malaysia Medical Centre, Department of Diagnostic Imaging, Kuala Lumpur (Malaysia); Engle, Mitchell Philip [The University of Texas M.D. Anderson Cancer Center, Department of Pain Medicine, Houston, TX (United States); Garg, Naveen [The University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Imaging, Houston, TX (United States); Wei, Wei; Amini, Behrang [The University of Texas M.D. Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States)

    2017-04-15

    To determine if focal increased uptake at the rotator interval (RI) and/or inferior capsule (IC) on{sup 18}F-FDG PET/CT (''positive PET'') predicts the presence of adhesive capsulitis (AC). Three populations were retrospectively examined. Group 1 included 1,137 consecutive {sup 18}F-FDG PET/CT studies and was used to determine the prevalence of focal uptake at the RI or IC. Group 2 included 361 cases from a 10-year period with {sup 18}F-FDG PET/CT and MRI of shoulder performed within 45 days of each other and was used to enrich the study group. Group 3 included 109 randomly selected patients from the same time frame as groups 1 and 2 and was used to generate the control group. The study group consisted of 15 cases from the three groups, which had positive PET findings. PET/CT images were assessed in consensus by two musculoskeletal radiologists. The reference standard for a diagnosis of AC was clinical and was made by review of the medical record by a pain medicine physician. The prevalence of focal activity at either the RI or IC (''positive PET'') was 0.53%. Nine patients had a clinical diagnosis of AC and 15 patients had a positive PET. The sensitivity and specificity of PET for detection of AC was 56% and 87%, respectively. PET/CT had a positive likelihood ratio for AC of 6.3 (95% CI: 2.8-14.6). Increased uptake at the RI or IC on PET/CT confers a moderate increase in the likelihood of AC. (orig.)

  1. Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

    Science.gov (United States)

    Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J; Miller, Bruce

    2018-03-01

    Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.

  2. Glenohumeral position during CT arthrography with arthroscopic correlation: optimization of diagnostic yield

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Gill, Corey M.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Taneja, Atul K. [Hospital Israelita Albert Einstein, Hospital do Coracao (HCor) and Teleimagem, Musculoskeletal Imaging, Sao Paulo, SP (Brazil)

    2017-06-15

    To evaluate the diagnostic yield of two acquisitions of single-contrast CT arthrography (CTA) of the shoulder in internal, neutral, or external glenohumeral rotation with arthroscopic correlation. The CT study was obtained using two acquisitions (first the humerus positioned in maximum tolerated external rotation with the arm along the body and the second with the humerus in internal rotation with the palm placed flat on the table). Two independent readers blinded to the arthroscopic results evaluated the CTA images for labral tears, glenoid bone loss/fractures, and cartilage loss. For each CTA acquisition, sensitivity and specificity for detection of the aforementioned pathology were assessed. Inter-reader agreement was quantified by weighted k statistics. Sensitivity and specificity for detecting anteroinferior or posterior labral tears was highest with neutral rotation (sensitivity 91-100%, specificity 61-100%). For glenoid fracture, sensitivity (67%) was highest with external rotation and specificity (100%) was highest with internal rotation. For cartilage loss, sensitivity (64%) and specificity (89%) was highest with external rotation and neutral rotation, respectively. Neutral rotation showed high sensitivity and specificity for glenoid fractures and cartilage loss. Inter-reader agreement ranged from fair to very good. Neutral glenohumeral position in shoulder CT arthrography was adequately sensitive and specific for the detection of intra-articular pathology, avoiding the use of more than one acquisition. (orig.)

  3. Morphological classification of acromial spur: correlation between Rockwood tilt view and arthroscopic finding

    Directory of Open Access Journals (Sweden)

    Kongmalai Pinkawas

    2017-01-01

    Full Text Available Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9% was the most common finding followed by the heel spur (27.8%. The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively. These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.

  4. MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER

    Science.gov (United States)

    CELIK, HALUK; SECKIN, MUSTAFA FAIK; AKCAL, MEHMET AKIF; KARA, ADNAN; KILINC, BEKIR ERAY; AKMAN, SENOL

    2017-01-01

    ABSTRACT Objective: Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods: A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results: Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients’ values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion: Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series. PMID:29375258

  5. Análise comparativa do resultado da sutura artroscópica da lesão do manguito rotador em pacientes fumantes e não fumantes Comparative analysis on the result from arthroscopic suturing of rotator cuff injuries between smoking and non-smoking patients

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2011-04-01

    Full Text Available OBJETIVO: Analisar de forma comparativa o resultado da sutura artroscópica da lesão do manguito rotador em pacientes fumantes e não fumantes. MÉTODOS: Foi analisado um grupo de 286 pacientes submetidos à sutura artroscópica de uma lesão primária do manguito rotador no período de 12 de junho de 2002 a 14 de maio de 2008. Os pacientes incluídos no estudo foram avaliados pela escala de UCLA com um seguimento mínimo de 12 meses e médio de 56,52 meses. As variáveis estudadas foram: idade, sexo, lado operado, dominância, perfil de uso de cigarros e índice de UCLA. RESULTADOS: O estudo avaliou um total de 205 pacientes. Foi analisada estatisticamente a média de idade (p = 0,289 e o sexo (p = 0,124 entre o grupo de pacientes fumantes e não fumantes e ambos foram considerados semelhantes. Quando analisamos os pacientes não fumantes (143, verificamos um UCLA médio de 34 (32 a 35. Quando analisamos os pacientes fumantes (51, verificamos um UCLA médio de 33 (29-35. Não houve diferença estatisticamente significativa quando foi avaliado de forma comparativa o UCLA de pacientes não fumantes com o de pacientes fumantes (p = 0,123. Para fins de análise estatística agrupamos as lesões pequenas e médias (107 e comparamos com as grandes e extensas (80 entre pacientes fumantes e não fumantes. Não houve diferença estatisticamente significativa pelo teste de Mann-Whitney quando foi avaliado de forma comparativa o UCLA de lesões pequenas e médias (p = 818. Houve diferença estatisticamente significativa pelo teste de Mann-Whitney quando foi avaliado de forma comparativa o UCLA de lesões grandes e extensas entre os pacientes não fumantes e fumantes, sendo que os pacientes não fumantes apresentaram melhor UCLA (p = 0,038. CONCLUSÃO: O resultado da sutura artroscópica das lesões grandes e extensas do manguito rotador é inferior em pacientes fumantes.OBJECTIVE: To comparatively analyze the results from arthroscopic suturing of rotator

  6. Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

    Science.gov (United States)

    Shim, Jae Woo; Park, Min Jong

    2017-11-01

    Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Arthroscopic Findings in Anterior Shoulder Instability

    OpenAIRE

    Hantes, Michael; Raoulis, Vasilios

    2017-01-01

    Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthros...

  8. ARTHROSCOPIC CORRECTION OF THE INJURIES OF THE COMPLEX «TENDON OF THE BICEPS LONG HEAD - THE ARTICULAR LIP» IN TREATMENT OF PATIENTS WITH FULL-LAYER RUPTURES OF THE ROTATOR CUFF

    Directory of Open Access Journals (Sweden)

    S. Y. Dokolin

    2013-01-01

    Full Text Available Damage of the long head of the biceps at the place of attachment to the articular tubercle supraglenoidal lip of shoulder, to the entrance and throughout intertubercle furrows are common causes of pain and dysfunction of the shoulder joint. At the same clinical manifestations of the morphology of such lesions may be different. The current literature discusses various options of surgical correction of the biceps injury. Variety of methods of surgical treatment and the lack of consensus in support of their application in different patients in different types of injuries were the basis for the present study. A prospective analysis of the functional results of surgical treatment of the 34 - year’s patients with associated rotator cuff (SSP+ISP+SSC+ and the tendon of the biceps muscle in age from 34 to 75 years. Options for surgical correction of the damaged part of the biceps were: biceps tenotomy, biceps tenotomy with intraarticular tenodez of the shoulder to the head before entering intertubercle furrow, biceps tenotomy and extraarticular subpectorialtenodez to the proximal humerus is intertubercle interferrent screw groove, as well as its attachment to the tendon suture large pectoral muscle. Choice of surgical approach depended on the patient's age, level of daily physical activity, morphology and localization of lesions. The best results were obtained when the extra-articular subpectorialtenodez of long head of the biceps to the proximal humerus interferrent screw and suture fixation to the pectoralis major muscle, the average follow-up was 16,6 ± 4,7 months.

  9. 2009 survey results: surgeon practice patterns regarding arthroscopic surgery.

    Science.gov (United States)

    Redfern, John; Burks, Robert

    2009-12-01

    A survey was conducted to collect information on the surgical management and practice preferences of the audience members at a recent continuing medical education conference. Participants were polled on a variety of surgical topics, and their responses were recorded using a wireless audience response system. The answers were tabulated and are presented in this report. The majority of respondents preferred an arthroscopic repair for rotator cuff tears (52%) and shoulder instability (71%). Most (50%) perform single-row repair; 33% perform double-row repair. For simple knee arthroscopy, most use preoperative antibiotics (85%), no tourniquet (53%), and no chemical anticoagulation or only compression boots (69%). For cruciate ligament reconstruction, the majority preferred only a preoperative antibiotic (67%), no chemical anticoagulation or only compression boots (56%), and single-bundle reconstruction (88%) using a transtibial femoral tunnel (78%). Most (47%) prefer an all inside suture-based meniscus repair device.

  10. Analgesia para a sutura artroscópica do manguito rotador: estudo comparativo entre o bloqueio interescalênico do plexo braquial e o bloqueio da bursa subacromial contínuo Management of pain after the rotator cuff arthroscopic suture: comparative study among the interescalenic blockade and the continuous intrabursal infusion

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2007-10-01

    Full Text Available OBJETIVO: Comparar o nível de dor pós-operatória de pacientes submetidos à sutura artroscópica da lesão do manguito rotador (MR que receberam protocolos diferentes de analgesia pós-operatória. Demonstrar a relação entre dor e o sexo do paciente, a dimensão da lesão suturada e a utilização da capsulotomia interna. Verificar a prevalência dos efeitos colaterais. MÉTODO: Foram analisados três grupos de pacientes operados entre 1º de junho de 2004 e 31 de maio de 2007. O grupo I foi composto pelos pacientes que receberam bloqueio interescalênico com ropivacaína a 0,75%. No grupo II, o mesmo bloqueio foi acrescido de 150µg de clonidina. No grupo III foi administrado um bolus de 30ml de ropivacaína a 0,75% para infiltração dos portais artroscópicos e diretamente no espaço subacromial, seguido de infusão contínua de ropivacaína a 0,2% em bomba de infusão. Os pacientes foram submetidos à medição da escala analógica visual (EAV com 24 horas após o procedimento. As variáveis estudadas foram: EAV, sexo, tamanho da lesão, necessidade de capsulotomia interna e prevalência dos efeitos colaterais. O estudo avaliou 196 pacientes, dos quais foram excluídos 51, totalizando n = 145 pacientes. O total de pacientes no grupo I foi de 65; no grupo II, de 19; e no grupo III, de 61. RESULTADOS: O índice da EAV médio encontrado no grupo I foi de 3,88 ± 1,737 (3; no grupo II, de 3,8 ± 1,6 (3; e no grupo III, de 1,95 ± 1,6 (2. Houve diferença significativa ao comparar os grupos I e III (p OBJECTIVE: To compare the level of postoperative pain in patients submitted to arthroscopic suture of a rotator cuff lesion who had different analgesia protocols. To demonstrate the relationship between pain and the gender of the patient, the dimension of the lesion sutured, and the use of internal capsulotomy. To check the prevalence of side effects. METHODS: Three groups of patients operated on between June 01, 2004 and May 31, 2007 were

  11. [Arthroscopic therapy of the unstable shoulder joint--acceptance and critical considerations].

    Science.gov (United States)

    Jerosch, J

    1997-01-01

    The purpose of this study was to document and to present the acceptance of arthroscopically performed stabilising procedures of the glenohumeral joint. In a nationwide survey of instructors of the association of arthroscopy, members of the arthroscopy group of the german orthopedic society, and orthopedic and trauma surgeons with special interest in joint surgery we evaluated the current treatment modalities for patients with unstable shoulder joints. After an average of 2.09 +/- 1.0 shoulder redislocations surgery is recommended. The Bankart-operation (63.4%) is the favourite procedure for open surgery. In a descended order the Weber rotation-osteotomie, the Putti-Platt operation, the Max-Lange procedure, and in a minimal amount of the cases the Bristow-procedure are performed. Looking at the arthroscopic procedures, the distribution is much more equal. The Caspari technique is used by 27.6% and the Morgan technique by 25.1%. Bone anchors are used by 20.4% and the Suretac is used by 18.9% of the surgeons. The anchor knot technique (8%) is only rarely performed. In case of an elongated capsule the majority of the surgeons would not perform arthroscopic surgery. 42.4% of the surgeons judge the arthroscopic technique less secure. However, 38.9% do not see any difference to open procedures. Taking the available information, arthroscopic stabilising procedures seems to have slightly inferior results compared to standard open surgery. The Bankart procedure with or without a capsular shift is still the golden standard.

  12. Arthroscopic surgery using radio-frequency electrocautery

    International Nuclear Information System (INIS)

    Takatsuka, Shigeyuki; Yoshida, Kan; Nakagawa, Kiyomasa; Yamamoto, Etsuhide; Kubota, Yoshiyuki; Narinobou, Masayoshi; Terai, Koichi; Hasegawa, Hiroshi

    2008-01-01

    Arthroscopic surgery using radio-frequency electrocautery was carried out on 23 temporomandibular joints (TMJs) in 13 patients. Because these patients did not respond to conservative therapy, surgery was indicated. Preoperative MRI showed anterior disc displacement without reduction in all patients. Disturbed translation was also recognized in all of the discs and mandibular condyles. Intraoperative arthroscopic examination showed severe fibrous adhesion in the upper joint compartment and disc displacement. Four joints showed perforation between the disc and retrodiscal tissue. Postoperative findings included an increased range of vertical maximal mouth opening and decreased pain on mandibular movement. Analyses of postoperative MRI indicated recovery of disc and condylar translation. These results suggested that the introduction of arthroscopic surgery using radiofrequency electrocautery would significantly reduce the number of patients with osteoarthritic TMJ disorders. (author)

  13. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique

    Science.gov (United States)

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-01-01

    Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  14. Modified Arthroscopic Brostrom Procedure With Bone Tunnels.

    Science.gov (United States)

    Lui, Tun Hing

    2016-08-01

    The open anatomic repair of the anterior talofibular and calcaneofibular ligaments (modified Brostrom procedure) is widely accepted as the standard surgical stabilization procedure for lateral ankle instability that does not respond to conservative measures. Arthroscopic Brostrom procedures with a suture anchor have been reported to achieve both anatomic repair of the lateral ankle ligaments and management of the associated intra-articular lesions. However, the complication rates are higher than open Brostom procedures. Many of these complications are associated with the use of a suture anchor. We report a modified arthroscopic Brostrom procedure in which the anterolateral ankle capsule is anchored to the lateral malleolus through small bone tunnels instead of suture anchors.

  15. Arthroscopic-Assisted Triangular Fibrocartilage Complex Reconstruction.

    Science.gov (United States)

    Chu-Kay Mak, Michael; Ho, Pak-Cheong

    2017-11-01

    Injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. Volar and dorsal radioulnar ligaments and their foveal insertion are the most important stabilizing components of the TFCC. In irreparable tears, anatomic reconstruction of the TFCC aims to restore normal biomechanics and stability of the distal radioulnar joint. We proposed a novel arthroscopic-assisted technique using a palmaris longus tendon graft. Arthroscopic-assisted TFCC reconstruction is a safe and effective approach with outcomes comparable to conventional open reconstruction and may result in a better range of motion from minimizing soft tissue dissection and subsequent scarring. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Examination of rotator cuff re-tear

    International Nuclear Information System (INIS)

    Kitahara, Hiroyuki; Yabe, Yoshihiro; Norimatsu, Takahiro; Adachi, Shinji; Sera, Keisuke

    2010-01-01

    The six-month post-operative re-tear rate in 72 arthroscopic rotator cuff repair cases was 16.3% by MRI. The re-tear rate of massive tears was 50%. We investigated the details of the re-tears by MRI and arthroscopic findings. High re-tear rates were connected with cuff tear size and fatty degeneration of muscle belly. Cases with poor cuff quality in arthroscopically showed high re-tear rate. These results suggest that surgery operation should be performed as soon as possible after diagnosis of cuff tear to obtain good results. Cases with damage of long head of the biceps (LHB) are likely to develop impingement causes of re-tears. Some type of rehabilitation is required to avoid impingement in such cases. (author)

  17. Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability.

    Science.gov (United States)

    Cho, Nam Su; Yi, Jin Woong; Lee, Bong Gun; Rhee, Yong Girl

    2009-11-01

    Only a few studies have provided homogeneous analysis of open revision surgery after a failed arthroscopic Bankart procedure. Open Bankart revision surgery will be effective in a failed arthroscopic anterior stabilization but inevitably results in a loss of range of motion, especially external rotation. Case series; Level of evidence, 4. Twenty-six shoulders that went through traditional open Bankart repair as revision surgery after a failed arthroscopic Bankart procedure for traumatic anterior shoulder instability were enrolled for this study. The mean patient age at the time of revision surgery was 24 years (range, 16-38 years), and the mean duration of follow-up was 42 months (range, 25-97 months). The preoperative mean range of motion was 173 degrees in forward flexion and 65 degrees in external rotation at the side. After revision surgery, the ranges measured 164 degrees and 55 degrees, respectively (P = .024 and .012, respectively). At the last follow-up, the mean Rowe score was 81 points, with 88.5% of the patients reporting good or excellent results. After revision surgery, redislocation developed in 3 shoulders (11.5%), all of which had an engaging Hill-Sachs lesion and associated hyperlaxity (2+ or greater laxity on the sulcus sign). Open revision Bankart surgery for a failed arthroscopic Bankart repair can provide a satisfactory outcome, including a low recurrence rate and reliable functional return. In open revision Bankart surgery after failed stabilization for traumatic anterior shoulder instability, the surgeon should keep in mind the possibility of a postoperative loss of range of motion and a thorough examination for not only a Bankart lesion but also other associated lesions, including a bone defect or hyperlaxity, to lower the risk of redislocation.

  18. Arthroscopic sheath design and technical evaluation

    NARCIS (Netherlands)

    Tuijthof, Gabriëlle J. M.; Blankevoort, Leendert; Herder, Just L.; van Dijk, C. Niek

    2009-01-01

    The maintenance of a clear view on the operation area is essential to perform a minimally invasive procedure In arthroscopy, this is achieved by irrigating the Joint with a saline fluid that is pumped through the joint At present the arthroscopic sheaths are not designed for optimal irrigation,

  19. Osteonecrosis of the knee following arthroscopic meniscectomy

    International Nuclear Information System (INIS)

    Dobado, M. C.; Mota, J.; Roca, M.

    2000-01-01

    Primary osteonecrosis of the knee is characterized by acute onset of pain in elderly individuals who present no risk factors. Osteonecrosis following arthroscopic surgery for meniscal repair is a rare occurrence, the etiology of which remains to be determined. The authors present the magnetic resonance findings in a new case and a review of the related literature. (Author) 7 refs

  20. The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football.

    Science.gov (United States)

    Dickens, Jonathan F; Owens, Brett D; Cameron, Kenneth L; DeBerardino, Thomas M; Masini, Brendan D; Peck, Karen Y; Svoboda, Steven J

    2017-07-01

    There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability. To examine the effect of "subcritical" bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population. Case-control study; Level of evidence, 3. Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization. Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with football ( X 2 = 15.80, P 13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.

  1. Tenotomia com ou sem tenodese da cabeça longa do bíceps no reparo artroscópico do manguito rotador Tenotomy with or without tenodesis of the long head of the biceps for arthroscopic repair of the rotator cuff

    Directory of Open Access Journals (Sweden)

    Roberto Yukio Ikemoto

    2012-01-01

    Full Text Available OBJETIVO: Comparação dos resultados funcionais nos pacientes submetidos à tenotomia com ou sem tenodese da CLB associada ao reparo da lesão do manguito rotador por visão artroscópica, com seguimento superior a dois anos. MÉTODO: Estudo retrospectivo não randomizado, com nível de evidência III, em que foram revisados os prontuários e realizada reavaliação clínica de 77 pacientes com lesão da cabeça longa do bíceps, sendo que 55 foram submetidos à tenotomia sem tenodese e 22 à tenotomia com a tenodese, com seguimento ambulatorial maior que dois anos. Foram avaliados idade, dominância, lado operado, tamanho das lesões classificadas por Gartsman, arco do movimento pré e pós-operatório, presença ou ausência do sinal do Popeye, dor na corredeira bicipital, avaliação segundo a escala University of California at Los Angeles e Elbow Strength Index. RESULTADOS: O UCLA médio total da amostra foi de 16,92 (8 a 25 para 31,45 (13 a 35 (p OBJECTIVE: To compare the functional results among patients un dergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff in juries, with a minimum two-year follow-up. METHOD: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of mo tion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA score and the elbow strength index. RESULTS: The mean UCLA score of the sample went from 16.92 (range: 8 to 25 to 31.45 (range: 13 to 35 (p < 0

  2. Avaliação da integridade anatômica por exame de ultrassom e funcional pelo índice de Constant & Murley do manguito rotador após reparo artroscópico Evaluation of anatomical integrity using ultrasound images, and functional integrity by the Constant & Murley score, of the rotator cuff following arthroscopic repair

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    2010-01-01

    large/massive in 25 (23%. The clinical results were assessed according to the Constant and Murley criteria. The results of the ultrasound (US refer to the reports of several radiologists. Statistical analysis was carried out according to the chi-square methods, Fisher's exact test, Student T test, Pearson, Kruscall-Wallis correlation and logistic regression (significance value p < 0.05. RESULTS: the Constant evaluation average was 85.3 ± 10.06 (46 to 99 in the normal shoulders and 83.96 ± 8.67 (59 to 99 in the operated shoulders (p = 0.224. Excellent and good results were found in 74 shoulders (67%, satisfactory and adequate results in 32 (29% and poor results in 4 (4%. The ultrasound evaluation showed 38 shoulders with re-rupture (35%, absence of rupture in 71 (65%. Of the 74 (67% shoulders with excellent/good results, 22 (30% presented re-rupture in the ultrasound report (p = 0.294. Of the four shoulders (4% with poor results, two (50% presented intact tendons (p = 0.294. CONCLUSION: There is no statistically valid correlation between the ultrasound diagnosis and the clinical evaluation of results in patients who underwent arthroscopic repair to treat full tear lesions of the rotator cuff. The clinical results in complete rotator cuff repairs under arthroscopy present a high level of functional recovery (Constant 83.96 when compared with the contralateral shoulder. The postoperative ultrasound image reports present a high percentage of re-rupture (35%; The postoperative strength is higher in patients aged under 60 years (p = 0.002 and in cases of lesions less than or equal to 3 cm. (p = 0.003.

  3. A Simple Method for Identifying the Acromioclavicular Joint During Arthroscopic Procedures

    OpenAIRE

    Javed, Saqib; Heasley, Richard; Ravenscroft, Matt

    2013-01-01

    Arthroscopic acromioclavicular joint excision is performed via an anterior portal and is technically demanding. We present a simple method for identifying the acromioclavicular joint during arthroscopic procedures.

  4. Integral Suture-Handling Techniques for Arthroscopic Sliding Knots

    OpenAIRE

    Kanchanatawan, Wichan; Kongtharvonskul, Jatupon; Dorjiee, Gem; Suppauksorn, Sunikom; Pornvoranunt, Umpire; Karchana, Pongsakorn

    2016-01-01

    In arthroscopic tissue repair, the final step is achieving adequate tissue approximation with a secure knot. The sliding knot is widely preferred over the nonsliding knot, with numerous publications describing knot configurations. However, in the literature there are few published descriptions of suture-handling techniques, even though they are fundamental to arthroscopic knot tying. We describe integral suture-handling techniques for arthroscopic sliding knots to improve the surgeon's perfor...

  5. Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

    OpenAIRE

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

    2014-01-01

    Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad,...

  6. Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies.

    Science.gov (United States)

    Hawi, Nael; Liodakis, Emmanouil; Garving, Christina; Habermeyer, Peter; Tauber, Mark

    2017-08-01

    This study aimed to demonstrate the prevalence of lesions in the biceps pulley complex in a representative, consecutive series of rotator cuff tears and rotator cuff interval treatments. We also analyzed associated tear pattern of rotator cuff injuries and superior labrum anterior-posterior (SLAP) lesions. We evaluated the relationships of these lesions to traumatic genesis and the prevalence of pulley lesions in revision cases. This retrospective study analyzed all pre- and intra-operative documentation on arthroscopic rotator cuff reconstructions and isolated pulley lesion treatments performed by a single surgeon over 2 consecutive years. According to Habermeyer et al., we classified cases into four groups, based on the presence of additional or related complete or partial rotator cuff tears, SLAP lesions, trauma, and primary or revision surgery. Among 382 patients with rotator cuff tears, 345 (90.3%) had an injured pulley system; 151 (43.8%) had partial tears of the rotator cuff; out of these, 106 (30.6%) were articular-sided. All of these articular-sided partial tears showed extension into the pulley complex. In 154 cases (44.6%), history of shoulder trauma was associated with the beginning of symptoms. In addition, concomitant SLAP lesions occurred in 25-62% of pulley lesions, correlating with the severity of pulley lesions. Among the 345 cases, there have been 32 (9.3%) revision cases where a pulley lesion was intra-operatively identified and addressed. Pulley complex lesions are present in 90.3% of surgically treated rotator cuff lesions, particularly in articular-sided injuries. In addition, we found a significant relationship between the incidence of SLAP lesions and the severity of pulley lesions. It seems reasonable to assume an important role of pulley system injuries in the pathogenesis of rotator cuff lesions.

  7. Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair.

    Science.gov (United States)

    Mollon, Brent; Mahure, Siddharth A; Ensor, Kelsey L; Zuckerman, Joseph D; Kwon, Young W; Rokito, Andrew S

    2016-10-01

    To quantify the incidence of and identify the risk factors for subsequent shoulder procedures after isolated SLAP repair. New York's Statewide Planning and Research Cooperative System database was searched between 2003 and 2014 to identify individuals with the sole diagnosis of a SLAP lesion who underwent isolated arthroscopic SLAP repair. Patients were longitudinally followed up for a minimum of 3 years to analyze for subsequent ipsilateral shoulder procedures. Between 2003 and 2014, 2,524 patients met our inclusion criteria. After 3 to 11 years of follow-up, 10.1% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair. The mean time to repeat shoulder surgery was 2.3 ± 2.1 years. Subsequent procedures included subacromial decompression (35%), debridement (26.7%). repeat SLAP repair (19.7%), and biceps tenodesis or tenotomy (13.0%). After isolated SLAP repair, patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.36-6.21; P = .005), whereas age older than 30 years was an independent risk factor for subsequent acromioplasty (OR, 2.3; 95% CI, 1.4-3.7; P surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. In addition, the number of isolated SLAP repairs performed has decreased over time, and management of failed SLAP repair has shifted toward biceps tenodesis or tenotomy over revision SLAP repair in more recent years. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Virtual MR arthroscopy of the shoulder: image gallery with arthroscopic correlation of major pathologies in shoulder instability.

    Science.gov (United States)

    Stecco, A; Volpe, D; Volpe, N; Fornara, P; Castagna, A; Carriero, A

    2008-12-01

    The purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well-assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology. We enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa--before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radiologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images. These images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings. Although in our pilot study the VA findings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images.

  9. Arthroscopic approach and anatomy of the hip.

    Science.gov (United States)

    Aprato, Alessandro; Giachino, Matteo; Masse, Alessandro

    2016-01-01

    Hip arthroscopy has gained popularity among the orthopedic community and a precise assessment of indications, techniques and results is constantly brought on. In this chapter the principal standard entry portals for central and peripheral compartment are discussed. The description starts from the superficial landmarks for portals placement and continues with the deep layers. For each entry point an illustration of the main structures encountered is provided and the principal structures at risk for different portals are accurately examined. Articular anatomical description is carried out from the arthroscope point of view and sub-divided into central and peripheral compartment. The two compartments are systematically analyzed and the accessible articular areas for each portal explained. Moreover, some anatomical variations that can be found in the normal hip are reported. The anatomical knowledge of the hip joint along with a precise notion of the structures encountered with the arthroscope is an essential requirement for a secure and successful surgery. Level of evidence: V.

  10. Arthroscopic management of painful first metatarsophalangeal joint

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    Debnath U

    2005-01-01

    Full Text Available Background: Arthroscopy of the great toe MTP joint has been practiced with favourable outcomes. A range of indications have been described ranging from synovitis to osteochondral defects. The purpose of the present study was to describe our technique and to assess the functional outcome following arthroscopic management of Hallux MTP disorders using AOFAS scoring system. Methods: We describe the technique of Hallux MTP joint arthroscopy in twenty patients. Indications included hallux rigidus with osteophytes, chondromalacia, OCDs, loose bodies, arthrofibrosis, synovitis, tophaceous gout arthritis and intra-articular fractures of MTP joint. All patients had been evaluated clinically and radiologically with record of their AOFAS scores pre-operatively. At a minimum follow-up of two years the clinical assessment was carried out with AOFAS scores. Results: The mean pre-operative and post-operative AOFAS score were 47 (range 10-78 and 97 (87 -100 respectively. The patient with intra-articular fracture had an excellent outcome following arthroscopic reduction of the fracture. Conclusion: Arthroscopic management of painful hallucial MTP joint is a specialized technique, which if performed for the right indications, gives a favourable outcome with minimal complications.

  11. Arthroscopic repair of chronic lateral ankle instability.

    Science.gov (United States)

    Corte-Real, Nuno M; Moreira, Rodrigo M

    2009-03-01

    The current "gold standard'' for treatment of chronic lateral ankle instability is the Broström-Gould procedure. Most authors recommend this type of operation even after an arthroscopic inspection of the joint. We review our results with an arthroscopic method of lateral ankle ligament repair. A method of arthroscopic lateral ligament repair with an anchor placed in the fibula is described. We used this technique on 31 consecutive patients (28 were available for followup). Twenty-one patients had work or traffic accidents, four suffered casual falls. and three had sport-related lesions. The patients were evaluated after 24.5 month average followup. The average postoperative AOFAS score was 85.3 (82.3 in the workers-compensation group and 94.4 in the others) and average satisfaction was 3.8 (3.5 to workers-compensation and 4.6 for the others). Complications occurred in nine patients (29%), but only three cases had ongoing problems. We had two recurrences (another sprain without instability on the stress radiograph). Three patients had some wound healing problems and three had injuries of the superficial peroneal nerve, one of which is persistent. One patient developed a deep venous thrombosis postoperatively. With this method, we achieved good clinical results. We had several complications but most of them were minor. It was a simple procedure with less morbidity to most patients. We believe it produced an anatomical repair of the lateral ligament with clinical and functional results similar to other techniques.

  12. Efficacy of holmium. Yttrium-aluminium-garnet (Ho: YAG) laser therapy for arthroscopic synovectomy of rheumatoid arthritis

    International Nuclear Information System (INIS)

    Inoue, Yasuo; Inoue, Kazuhiko; Kanbe, Katsuaki

    2008-01-01

    To clarify the efficacy of holmium: yttrium-aluminium-garnet (Ho: YAG) laser therapy for arthroscopic synovectomy of rheumatoid arthritis (RA), we treated 13 shoulders of 11 RA patients of whom 1 was stage I, 7 stage II, 2 stage III, and 1 stage IV. The duration of RA is 4.6 years on average and the follow-up period is an average of 14 months. The Ho: YAG laser was set at 10 Watt (W) to treat the bone erosion areas so as to reach the deep zones of the pannus in order to resect the synovium. We compared C-reactive protein (CRP), Disease activity score (DAS) 28 and magnetic resonance image (MRI) findings before and after surgery. We cultured primary synovial cells to assay cytokine production of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α. Morphological examination was performed after treatment with the Ho: YAG laser at 0, 1, 5, 10, 15 and 20 W. We found villous synovium proliferation with vascularity in the rotator interval and supra spinatus tendon in the shoulder joints. In the subacromial bursa, yellow fat tissue and white fibrous soft tissue were detected in almost all shoulders. After synovectomy using the Ho: YAG laser, CRP decreased from an average of 3.6 to 0.8 and DAS28 also decreased from an average of 5.4 to 3.7 at 14 months after surgery. MRI showed decreased panni with synovium and did not precede joint destruction after 14 months in 10 shoulders out of 13 (77%). At 20 W of the Ho: YAG laser treatment, the synovial cells shrank as in apoptosis and the number of cells also decreased. Laser treatment also resulted in the following significant changes: TNF-α production increased at 1, 10, 15 and 20 W (compared with 0 W) but not dose dependently; IL-1β and IL-6 increased up to 10 W (compared with 0 W) but decreased at 15 and 20 W (compared with 10 W). In morphological examination, after treatment with the Ho: YAG laser at 15 W, the synovial cells expanded and the number of cells decreased. Therefore, Ho: YAG laser therapy is effective

  13. Arthroscopic surgery for degenerative knee

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, C B; Roos, E M

    2015-01-01

    . DATA SOURCES: Systematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms. ELIGIBILITY CRITERIA FOR SELECTING...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

  14. Arthroscopic Hip Labral Repair: The Iberian Suture Technique

    OpenAIRE

    Stubbs, Allston J.; Andersen, Jason S.; Mannava, Sandeep; Wooster, Benjamin M.; Howse, Elizabeth A.; Winter, S. Bradley

    2014-01-01

    Arthroscopic hip labral repair has beneficial short-term outcomes; however, debate exists regarding ideal surgical labral repair technique. This technical note presents an arthroscopic repair technique that uses intrasubstance labral suture passage to restore the chondrolabral interface. This “Iberian suture technique” allows for an anatomic repair while posing minimal risk of damage to the labral and chondral tissues.

  15. Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

    OpenAIRE

    Ming-Long Yeh; Chih-Kai Hong; Wei-Ren Su; I-Ming Jou; Cheng-Li Lin; Chii-Jen Lin

    2015-01-01

    Rotator cuff tears are one of the most common disorders of the shoulder and can have significant effects on daily activities as a result of pain, loss of motion and strength. The goal of rotator cuff repair is aimed at anatomic restoration of the rotator cuff tendon to reduce pain and improve the joint function. Recently, arthroscopic repair has been widely accepted for treatment of rotator cuff tears due to its equal or better results than those from open repair. In 2006, a...

  16. Extracapsular approach for arthroscopic treatment of femoroacetabular impingement: clinical and radiographic results and complications

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVES: To evaluate the clinical and radiographic results and complications relating to patients undergoing arthroscopic treatment for femoroacetabular impingement by means of an extracapsular approach. METHODS: Between January 2011 and March 2012, 49 patients (50 hips underwent arthroscopic treatment for femoroacetabular impingement, performed by the hip surgery team of the Orthopedic Hospital of Passo Fundo, Rio Grande do Sul. Forty patients (41 hips fulfilled all the requirements for this study. The mean follow-up was 29.1 months. The patients were assessed clinically by means of the Harris Hip score, as modified by Byrd (MHHS, the Non-Arthritic Hip score (NAHS and the internal rotation of the hip. Their hips were also evaluated radiographically, with measurement of the CE angle, dimensions of the joint space, alpha angle, neck-head index, degree of arthrosis and presence of heterotopic ossification of the hip. RESULTS: Out of the 41 hips treated, 31 (75.6% presented good or excellent clinical results. There was a mean postoperative increase of 22.1 points for the MHHS, 21.5 for the NAHS and 16.4° for the internal rotation of the hip ( p< 0.001. Regarding the radiographic evaluation, correction to normal values was observed for the alpha angle and neck-head index, with a mean postoperative decrease of 32.9° and mean increase of 0.10, respectively ( p< 0.001. CONCLUSION: Arthroscopic treatment of femoroacetabular impingement by means of an extracapsular approach presented satisfactory clinical and radiographic results over a mean follow-up of 29.1 months, with few complications.

  17. A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations

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    Jordan, R.W.; Naeem, R.; Srinivas, K.; Shyamalan, G. [Birmingham Heartlands Hospital, Birmingham (United Kingdom)

    2015-05-01

    The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor. (orig.)

  18. A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations

    International Nuclear Information System (INIS)

    Jordan, R.W.; Naeem, R.; Srinivas, K.; Shyamalan, G.

    2015-01-01

    The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor. (orig.)

  19. Development of an Arthroscopic Joint Capsule Injury Model in the Canine Shoulder.

    Directory of Open Access Journals (Sweden)

    David Kovacevic

    Full Text Available The natural history of rotator cuff tears can be unfavorable as patients develop fatty infiltration and muscle atrophy that is often associated with a loss of muscle strength and shoulder function. To facilitate study of possible biologic mechanisms involved in early degenerative changes to rotator cuff muscle and tendon tissues, the objective of this study was to develop a joint capsule injury model in the canine shoulder using arthroscopy.Arthroscopic surgical methods for performing a posterior joint capsulectomy in the canine shoulder were first defined in cadavers. Subsequently, one canine subject underwent bilateral shoulder joint capsulectomy using arthroscopy, arthroscopic surveillance at 2, 4 and 8 weeks, and gross and histologic examination of the joint at 10 weeks.The canine subject was weight-bearing within eight hours after index and follow-up surgeries and had no significant soft tissue swelling of the shoulder girdle or gross lameness. Chronic synovitis and macroscopic and microscopic evidence of pathologic changes to the rotator cuff bony insertions, tendons, myotendinous junctions and muscles were observed.This study demonstrates feasibility and proof-of-concept for a joint capsule injury model in the canine shoulder. Future work is needed to define the observed pathologic changes and their role in the progression of rotator cuff disease. Ultimately, better understanding of the biologic mechanisms of early progression of rotator cuff disease may lead to clinical interventions to halt or slow this process and avoid the more advanced and often irreversible conditions of large tendon tears with muscle fatty atrophy.

  20. All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results.

    Science.gov (United States)

    Giannakos, Antonios; Vezeridis, Peter S; Schwartz, Daniel G; Jany, Richard; Lafosse, Laurent

    2017-01-01

    To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique. Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8 months (range, 15 to 60 months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair. Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan. An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability in this challenging patient population. In our hands, this procedure yields good

  1. Arthroscopic treatment for chronic lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC in patients with chronic lateral epicondylitis that was refractory to conservative treatment. METHODS: Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS for pain. RESULTS: A total of 15 patients (9 men and 6 women were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100. The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used ( p 0.05. CONCLUSION: Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

  2. Arthroscopic treatment for chronic lateral epicondylitis☆

    Science.gov (United States)

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    Objective To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Methods Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. Results A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Conclusion Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure. PMID:26401498

  3. Arthroscopic treatment for chronic lateral epicondylitis.

    Science.gov (United States)

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

  4. Physical Therapy Protocols for Arthroscopic Bankart Repair.

    Science.gov (United States)

    DeFroda, Steven F; Mehta, Nabil; Owens, Brett D

    Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols. The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols. Descriptive epidemiology study. Level 3. Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport. Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 ± 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 ± 2.8 weeks) and full active range of motion (mean, 12.2 ± 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists' (ASSET) consensus protocol. Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients. This study highlights the importance of attending surgeons being very clear and specific with

  5. Chronic ankle instability: Arthroscopic anatomical repair.

    Science.gov (United States)

    Arroyo-Hernández, M; Mellado-Romero, M; Páramo-Díaz, P; García-Lamas, L; Vilà-Rico, J

    Ankle sprains are one of the most common injuries. Despite appropriate conservative treatment, approximately 20-40% of patients continue to have chronic ankle instability and pain. In 75-80% of cases there is an isolated rupture of the anterior talofibular ligament. A retrospective observational study was conducted on 21 patients surgically treated for chronic ankle instability by means of an arthroscopic anatomical repair, between May 2012 and January 2013. There were 15 men and 6 women, with a mean age of 30.43 years (range 18-48). The mean follow-up was 29 months (range 25-33). All patients were treated by arthroscopic anatomical repair of anterior talofibular ligament. Four (19%) patients were found to have varus hindfoot deformity. Associated injuries were present in 13 (62%) patients. There were 6 cases of osteochondral lesions, 3 cases of posterior ankle impingement syndrome, and 6 cases of peroneal pathology. All these injuries were surgically treated in the same surgical time. A clinical-functional study was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean score before surgery was 66.12 (range 60-71), and after surgery it increased up to a mean of 96.95 (range 90-100). All patients were able to return to their previous sport activity within a mean of 21.5 weeks (range 17-28). Complications were found in 3 (14%) patients. Arthroscopic anatomical ligament repair technique has excellent clinical-functional results with a low percentage of complications, and enables patients to return to their previous sport activity within a short period of time. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Arthroscopic Talocalcaneal Coalition Resection in Children.

    Science.gov (United States)

    Knörr, Jorge; Soldado, Francisco; Menendez, Mariano E; Domenech, Pedro; Sanchez, Mikel; Sales de Gauzy, Jérôme

    2015-12-01

    To present the technique and outcomes of arthroscopic talocalcaneal coalition (TCC) resection in pediatric patients. We performed a prospective study of 16 consecutive feet with persistent symptomatic TCCs in 15 children. The mean age was 11.8 years (range, 8 to 15 years), and the mean follow-up period was 28 months (range, 12 to 44 months). A posterior arthroscopic TCC resection was performed. The plantar footprint, subtalar motion, pain, and the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale score were evaluated preoperatively and postoperatively. Preoperative computed tomography (CT) scans were used to classify the coalition according to the Rozansky classification, to measure the percentage of involvement of the surface area, and to determine the degree of hindfoot valgus. Postoperative CT scans at 1 year (n = 15) and 3 years (n = 5) were used to assess recurrences. Patient satisfaction was also evaluated. The TCC distribution according to the Rozansky classification was type I in 7 cases, type II in 3, type III in 3, and type IV in 3. In all cases the arthroscopic approach enabled complete coalition resection. All patients increased by at least 1 stage in the footprint classification and showed clinical subtalar mobility after surgery. All patients showed a statistically significant improvement in pain after surgery except for 1 patient in whom complex regional pain syndrome developed (P < .001). The mean American Orthopaedic Foot & Ankle Society score was 56.8 (range, 45 to 62) preoperatively versus 90.9 (range, 36 to 100) postoperatively, showing a statistically significant increase (P < .001). Preoperative CT scans showed that all TCCs involved the medial subtalar joint facet, with mean involvement of 40.8% of the articular surface. All postoperative CT scans showed complete synostosis resections with no recurrences at final follow-up. At final follow-up, all patients were either satisfied (n = 4 [27%]) or extremely satisfied (n = 10 [67

  7. Rotator cuff tear: A detailed update

    Directory of Open Access Journals (Sweden)

    Vivek Pandey

    2015-01-01

    Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

  8. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings

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    Monu, J.U.V. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pruett, S. [Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Vanarthos, W.J. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pope, T.L. Jr. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States)

    1994-10-01

    Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenbid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery. (orig.)

  9. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings

    International Nuclear Information System (INIS)

    Monu, J.U.V.; Pruett, S.; Vanarthos, W.J.; Pope, T.L. Jr.

    1994-01-01

    Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenbid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery. (orig.)

  10. A CLINICAL STUDY OF ARTHROSCOPIC MANAGEMENT OF ANTERIOR C RUCIATE LIGAMENT INJURIES OF KNEE JOINT

    Directory of Open Access Journals (Sweden)

    Paragjyoti

    2015-09-01

    Full Text Available BACKGROUND : Anterior C ruciate L igament (ACL tear is a common sports injury of the knee. There are a lot of controversies related to the management of this injury and more than 2000 papers have been published on the various aspects of the topic. Arthroscopic reconstruction of the ACL with autogenous graft material is widely used nowadays. The two most commonly used grafts are the central one - third of the patellar ligament (bone - tendon - bone, BTB and the hamstring tendon ( S emitendinosus - gracilis, STG construct but the former graft leads to increased donor site morbidity & hurdles in postoperative rehab & pain. The aim of the study is to study the Arthroscopic management of anterior cruciate ligament injury of knee joint using quadrupled hamstring graft. METHOD: The study was carried out on 30 cases of anterior cruciate ligament injury of knee joint attending the OPD and emergency of department of Orthopaedics, Silchar Medical College & Hospital who met the inclusion criteria. An informed consent was obtained from each patient prior to participation in the study. All the patients were examined in detail and worked up to obtain pre - anaesthetic clearance. X - rays and MRI were done routinely in all the cases. Clinical and radiological parameters were recorded. Arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft was done in all the patients. Concomitant meniscal inju ries were treated according to the merit of the injury. Patients were followed up at regular intervals and outcome variables were assessed and recorded. RESULTS: Results of our study clearly showed that arthroscopic ACL reconstruction using quadrupled hamstring graft is a safe, effective and reproducible procedure in restoring knee function with minimal donor site morbidity. At follow up evaluation, all patients had good outcomes in terms of clinical stability, range of motion and general symptoms. CONCLUSION: From the results in this study

  11. Functionality after arthroscopic debridement of central triangular fibrocartilage tears with central perforations.

    Science.gov (United States)

    Möldner, Meike; Unglaub, Frank; Hahn, Peter; Müller, Lars P; Bruckner, Thomas; Spies, Christian K

    2015-02-01

    To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length. Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement. Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar

  12. Arthroscopic Revision Surgery for Failure of Open Latarjet Technique.

    Science.gov (United States)

    Cuéllar, Adrián; Cuéllar, Ricardo; de Heredia, Pablo Beltrán

    2017-05-01

    To evaluate the efficacy in treating pain, limited range of motion, and continued instability of the Latarjet open technique via the use of arthroscopy. A retrospective review of patients who underwent arthroscopic capsule plication after failure of an open Latarjet technique was performed. Revision surgery was indicated in cases of recurrent instability and associated pain. Only patients with a glenoid defect failed due to capsular redundancy is amenable to successful treatment with arthroscopic capsuloplasty. Arthroscopic approaches can offer a good solution for treating previously failed open Latarjet procedures. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011

    DEFF Research Database (Denmark)

    Thorlund, Jonas B; Hare, Kristoffer B; Lohmander, Stefan

    2014-01-01

    Background - Arthroscopic meniscal surgery is the most common orthopedic procedure, and the incidence has increased in Denmark over the last 10 years. Concomitantly, several randomized controlled trials have shown no benefit of arthroscopic procedures including arthroscopic partial meniscectomy i...

  14. Arthroscopic partial lateral meniscectomy in an otherwise normal knee

    DEFF Research Database (Denmark)

    Scheller, G; Sobau, C; Bülow, J U

    2001-01-01

    To determine the clinical, functional, and radiographic long-term results of patients who underwent arthroscopic partial lateral meniscectomy in an otherwise normal knee. Type of Study: This was a retrospective case-control study....

  15. Performance of arthroscopic irrigation systems assessed with automatic blood detection

    NARCIS (Netherlands)

    Tuijthof, G. J. M.; de Vaal, M. M.; Sierevelt, I. N.; Blankevoort, L.; van der List, M. P. J.

    2011-01-01

    During arthroscopies, bleeding episodes occur as a result of tissue damage. Irrigation systems assist in minimizing these disturbances. The performance of three arthroscopic irrigation systems in clearing bleeding episodes was evaluated objectively. One surgeon performed 99 shoulder arthroscopies

  16. Postoperative fentanyl patch versus subacromial bupivacaine infusion in arthroscopic shoulder surgery.

    Science.gov (United States)

    Merivirta, Riika; Äärimaa, Ville; Aantaa, Riku; Koivisto, Mari; Leino, Kari; Liukas, Antti; Kuusniemi, Kristiina

    2013-07-01

    The purpose of our study was to compare the effectiveness of subacromial bupivacaine infusion and a transdermal fentanyl patch in the treatment of postoperative pain after arthroscopic shoulder surgery. Sixty patients with rotator cuff disease scheduled for elective arthroscopic shoulder surgery were enrolled in the study. For the treatment of postoperative pain, 30 patients constituted group F and received a 12.0-μg/h fentanyl patch for 72 hours and saline solution infusion in a subacromial manner at the rate of 4 mL/h. The remaining 30 patients constituted group B and received a placebo patch and an infusion of 2.5-mg/mL bupivacaine in a subacromial manner for 72 hours. The primary outcome measure was the postoperative numerical rating scale pain score. The consumption of opioids, ibuprofen, and acetaminophen was also recorded. The Constant scores and general recovery were followed up until the 90th postoperative day. There was no statistically significant difference in the numerical rating scale scores (P = .60) between the groups. No differences in the use of rescue analgesic were observed except that the patients receiving bupivacaine used more ibuprofen (median, 1,200 mg v 600 mg) during the day of surgery (P = .042). No difference was found in general recovery between the groups. A fentanyl patch delivering 12-μg/h fentanyl offers an easy and safe treatment option as a part of multimodal analgesia with few adverse effects in the treatment of postoperative pain in a carefully selected patient group after arthroscopic shoulder surgery. Level I, randomized controlled trial. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Arthroscopically-Asissted Achilles Tendon Repair; Long-Term Results

    OpenAIRE

    Turgut, Ak?n; Asfuro?lu, Mert Zeynel

    2014-01-01

    Objectives: The ruptures of the Achilles tendon (AT) are relatively common. Since there is no consensus on the best method of the repair of the AT; the treatment is determined on the preference of the surgeon and the patient. The study evaluating the cadaveric and short term clinical results done by our clinic in 2002, has shown us that arthroscopically Achilles tendon repair can be good choise in achilles tendon ruptures. Methods: Fortyfour patients who underwent arthroscopically assisted ac...

  18. Arthroscopy Techniques: The Premier Arthroscopic Video Library.

    Science.gov (United States)

    Leland, J Martin; Lubowitz, James H; Provencher, Matthew T

    2016-12-01

    Arthroscopy has always been focused on its roots-providing practical, clinically relevant information for the practicing arthroscopist. In the digital age, there is a need for publication platforms dedicated to multimedia presentations, hence the birth of Arthroscopy Techniques, Arthroscopy's online video companion. With over 700 videos, our library is filled with an exceptional collection of arthroscopic educational material, with topics ranging from the basics of arthroscopy to the most complex surgical procedures. One series, published this month, explores elbow arthroscopy with specific attention to describing various elbow portals, patient positioning, and tricks of elbow arthroscopy known only to the masters. If you have yet to view Arthroscopy Techniques, experience the future of arthroscopy today at www.ArthroscopyTechniques.org! Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  19. New arthroscopic assisted technique for ankle instability

    International Nuclear Information System (INIS)

    Gerstner Garces, Juan Ricardo

    2004-01-01

    An assisted arthroscopic technique for chronic ankle instability is presented by the author, together with his results for 27 patients treated between January 2000 and February 2004, with a minimum follow-up of six months. Indications for his technique, according to the rehabilitation protocol of the Medical Centre, included patients with chronic subjective and objective ankle instability, anteroposterior instability, associated anteromedical impingement syndromes, non competitive athletes, patients not displaying defects in the alignment of the axis of foot and ankle, or systemic disorders such as diabetes mellitus, collagenisis or hyperelasticity. Patients were evaluated according to the AOFAS scale for the outcome of ankle procedures, and followed up for a minimum period of six months. Positive results confirm an efficient and effective technique, simple and easy to reproduce, that does not hinder future open anatomical or non-anatomical reconstruction, and in which complications are minimal

  20. Arthroscopic knee anatomy in young achondroplasia patients

    Science.gov (United States)

    del Pilar Duque Orozco, M.; Record, N. C.; Rogers, K. J; Bober, M. B.; Mackenzie, W. G.; Atanda, A.

    2017-01-01

    Abstract Purpose Achondroplasia is the most common form of skeletal dysplasia, affecting more than 250 000 individuals worldwide. In these patients, the developing knee undergoes multiple anatomical changes. The purpose of this study was to characterise the intra-articular knee anatomy in children with achondroplasia who underwent knee arthroscopy. Methods Records of achondroplasia patients who underwent knee arthroscopy between 2009 and 2014 were reviewed. Demographic data, operative reports, follow-up notes, MRI and arthroscopy images were reviewed. Bony, cartilaginous and ligamentous changes were noted. The trochlea sulcus angle was measured from intra-operative arthroscopic images. Results A total of 12 knee arthroscopies in nine patients were performed. The mean age at surgery was 16.9 years (12 to 22). In all patients, the indication for surgery was knee pain and/or mechanical symptoms that were refractory to non-operative treatment. Three anatomical variations involving the distal femur were found in all knees: a deep femoral trochlea; a high A-shaped intercondylar notch; and a vertically oriented anterior cruciate ligament. The average trochlea sulcus angle measured 123°. Pathology included: synovial plica (one knee); chondral lesions (three knees); discoid lateral meniscus (11 knees); and meniscal tears (six knees). All patients were pain-free and returned to normal activity at final follow-up. Conclusion Children with achondroplasia have characteristic distal femur anatomy noted during knee arthroscopy. These variations should be considered normal during knee arthroscopy in these patients. Arthroscopic findings confirmed previous MRI findings within this specific population with the addition of a deep trochlear groove which was not previously reported. PMID:28828058

  1. Arthroscopic skills assessment and use of box model for training in arthroscopic surgery using Sawbones – “FAST” workstation

    Directory of Open Access Journals (Sweden)

    Goyal Saumitra

    2016-01-01

    Full Text Available Purpose: Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules. Methods: Twenty orthopaedic surgeons performed a set of tasks to assess a arthroscopic triangulation, b navigation, c object handling and d meniscus trimming using SAWBONES “FAST” arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; “Novice”, “Beginner”, “Intermediate” and “Advanced” based on previous arthroscopy experience, for analyses of performance. Results: The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p 85% of subjects across all the levels reported improvement in performance with sequential tasks. Conclusion: Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.

  2. Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

    Science.gov (United States)

    Woo, Sung Jong; Jegal, Midum; Park, Min Jong

    2016-01-01

    Background: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. Materials and Methods: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work. Results: Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain. Conclusions: Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability. PMID:27293286

  3. Tratamento artroscópico do impacto femoroacetabular Arthroscopic treatment of femoroacetabular impingement

    Directory of Open Access Journals (Sweden)

    Giancarlo C. Polesello

    2009-06-01

    Full Text Available OBJETIVOS: O propósito deste estudo é avaliar os resultados em curto prazo do tratamento artroscópico do impacto femoroacetabular. A hipótese é a de que os resultados do tratamento artroscópico são favoráveis. MÉTODOS: Entre agosto de 2003 e agosto de 2007, 28 quadris foram submetidos ao tratamento do impacto femoroacetabular pela via artroscópica. A idade média dos pacientes foi de 34 anos, com média de seguimento de 27 meses. Quanto à melhora clínica, os pacientes foram avaliados pré e pósoperatoriamente pelo Harris Hip Score (HHS modificado por Byrd. Os pacientes foram avaliados pré e pós-operatoriamente em relação à rotação interna do quadril acometido. Os valores obtidos nos índices acima foram analisados estatisticamente através do método de Wilcoxon para a avaliação de variáveis não paramétricas. RESULTADOS: O Harris Hip Score médio pré-operatório foi de 54,2 e o pós-operatório, de 94,8 (p OBJECTIVE: The purpose of this study is to evaluate the short-term follow-up results of arthroscopic treatment of femoroacetabular impingement. Our hypothesis is that arthroscopic treatment results are favorable. METHODS: Between August 2003 and August 2007, 28 hips had femoroacetabular impingement treated by hip arthroscopy. The mean age was 34 years, with mean follow-up period of 27 months. Clinical results were graded with the modified Harris hip score, which was measured pre-and postoperatively. Patients had also their internal rotation analyzed. These parameters were calculated by using Wilcoxon's t test for analysis of nonparametric paired samples performed. RESULTS: The mean preoperative Harris Hip Score was 54.2, improving to 94.8 postoperatively (p<0,001. The mean increase was 37.5 points. We had 4 good results (15% and 24 excellent results (85%. Preoperatively, the patients had a mean internal rotation of 17º, and, postoperatively, 36º. The average internal rotation increase was 19º (p<0,001. CONCLUSIONS

  4. Comparison of clinical efficacy among remifentanil, nicardipine, and remifentanil plus nicardipine continuous infusion for hypotensive anesthesia during arthroscopic shoulder surgery.

    Science.gov (United States)

    Kim, Joon Yub; Song, Seong Hun; Cho, Jae Ho; Cho, Hyung Rae

    2017-01-01

    Hypotensive anesthesia is crucial during arthroscopic shoulder surgery to reduce bleeding and allow for clear visibility. The aim of this study was to compare the clinical efficacy of continuous infusion of remifentanil, nicardipine, and remifentanil plus nicardipine to control hypotensive anesthesia in arthroscopic shoulder surgery. For this study, we enrolled 45 consecutive patients who were scheduled to have arthroscopic rotator cuff repair surgery and randomly allocated them into remifentanil (group R, n = 15), nicardipine (group N, n = 15), and remifentanil plus nicardipine (group RN, n = 15) groups. During the surgeries, these drugs were administered with continuous infusion. We analyzed the mean arterial pressure (MAP) and heart rate during surgery, stay time in the recovery room, visual analogue scale (VAS) scores, use of antiemetics in the recovery room, and postoperative blood urea nitrogen and creatinine changes. The VAS score in the recovery room was higher for group R (mean 5.6, SD 1.4) than for groups N (mean 3.9, SD 0.9) and RN (mean 4.0, SD 1.1; p = 0.000). There were no statistical differences regarding other clinical variables among the three groups (all p > 0.05) except for MAP at 120 min of surgery between groups N and RN (N: 84.67 (SD 10.7) mmHg, RN: 65.4 (SD 9.2) mmHg, p = 0.027). The continuous infusion of remifentanil plus nicardipine appeared to be advantageous for maintaining hypotensive anesthesia until 120 min of arthroscopic shoulder surgery without rebound pain in a postanesthesia care unit.

  5. Arthroscopic repair of lateral ankle ligament complex by suture anchor.

    Science.gov (United States)

    Wang, Jingwei; Hua, Yinghui; Chen, Shiyi; Li, Hongyun; Zhang, Jian; Li, Yunxia

    2014-06-01

    Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. Level

  6. Recurrent rotator cuff tear: is ultrasound imaging reliable?

    Science.gov (United States)

    Gilat, Ron; Atoun, Ehud; Cohen, Ornit; Tsvieli, Oren; Rath, Ehud; Lakstein, Dror; Levy, Ofer

    2018-02-02

    The diagnostic workup of the painful shoulder after rotator cuff repair (RCR) can be quite challenging. The aim of this study was to assess the reliability of ultrasonography (US) for the detection of recurrent rotator cuff tears in patients with shoulder pain after RCR. We hypothesized that US for the diagnosis of recurrent rotator cuff tear after RCR would not prove to be reliable when compared with surgical arthroscopic confirmation (gold standard). In this cohort study (diagnosis), we retrospectively analyzed the data of 39 patients with shoulder pain after arthroscopic RCR who had subsequently undergone US, followed by revision arthroscopy. The rotator cuff was evaluated first using US for the presence of retears. Thereafter, revision arthroscopy was performed, and the diagnosis was either established or disproved. The sensitivity and specificity of US were assessed in reference to revision arthroscopy (gold standard). A rotator cuff retear was indicated by US in 21 patients (54%) and by revision arthroscopy in 26 patients (67%). US showed a sensitivity of 80.8% and specificity of 100% in the diagnosis of rotator cuff retears. Omission of partial rotator cuff retears resulted in a spike in sensitivity to 94.7%, with 100% specificity remaining. US imaging is a highly sensitive and specific test for the detection of recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Woodmass JM

    2015-04-01

    Full Text Available Jarret M Woodmass,1 John G Esposito,1 Yohei Ono,1,2 Atiba A Nelson,1 Richard S Boorman,1 Gail M Thornton,1,3 Ian KY Lo1 1Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; 2Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada Purpose: Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods: Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH” OR “acromioclavicular* (text” OR “coracoclavicular* (text” AND “Arthroscopy (MeSH” OR “Arthroscop* (text” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence: IV Results: A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26

  8. Medical Malpractice Litigation Following Arthroscopic Surgery.

    Science.gov (United States)

    Shah, Kalpit N; Eltorai, Adam E M; Perera, Sudheesha; Durand, Wesley M; Shantharam, Govind; Owens, Brett D; Daniels, Alan H

    2018-04-10

    Our study aims to analyze a variety of factors involving malpractice lawsuits following arthroscopy, focusing on reasons for lawsuit and establishing predictors for the outcome of the lawsuit. Two legal databases, VerdictSearch and Westlaw, were queried for arthroscopic cases in adult patients. For all included cases, clinical and demographic data were recorded. The effects of plaintiff demographics, joint involved, lawsuit allegation, case ruling, and size of indemnity payments were assessed. Of the 240 included cases, 62 (26%) resulted in plaintiff verdict, 160 (67%) resulted in defense verdict, and 18 (8%) were settled without trial. Plaintiff demographics (age and sex) had no effect on the case ruling. There was no statistical difference between indemnity awards for plaintiff verdicts ($1,013,494) and settled cases ($848,331; P = .13). Patient death was noted in 20 cases (8.3%); a significantly higher proportion of these cases were settled versus went to trial (P = .0022), including 19 patients (95%) who had knee arthroscopy and 16 deaths (80%) resulting from a pulmonary embolus. Plaintiff verdict or settlement were seen significantly more frequently for vascular complications and wrong-sided surgery. Alternatively, defense verdicts followed lawsuits alleging surgeon technical error. Wrong-sided surgery, retained instruments, deep venous thrombosis, and postoperative infections were seen at a significantly higher proportion after knee arthroscopy than after arthroscopy of other joints. Similarly, neurological injury was significantly associated with elbow and hip arthroscopy, while allegations of technical error by the surgeon and block-related complications were associated with shoulder arthroscopy. Plaintiff verdict or settlement were seen for vascular complications and wrong-sided surgery, while defense verdicts followed lawsuits alleging surgeon technical error and block-related complications. We also identified types of allegations that were associated

  9. Anaesthetic management of shoulder arthroscopic repair in Parkinson′s disease with deep brain stimulator

    Directory of Open Access Journals (Sweden)

    Ranju Gandhi

    2014-01-01

    Full Text Available We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson′s disease (PD with deep brain stimulator (DBS using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.

  10. Arthroscopic ankle arthrodesis with intra-articular distraction.

    Science.gov (United States)

    Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

    2014-01-01

    Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Do Arthroscopic Fluid Pumps Display True Surgical Site Pressure During Hip Arthroscopy?

    Science.gov (United States)

    Ross, Jeremy A; Marland, Jennifer D; Payne, Brayden; Whiting, Daniel R; West, Hugh S

    2018-01-01

    To report on the accuracy of 5 commercially available arthroscopic fluid pumps to measure fluid pressure at the surgical site during hip arthroscopy. Patients undergoing hip arthroscopy for femoroacetabular impingement were block randomized to the use of 1 of 5 arthroscopic fluid pumps. A spinal needle inserted into the operative field was used to measure surgical site pressure. Displayed pump pressures and surgical site pressures were recorded at 30-second intervals for the duration of the case. Mean differences between displayed pump pressures and surgical site pressures were obtained for each pump group. Of the 5 pumps studied, 3 (Crossflow, 24K, and Continuous Wave III) reflected the operative field fluid pressure within 11 mm Hg of the pressure readout. In contrast, 2 of the 5 pumps (Double Pump RF and FMS/DUO+) showed a difference of greater than 59 mm Hg between the operative field fluid pressure and the pressure readout. Joint-calibrated pumps more closely reflect true surgical site pressure than gravity-equivalent pumps. With a basic understanding of pump design, either type of pump can be used safely and efficiently. The risk of unfamiliarity with these differences is, on one end, the possibility of pump underperformance and, on the other, potentially dangerously high operating pressures. Level II, prospective block-randomized study. Copyright © 2017. Published by Elsevier Inc.

  12. Arthroscopic Surgical Technique for an Acute Talar Dome Osteochondral Lesion in a Professional Rugby League Player.

    Science.gov (United States)

    Sullivan, Martin; Fraser, Ethan J; Linklater, James; Harris, Craig; Morgan, Kieran

    2017-06-01

    Talar osteochondral lesions represent challenging clinical entities, particularly in high-demand athletes. Surgical treatment of large lesions often requires a 2-step procedure, or the use of osteotomy in the case of autologous osteochondral transfer, which can delay return to sport. A professional rugby league player underwent surgery for a complex injury to the ankle. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Autologous cartilage was then reimplanted arthroscopically. The patient was allowed full ankle motion from 2 weeks postoperatively, and weightbearing was commenced at 6 weeks. Follow-up imaging and functional outcomes, including return to sport, were assessed at regular intervals. The patient was able to return to professional rugby league by 23 weeks postoperatively. Magnetic resonance imaging at 16 months postoperatively showed restoration of the subchondral plate and osseous infill. At final follow-up, the patient remained pain free and was playing at preinjury level. This report describes good outcomes using a novel, 1-step cartilage repair technique to treat a large talar osteochondral lesion in a professional athlete. Level V: Expert opinion.

  13. The three-portal technique in arthroscopic lateral epicondylitis release

    Directory of Open Access Journals (Sweden)

    Ashok Gowda

    2017-01-01

    Full Text Available Lateral epicondylitis, commonly referred to as tennis elbow, is a syndrome characterized by pain over the origin of the common extensor muscles of the fingers, hand and wrist at the lateral epicondyle. Reports of 70-90% response to conservative treatment at one year have been documented in the literature though refractory cases often require surgical management. Arthroscopic treatment of lateral epicondylitis allows for intra-articular visualization for concomitant pathology and localization of the Extensor Carpi Radialis Brevis tendon. Additionally, compared to the open technique, the arthroscopic technique has a lower morbidity and an earlier return to work and activity. Here we describe a three portal technique for improved visualization in arthroscopic lateral epicondylitis release.

  14. ARTHROSCOPIC TREATMENT OF ANTERIOR IMPINGEMENT IN THE ANKLE

    Directory of Open Access Journals (Sweden)

    Martin Mikek

    2004-12-01

    Full Text Available Background. Anterior soft tissue impingement is a common cause of chronic pain in the ankle. The preferred method of operative treatment is an arthroscopic excision of hypertrophic fibrous and synovial tissue in the anterior part of the ankle joint.Methods. We present the results of arthroscopic treatment of anterior ankle impingement in group of 14 patients.Results. Subjective improvement after the procedure was observed in all patients and 13 of them (93% were without any symptoms after the operation. One patient reported of intermittent pain, especially when walking on uneven grounds.Conclusions. We conclude that arthroscopic excision of hypertrophic synovial tissue in the anterior part of the ankle which causes the symptoms of impingement is a minimally invasive procedure that is both safe and reliable. When used for appropriate indications, an improvement can be expected in over 90% of patients.

  15. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    Science.gov (United States)

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

  16. The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release.

    Science.gov (United States)

    Gowda, Ashok; Kennedy, Gannon; Gallacher, Stacey; Garver, Jennie; Blaine, Theodore

    2016-11-17

    Lateral epicondylitis, commonly referred to as tennis elbow, is a syndrome characterized by pain over the origin of the common extensor muscles of the fingers, hand and wrist at the lateral epicondyle. Reports of 70-90% response to conservative treatment at one year have been documented in the literature though refractory cases often require surgical management. Arthroscopic treatment of lateral epicondylitis allows for intra-articular visualization for concomitant pathology and localization of the Extensor Carpi Radialis Brevis tendon. Additionally, compared to the open technique, the arthroscopic technique has a lower morbidity and an earlier return to work and activity. Here we describe a three portal technique for improved visualization in arthroscopic lateral epicondylitis release.

  17. Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis.

    Science.gov (United States)

    Desai, Mihir J; Ramalingam, Hari; Ruch, David S

    2017-05-01

    Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. We present a case of a young athlete who developed HO after the arthroscopic treatment of lateral epicondylitis. This is a case report chart review of a 24 year old male with lateral epicondylitis. After failing conservative measures, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin ensued. The treatment and patient's final disposition were reported. The patient developed heterotopic ossification of the elbow follow arthroscopic debridement of the ECRB origin. Further surgery was required to excise the heterotopic ossification. Good recovery of motion was achieved. To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.

  18. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery

    International Nuclear Information System (INIS)

    Al-Kaar, M.; Garcia, J.; Fritschy, D.; Bonvin, J.C.

    1997-01-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors)

  19. Arthroscopic meniscectomy in medial compartment osteoarthritis of the knee

    International Nuclear Information System (INIS)

    Noguchi, Joji; Shimoyama, Gishichiro; Shinozaki, Toshiro; Nagata, Kensei

    2007-01-01

    The purpose of this research is to evaluate the results of arthroscopic meniscectomy in medial compartment osteoarthritis of the knee. The operation was performed on 25 knee joints (8 male, 17 female) with the mean age of 67 years. The mean period of follow-up was 19 months. Clinical results were more or less excellent, but radiological assessment suggested slight osteoarthritic changes. In addition, two cases progressed to subchondral bone collapse. Of 12 cases which had no bone marrow edema on MRI before surgery, six (50%) cases showed it at follow-up. These findings suggest a possible relationship between arthroscopic meniscectomy and later appearance of osteonecrosis in some cases. (author)

  20. Incidence of retear with double-row versus single-row rotator cuff repair.

    Science.gov (United States)

    Shen, Chong; Tang, Zhi-Hong; Hu, Jun-Zu; Zou, Guo-Yao; Xiao, Rong-Chi

    2014-11-01

    Rotator cuff tears have a high recurrence rate, even after arthroscopic rotator cuff repair. Although some biomechanical evidence suggests the superiority of the double-row vs the single-row technique, clinical findings regarding these methods have been controversial. The purpose of this study was to determine whether the double-row repair method results in a lower incidence of recurrent tearing compared with the single-row method. Electronic databases were systematically searched to identify reports of randomized, controlled trials (RCTs) comparing single-row with double-row rotator cuff repair. The primary outcome assessed was retear of the repaired cuff. Secondary outcome measures were the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Constant shoulder score, and the University of California, Los Angeles (UCLA) score. Heterogeneity between the included studies was assessed. Six studies involving 428 patients were included in the review. Compared with single-row repair, double-row repair demonstrated a lower retear incidence (risk ratio [RR]=1.71 [95% confidence interval (CI), 1.18-2.49]; P=.005; I(2)=0%) and a reduced incidence of partial-thickness retears (RR=2.16 [95% CI, 1.26-3.71]; P=.005; I(2)=26%). Functional ASES, Constant, and UCLA scores showed no difference between single- and double-row cuff repairs. Use of the double-row technique decreased the incidence of retears, especially partial-thickness retears, compared with the single-row technique. The functional outcome was not significantly different between the 2 techniques. To improve the structural outcome of the repaired rotator cuff, surgeons should use the double-row technique. However, further long-term RCTs on this topic are needed. Copyright 2014, SLACK Incorporated.

  1. Rotating flow

    CERN Document Server

    Childs, Peter R N

    2010-01-01

    Rotating flow is critically important across a wide range of scientific, engineering and product applications, providing design and modeling capability for diverse products such as jet engines, pumps and vacuum cleaners, as well as geophysical flows. Developed over the course of 20 years' research into rotating fluids and associated heat transfer at the University of Sussex Thermo-Fluid Mechanics Research Centre (TFMRC), Rotating Flow is an indispensable reference and resource for all those working within the gas turbine and rotating machinery industries. Traditional fluid and flow dynamics titles offer the essential background but generally include very sparse coverage of rotating flows-which is where this book comes in. Beginning with an accessible introduction to rotating flow, recognized expert Peter Childs takes you through fundamental equations, vorticity and vortices, rotating disc flow, flow around rotating cylinders and flow in rotating cavities, with an introduction to atmospheric and oceanic circul...

  2. Rotational seismology

    Science.gov (United States)

    Lee, William H K.

    2016-01-01

    Rotational seismology is an emerging study of all aspects of rotational motions induced by earthquakes, explosions, and ambient vibrations. It is of interest to several disciplines, including seismology, earthquake engineering, geodesy, and earth-based detection of Einstein’s gravitation waves.Rotational effects of seismic waves, together with rotations caused by soil–structure interaction, have been observed for centuries (e.g., rotated chimneys, monuments, and tombstones). Figure 1a shows the rotated monument to George Inglis observed after the 1897 Great Shillong earthquake. This monument had the form of an obelisk rising over 19 metres high from a 4 metre base. During the earthquake, the top part broke off and the remnant of some 6 metres rotated about 15° relative to the base. The study of rotational seismology began only recently when sensitive rotational sensors became available due to advances in aeronautical and astronomical instrumentations.

  3. Haptic feedback can provide an objective assessment of arthroscopic skills.

    Science.gov (United States)

    Chami, George; Ward, James W; Phillips, Roger; Sherman, Kevin P

    2008-04-01

    The outcome of arthroscopic procedures is related to the surgeon's skills in arthroscopy. Currently, evaluation of such skills relies on direct observation by a surgeon trainer. This type of assessment, by its nature, is subjective and time-consuming. The aim of our study was to identify whether haptic information generated from arthroscopic tools could distinguish between skilled and less skilled surgeons. A standard arthroscopic probe was fitted with a force/torque sensor. The probe was used by five surgeons with different levels of experience in knee arthroscopy performing 11 different tasks in 10 standard knee arthroscopies. The force/torque data from the hand and tool interface were recorded and synchronized with a video recording of the procedure. The torque magnitude and patterns generated were analyzed and compared. A computerized system was used to analyze the force/torque signature based on general principles for quality of performance using such measures as economy in movement, time efficiency, and consistency in performance. The results showed a considerable correlation between three haptic parameters and the surgeon's experience, which could be used in an automated objective assessment system for arthroscopic surgery. Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  4. Arthroscopic treatment of bony loose bodies in the subacromial space

    Directory of Open Access Journals (Sweden)

    Wei Li

    2015-01-01

    Conclusion: The mechanism of formation of bony loose bodies is not clear, may be associated with synovial cartilage metaplasia. Arthroscopic removal of loose bodies and bursa debridement is a good option for treatment of the loose body in the subacromial space, which can receive good function.

  5. Substantial disability 3 months after arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Roos, Ewa M.; Roos, H P; Ryd, L

    2000-01-01

    To our knowledge, this is the first prospective study using validated questionnaires to assess patient-relevant outcomes after arthroscopic partial meniscectomy. Data from the Knee Injury and Osteoarthritis Outcome Score (KOOS), the SF-36 Medical Outcomes Study Short-Form Health Survey, and the L...

  6. Possibilities for arthroscopic treatment of the ageing sternoclavicular joint

    DEFF Research Database (Denmark)

    Rathcke, Martin; Tranum-Jensen, Jorgen; Krogsgaard, Michael Rindom

    2017-01-01

    AIM To investigate if there are typical degenerative changes in the ageing sternoclavicular joint (SCJ), potentially accessible for arthroscopic intervention. METHODS Both SCJs were obtained from 39 human cadavers (mean age: 79 years, range: 59-96, 13 F/26 M). Each frozen specimen was divided fro...

  7. Comparison between open and arthroscopic procedure for lateral clavicle resection

    NARCIS (Netherlands)

    Duindam, N.; Kuiper, J.W.P.; Hoozemans, M.J.M.; Burger, B.J.

    2014-01-01

    Purpose: Arthroscopic lateral clavicle resection (LCR) is increasingly used, compared to an open approach, but literature does not clearly indicate which approach is preferable. The goal of this study was to compare function and pain between patients who underwent lateral clavicle resection using an

  8. Current Biomechanical Concepts for Rotator Cuff Repair

    Science.gov (United States)

    2013-01-01

    For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

  9. Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier?

    Science.gov (United States)

    Soeur, L; Desmoineaux, P; Devillier, A; Pujol, N; Beaufils, P

    2016-10-01

    When managed conservatively, lateral epicondylitis often subsides only after considerable time, during which social and occupational activities are severely disrupted. If conservative management fails, a recently introduced option is arthroscopic release of the extensor carpi radialis brevis (ECRB). The primary objective of this study was to compare clinical outcomes of this procedure according to preoperative symptom duration. Earlier arthroscopic release is associated with better functional outcomes. Consecutive patients with arthroscopically managed lateral epicondylitis were included in a retrospective study. Arthroscopy was performed only after at least 6 months of conservative treatment. The criteria to evaluate the clinical outcomes were the Nirschl and Quick-DASH scores, muscle strength, time to pain relief, and percentage of functional recovery. Thirty-five patients were evaluated at a median of 4 years (range: 1-12 years) after surgery. Mean preoperative symptom duration was 18 months (range: 6-106 months) with a mean sick leave duration of 2.3±4.9 months. Postoperatively, mean time to recovery was 37.5 days (range: 7 days to 5 years) and mean sick leave duration was 2.4±2.4 months. The mean Quick-DASH score was 15.9±19.1. The Nirschl score improved significantly, from 26.4±7.9 to 66.3±16.3. The initial muscle strength deficit was 10.1±33.2% and muscle strength at last follow-up was increased by 4.3±30.3%. Symptom duration showed no correlations with any of the clinical outcome measures. Outcomes after arthroscopic release were not associated with symptom duration in this study. Nevertheless, the good clinical outcomes support treatment with arthroscopic release after only 6 months of conservative management. IV, retrospective study. Copyright © 2016. Published by Elsevier Masson SAS.

  10. Fundamental arthroscopic skill differentiation with virtual reality simulation.

    Science.gov (United States)

    Rose, Kelsey; Pedowitz, Robert

    2015-02-01

    The purpose of this study was to investigate the use and validity of virtual reality modules as part of the educational approach to mastering arthroscopy in a safe environment by assessing the ability to distinguish between experience levels. Additionally, the study aimed to evaluate whether experts have greater ambidexterity than do novices. Three virtual reality modules (Swemac/Augmented Reality Systems, Linkoping, Sweden) were created to test fundamental arthroscopic skills. Thirty participants-10 experts consisting of faculty, 10 intermediate participants consisting of orthopaedic residents, and 10 novices consisting of medical students-performed each exercise. Steady and Telescope was designed to train centering and image stability. Steady and Probe was designed to train basic triangulation. Track and Moving Target was designed to train coordinated motions of arthroscope and probe. Metrics reflecting speed, accuracy, and efficiency of motion were used to measure construct validity. Steady and Probe and Track a Moving Target both exhibited construct validity, with better performance by experts and intermediate participants than by novices (P virtual reality modules developed through task deconstruction. Participants with the most arthroscopic experience performed better and were more consistent than novices on all 3 virtual reality modules. Greater arthroscopic experience correlates with more symmetry of ambidextrous performance. However, further adjustment of the modules may better simulate fundamental arthroscopic skills and discriminate between experience levels. Arthroscopy training is a critical element of orthopaedic surgery resident training. Developing techniques to safely and effectively train these skills is critical for patient safety and resident education. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability

    Directory of Open Access Journals (Sweden)

    Abolghasem Zarezade

    2014-01-01

    Full Text Available Background: Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared. Materials and Methods: This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software. Results: Six patients (16.22% had inappropriate condition with ROWE score (score less than 75; of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78. Nine patients (24.32% had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67. Finally, 22 patients (59.46% showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56. According to Fisher′s exact test, there were no significant differences between the two groups (P = 0.15. Conclusion: The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method.

  12. [Efficacies of arthroscopic debridement and olecranon fossa plasty in the treatment of osteoarthritis and posterior elbow impingement].

    Science.gov (United States)

    Liu, Yu-jie; Wang, Jun-liang; Li, Hai-feng; Qi, Wei; Wang, Ning

    2012-07-17

    To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint. Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement. Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases. Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

  13. A novel graphical user interface for ultrasound-guided shoulder arthroscopic surgery

    Science.gov (United States)

    Tyryshkin, K.; Mousavi, P.; Beek, M.; Pichora, D.; Abolmaesumi, P.

    2007-03-01

    This paper presents a novel graphical user interface developed for a navigation system for ultrasound-guided computer-assisted shoulder arthroscopic surgery. The envisioned purpose of the interface is to assist the surgeon in determining the position and orientation of the arthroscopic camera and other surgical tools within the anatomy of the patient. The user interface features real time position tracking of the arthroscopic instruments with an optical tracking system, and visualization of their graphical representations relative to a three-dimensional shoulder surface model of the patient, created from computed tomography images. In addition, the developed graphical interface facilitates fast and user-friendly intra-operative calibration of the arthroscope and the arthroscopic burr, capture and segmentation of ultrasound images, and intra-operative registration. A pilot study simulating the computer-aided shoulder arthroscopic procedure on a shoulder phantom demonstrated the speed, efficiency and ease-of-use of the system.

  14. Interval selection with machine-dependent intervals

    OpenAIRE

    Bohmova K.; Disser Y.; Mihalak M.; Widmayer P.

    2013-01-01

    We study an offline interval scheduling problem where every job has exactly one associated interval on every machine. To schedule a set of jobs, exactly one of the intervals associated with each job must be selected, and the intervals selected on the same machine must not intersect.We show that deciding whether all jobs can be scheduled is NP-complete already in various simple cases. In particular, by showing the NP-completeness for the case when all the intervals associated with the same job...

  15. Global rotation

    International Nuclear Information System (INIS)

    Rosquist, K.

    1980-01-01

    Global rotation in cosmological models is defined on an observational basis. A theorem is proved saying that, for rigid motion, the global rotation is equal to the ordinary local vorticity. The global rotation is calculated in the space-time homogeneous class III models, with Godel's model as a special case. It is shown that, with the exception of Godel's model, the rotation in these models becomes infinite for finite affine parameter values. In some directions the rotation changes sign and becomes infinite in a direction opposite to the local vorticity. The points of infinite rotation are identified as conjugate points along the null geodesics. The physical interpretation of the infinite rotation is discussed, and a comparison with the behaviour of the area distance at conjugate points is given. (author)

  16. Results of Latarjet Coracoid Transfer to Revise Failed Arthroscopic Instability Repairs

    OpenAIRE

    Nicholson, Gregory P.; Rahman, Zain; Verma, Nikhil N.; Romeo, Anthony A.; Cole, Brian J.; Gupta, Anil Kumar; Bruce, Benjamin

    2014-01-01

    Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ?, 11?) that underwent Latarjet cor...

  17. The 25 most cited articles in arthroscopic orthopaedic surgery.

    Science.gov (United States)

    Cassar Gheiti, Adrian J; Downey, Richard E; Byrne, Damien P; Molony, Diarmuid C; Mulhall, Kevin J

    2012-04-01

    The purpose of this study was to use Web of Knowledge to determine which published arthroscopic surgery-related articles have been cited most frequently by other authors by ranking the 25 most cited articles. We furthermore wished to determine whether there is any difference between a categorical "journal-by-journal" analysis and an "all-database" analysis in arthroscopic surgery and whether such a search methodology would alter the results of previously published lists of "citation classics" in the field. We analyzed the characteristics of these articles to determine what qualities make an article important to this subspecialty of orthopaedic surgery. Web of Knowledge was searched on March 7, 2011, using the term "arthroscopy" for citations to articles related to arthroscopy in 61 orthopaedic journals and using the all-database function. Each of the 61 orthopaedic journals was searched separately for arthroscopy-related articles to determine the 25 most cited articles. An all-database search for arthroscopy-related articles was carried out and compared with a journal-by-journal search. Each article was reviewed for basic information including the type of article, authorship, institution, country, publishing journal, and year published. The number of citations ranged from 189 to 567 in a journal-by-journal search and from 214 to 1,869 in an all-database search. The 25 most cited articles on arthroscopic surgery were published in 11 journals: 8 orthopaedic journals and 3 journals from other specialties. The most cited article in arthroscopic orthopaedic surgery was published in The New England Journal of Medicine, which was not previously identified by a journal-by-journal search. An all-database search in Web of Knowledge gives a more in-depth methodology of determining the true citation ranking of articles. Among the top 25 most cited articles, autologous chondrocyte implantation/transplantation is currently the most cited and most popular topic in arthroscopic

  18. Synovial Chondromatosis of the Subacromial Bursa Causing a Bursal-Sided Rotator Cuff Tear

    Directory of Open Access Journals (Sweden)

    Julie A. Neumann

    2015-01-01

    Full Text Available Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up.

  19. Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation

    Directory of Open Access Journals (Sweden)

    Philippe Loriaut

    2017-01-01

    Conclusion: The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

  20. Results of infected total knee arthroplasty treated with arthroscopic debridement and continuous antibiotic irrigation system

    Directory of Open Access Journals (Sweden)

    Che-Wei Liu

    2013-01-01

    Conclusion: Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.

  1. Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study.

    Science.gov (United States)

    Tonogai, Ichiro; Hayashi, Fumio; Tsuruo, Yoshihiro; Sairyo, Koichi

    2018-02-01

    Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Level IV, Anatomic study.

  2. Arthroscopic partial meniscectomy in middle-aged patients with mild or no knee osteoarthritis

    DEFF Research Database (Denmark)

    Hare, Kristoffer B; Lohmander, Stefan; Christensen, Robin

    2013-01-01

    Arthroscopic partial meniscectomy has been shown to be of no benefit to patients with concomitant knee osteoarthritis, but the optimal treatment of a degenerative meniscus tear in patients with mild or no knee osteoarthritis is unknown. This article describes the rationale and methodology...... of a randomized sham-controlled trial to assess the benefit of arthroscopic partial meniscectomy of a medial meniscus tear in patients with mild or no knee osteoarthritis. The objective of the study is to test whether the benefit from arthroscopic partial meniscectomy in patients with knee pain, medial meniscus...... lesion and mild/no knee osteoarthritis, is greater after arthroscopic partial meniscectomy than following sham surgery....

  3. [Posterosuperior impingement of the shoulder in the athlete: results of arthroscopic debridement in 75 patients].

    Science.gov (United States)

    Riand, N; Boulahia, A; Walch, G

    2002-02-01

    patients were very satisfied, 22 were satisfied and 45 were disappointed. Twelve patients had resumed their sports activities at their former level with loaded arm movement and one patient had interrupted all sports activities. At last follow-up, 22 patient had undergone another surgical procedure: 20 derotation osteotomies of the humerus, one anterior stabilization, one acromioplasty. The notion of posterosuperior impingement is increasingly recognized as the cause of pain in thrower athletes. Loaded arm movements produce a physiological contact between the posteriorsuperior edge of the glenoid cavity and the deep aspect of the rotator cuff. Injury results from repeated loaded arm movements in throwers. In our series, all the patients had at least one lesion, either involving the cuff or the labrum. According to the Snyder classification, 80% of the supraspinatus lesions were grade 1 or grade 2. We did not have any full thickness tears. All patients with a normal cuff were found to have a lesion of the posterosuperior labrum. At arthroscopy, dynamic assessment evidenced an impingement between the supraspinatus (or the infraspinatus) and the labrum or the bony edge of the glenoid cavity. Only three patients had a labral lesion anterior to the biceps insertion that could be considered a type 1 or 2 slap lesion. Unlike earlier reports by others, we had disappointing results after debridement: 60% of the patients were disappointed after the procedure and only 40% were satisfied (22 patients) or very satisfied (8 patients). Patient satisfaction depended greatly on the level of sports activity attained after arthroscopy, the eight very satisfied patients had resumed their former level. None of the professional athletes or those competing at the international level were very satisfied with arthroscopic debridement. There was an inverse relationship between level of competition and patient satisfaction after debridement.

  4. ARTHROSCOPIC RECONSTRUCTION OF THE KNEE POSTERIOR CRUCIATE LIGAMENT

    Directory of Open Access Journals (Sweden)

    I. A. Kuznetsov

    2011-01-01

    Full Text Available In this article there were published diagnostic and surgery principles and the clinical results of arthroscopic single bundle posterior cruciate ligament (PCL reconstruction in patients with chronic PCL instability not responding to conservative treatment. There were treated 27 patients with PCL instability since 2006 till 2010. 10 of 27 patients were available for followup with an average elapsed time of 6,1 years between onset of injury and surgery and an average duration of 1,8 years between reconstruction and evaluation. Although there still is some controversy on the indication for treatment of PCL injury, we conclude on the basis of our findings that arthroscopic reconstruction of symptomatic chronic PCL instability can be greatly beneficial.

  5. Arthroscopic treatment for calcific tendinitis; a case report

    Directory of Open Access Journals (Sweden)

    Mihai T. Gavrilă

    2017-05-01

    Full Text Available Calcific tendinitis is a common cause of shoulder pain, peaking in the fourth and fifth decades of life. The excruciate pain; especially during the night is the symptom who brings patient to the doctor. In many cases conservative treatment is the best choice. Sometimes it doesn’t work and is necessary operative treatment. It is presented a case of 60 years old women who had calcific tendinits for several years and accused pain few months with absence of improvement after conservative treatment. The patient was treated surgically with removal of calcium deposit arthroscopically. After surgery, pain relief was dramatic and movement increased rapidly. Results were very good with no complications. As a conclusion, arthroscopic evacuation of calcific deposit could be considered the best solution for patients whose symptomatology fail to improve after conservative treatment.

  6. Arthroscopic management of the contact athlete with instability.

    Science.gov (United States)

    Harris, Joshua D; Romeo, Anthony A

    2013-10-01

    The shoulder is the most commonly dislocated joint in the body, with a greater incidence of instability in contact and collision athletes. In contact and collision athletes that have failed nonoperative treatment, the most important factors to consider when planning surgery are amount of bone loss (glenoid, humeral head); patient age; and shoulder hyperlaxity. Clinical outcomes, instability recurrence rate, and return to sport rate are not significantly different between arthroscopic suture anchor and open techniques. Lateral decubitus positioning with distraction and four portal (including seven-degree and 5-o’clock positions) techniques allow for 360-degree access to the glenoid rim, with placement of at least three sutures anchors below 3 o’clock for optimal results. In patients with significant glenoid bone loss (>20%-25%, inverted pear glenoid), open bone augmentation techniques are indicated and arthroscopic techniques are contraindicated. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Arthroscopic treatment of symptomatic type D medial plica

    OpenAIRE

    Uysal, Mustafa; Asik, Mehmet; Akpinar, Sercan; Ciftci, Feyyaz; Cesur, Necip; Tandogan, Reha N.

    2007-01-01

    We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our...

  8. Clinical outcomes after arthroscopic release for recalcitrant frozen shoulder.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

    2014-09-01

    To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

  9. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    Directory of Open Access Journals (Sweden)

    Benjamin D. Kuhns

    2015-12-01

    Full Text Available Femoroacetabular impingement (FAI is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1 open hip dislocation, (2 reverse peri-acetabular osteotomy, (3 the direct anterior mini-open approach, and (4 arthroscopic surgery for femoroacetabular impingement.

  10. A novel ultrasound-guided shoulder arthroscopic surgery

    Science.gov (United States)

    Tyryshkin, K.; Mousavi, P.; Beek, M.; Chen, T.; Pichora, D.; Abolmaesumi, P.

    2006-03-01

    This paper presents a novel ultrasound-guided computer system for arthroscopic surgery of the shoulder joint. Intraoperatively, the system tracks and displays the surgical instruments, such as arthroscope and arthroscopic burrs, relative to the anatomy of the patient. The purpose of this system is to improve the surgeon's perception of the three-dimensional space within the anatomy of the patient in which the instruments are manipulated and to provide guidance towards the targeted anatomy. Pre-operatively, computed tomography images of the patient are acquired to construct virtual threedimensional surface models of the shoulder bone structure. Intra-operatively, live ultrasound images of pre-selected regions of the shoulder are captured using an ultrasound probe whose three-dimensional position is tracked by an optical camera. These images are used to register the surface model to the anatomy of the patient in the operating room. An initial alignment is obtained by matching at least three points manually selected on the model to their corresponding points identified on the ultrasound images. The registration is then improved with an iterative closest point or a sequential least squares estimation technique. In the present study the registration results of these techniques are compared. After the registration, surgical instruments are displayed relative to the surface model of the patient on a graphical screen visible to the surgeon. Results of laboratory experiments on a shoulder phantom indicate acceptable registration results and sufficiently fast overall system performance to be applicable in the operating room.

  11. Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Yang, Ye; Zeng, Chao; Wei, Jie; Li, Hui; Yang, Tuo; Deng, Zhen-Han; Li, Yu-Sheng; Yang, Tu-Bao; Lei, Guang-Hua

    2017-03-01

    The purpose of this meta-analysis was to compare the efficacy and safety of single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone for pain management following arthroscopic knee surgery. A comprehensive literature search was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine plus morphine and bupivacaine alone for post-operative pain, using MEDLINE (1966-2014), Cochrane Library and EMBASE databases. The weighted mean difference (WMD), relative risk (RR) and their corresponding 95 % confidence intervals (CIs) were calculated using RevMan statistical software. A total of twenty-nine trials (n = 1167) were included. The post-operative visual analog scale (VAS) pain score of the bupivacaine plus morphine group compared with the bupivacaine alone group was significantly lower (WMD -1.15, 95 % CI -1.67 to -0.63, p bupivacaine plus morphine was shown to be significantly better than bupivacaine alone at relieving post-operative pain after arthroscopic knee surgery without increasing the short-term side effects. Routine use of single-dose intra-articular bupivacaine plus morphine is an effective way for pain management after arthroscopic knee surgery. II.

  12. A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study.

    Science.gov (United States)

    Dhir, Shalini; Sondekoppam, Rakesh V; Sharma, Ranjita; Ganapathy, Sugantha; Athwal, George S

    2016-01-01

    The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB. Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion. Pain scores, satisfaction, and adverse effects were recorded in the recovery room, 6 hours, 24 hours, and 7 days after surgery. Combined suprascapular and axillary nerve block provided nonequivalent analgesia when compared with ISB at different time points postoperatively, except on postoperative day 7. Interscalene block had better mean static pain score in the recovery room (ISB 1.80 [95% confidence interval [CI], 1.10-2.50] vs SSAX 5.45 [95% CI, 4.40-6.49; P shoulder surgery. While SSAX provides better quality pain relief at rest and fewer adverse effects at 24 hours, ISB provides better analgesia in the immediate postoperative period. For arthroscopic shoulder surgery, SSAX can be a clinically acceptable analgesic option with different analgesic profile compared with ISB.

  13. ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW

    Directory of Open Access Journals (Sweden)

    M. R. Salikhov

    2017-01-01

    Full Text Available In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р<0,05. VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р<0,05. Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and

  14. Rotating Wavepackets

    Science.gov (United States)

    Lekner, John

    2008-01-01

    Any free-particle wavepacket solution of Schrodinger's equation can be converted by differentiations to wavepackets rotating about the original direction of motion. The angular momentum component along the motion associated with this rotation is an integral multiple of [h-bar]. It is an "intrinsic" angular momentum: independent of origin and…

  15. Rotating dryer

    International Nuclear Information System (INIS)

    Noe, C.

    1984-01-01

    Products to dry are introduced inside a rotating tube placed in an oven, the cross section of the tube is an arc of spiral. During clockwise rotation of the tube products are maintained inside and mixed, during anticlockwise products are removed. Application is made to drying of radioactive wastes [fr

  16. Convex Interval Games

    NARCIS (Netherlands)

    Alparslan-Gok, S.Z.; Brânzei, R.; Tijs, S.H.

    2008-01-01

    In this paper, convex interval games are introduced and some characterizations are given. Some economic situations leading to convex interval games are discussed. The Weber set and the Shapley value are defined for a suitable class of interval games and their relations with the interval core for

  17. Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study.

    Science.gov (United States)

    Bosco, Laura; Zhou, Cheng; Murdoch, John A C; Bicknell, Ryan; Hopman, Wilma M; Phelan, Rachel; Shyam, Vidur

    2017-10-01

    Arthroscopic shoulder surgery can be performed with an interscalene brachial plexus block (ISBPB) alone, ISBPB combined with general anesthesia (GA), or GA alone. Postoperative pain is typically managed with opioids; however, both GA and opioids have adverse effects which can delay discharge. This retrospective study compares the efficacy of four methods of anesthesia management for arthroscopic shoulder surgery. Charts of all patients who underwent shoulder surgery by a single surgeon from 2012-2015 were categorized by analgesic regimen: GA only (n = 177), single-shot ISBPB only (n = 124), or pre- vs postoperative ISBPB combined with GA (ISBPB + GA [n = 72] vs GA + ISBPB [n = 52], respectively). The primary outcome measure was the time to discharge from the postanesthesia care unit (PACU). Mean (SD) time in the PACU ranged from 70.5 (39.9) min for ISBPB only to 111.2 (56.9) min for GA only. Use of ISBPB in any combination and regardless of timing resulted in significantly reduced PACU time, with a mean drop of 27.2 min (95% confidence interval [CI], 17.3 to 37.2; P shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.

  18. ARTHROSCOPIC TREATMENT OF THE LATERAL ELBOW PAIN –OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Oskar Zupanc

    2008-01-01

    Arthroscopic treatment of the lateral elbow pain has been proved to be very effectiveespecially in younger population and in patients with early elbow osteoarthritis. The lengthof hospital stay is reduced. However, the length of rehabilitation depends on the stage ofelbow osteoarthritis and extensiveness of the arthroscopic intervention

  19. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex.

    Science.gov (United States)

    Mathoulin, C L

    2017-07-01

    This review includes updated understanding of the roles of intrinsic and extrinsic carpal ligaments in scapholunate instability and details the author's experience of indications, arthroscopic repair methods, and outcomes of treating the instability. A classification on triangular fibrocartilage complex injuries is reviewed, followed by author's indications, methods, and outcomes of arthroscopic repair of triangular fibrocartilage complex injuries.

  20. Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes.

    Science.gov (United States)

    Knapik, Derrick M; Sheehan, Joe; Nho, Shane J; Voos, James E; Salata, Michael J

    2018-02-01

    Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Cohort study; Level of evidence, 3. Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes during their first season in the NFL.

  1. [Arthroscopic double-row reconstruction of high-grade subscapularis tendon tears].

    Science.gov (United States)

    Plachel, F; Pauly, S; Moroder, P; Scheibel, M

    2018-04-01

    Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

  2. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion.

    Science.gov (United States)

    Burkhart, S S; De Beer, J F

    2000-10-01

    Our goal was to analyze the results of 194 consecutive arthroscopic Bankart repairs (performed by 2 surgeons with an identical suture anchor technique) in order to identify specific factors related to recurrence of instability. Case series. We analyzed 194 consecutive arthroscopic Bankart repairs by suture anchor technique performed for traumatic anterior-inferior instability. The average follow-up was 27 months (range, 14 to 79 months). There were 101 contact athletes (96 South African rugby players and 5 American football players). We identified significant bone defects on either the humerus or the glenoid as (1) "inverted-pear" glenoid, in which the normally pear-shaped glenoid had lost enough anterior-inferior bone to assume the shape of an inverted pear; or (2) "engaging" Hill-Sachs lesion of the humerus, in which the orientation of the Hill-Sachs lesion was such that it engaged the anterior glenoid with the shoulder in abduction and external rotation. There were 21 recurrent dislocations and subluxations (14 dislocations, 7 subluxations). Of those 21 shoulders with recurrent instability, 14 had significant bone defects (3 engaging Hill-Sachs and 11 inverted-pear Bankart lesions). For the group of patients without significant bone defects (173 shoulders), there were 7 recurrences (4% recurrence rate). For the group with significant bone defects (21 patients), there were 14 recurrences (67% recurrence rate). For contact athletes without significant bone defects, there was a 6.5% recurrence rate, whereas for contact athletes with significant bone defects, there was an 89% recurrence rate. (1) Arthroscopic Bankart repairs give results equal to open Bankart repairs if there are no significant structural bone deficits (engaging Hill-Sachs or inverted-pear Bankart lesions). (2) Patients with significant bone deficits as defined in this study are not candidates for arthroscopic Bankart repair. (3) Contact athletes without structural bone deficits may be treated by

  3. Functional outcomes after arthroscopic treatment of lateral epicondylitis

    International Nuclear Information System (INIS)

    Wada, Takuro; Moriya, Tamami; Iba, Kosuke; Ozasa, Yasuhiro; Sonoda, Tomoko; Aoki, Mitsuhiro; Yamashita, Toshihiko

    2009-01-01

    The purpose of this study was to evaluate surgical outcomes of arthroscopic debridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of debridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). After surgery, according to the patients' reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P<0.0001), and that during activity improved from 7.8 points to 0.9 points (P<0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P<0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P=0.02) and receiving public assistance (P=0.01) were significantly associated with worse DASH scores. Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score. (author)

  4. Open Latarjet procedure for failed arthroscopic Bankart repair.

    Science.gov (United States)

    Flinkkilä, T; Sirniö, K

    2015-02-01

    This retrospective study assessed the functional results of open Latarjet operation for recurrence of instability after arthroscopic Bankart repair in a consecutive series of patients. Fifty two patients (mean age 28.4 [range 17-62] years, 45 men) were operated on using open Latarjet operation after one (n=46) or two (n=6) failed arthroscopic Bankart repairs. The indication for revision surgery was recurrent dislocation or subluxation. Fifty patients had a Hill-Sachs lesion and 32 patients had glenoid bone lesions on plain radiographs. No attempt was made to grade the severity of bony pathology. Functional outcome and stability of 49 shoulders were assessed after an average follow-up of 38 (range 24-85) months using Western Ontario Shoulder Instability (WOSI) score, Oxford shoulder instability score, and subjective shoulder value (SSV). Forty-two patients had a stable shoulder at follow-up. Seven of 49 (14%) had symptoms of instability; one patient had recurrent dislocation, and six patients had subluxations. Mean WOSI, Oxford, and SSV scores were 83.9, 19.9, and 84.9, respectively. All scores were significantly better in patients who had a stable shoulder compared with those who had an unstable shoulder (WOSI 86.8 vs. 64.3; Oxford 18.2 vs. 30.8; and SSV 88.3 vs. 61.7; Pfailed arthroscopic Bankart repair. The instability recurrence rate is acceptable and the reoperation rate was low. Level IV, retrospective case series. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Chondromalacia patellae: Bone scintigraphy correlated with arthroscopic findings

    International Nuclear Information System (INIS)

    Kohn, H.S.; Guten, G.N.; Collier, B.D.; Veluvolu, P.; Whalen, J.P.

    1987-01-01

    Fifty adult sports medicine patients with anterior knee pain and other clinical findings of chondromalacia patellae unresponsive to more than 3 months of conservative therapy were evaluated with bone scintigraphy with subsequent arthroscopic correlation. There was significant correlation (Sperman rank correlation = .545, P < .001) between the intensity of increased patellar scintigraphic activity and the Metcalf grade of chondromalacia seen at arthroscopy. Bone scintigraphy also disclosed clinically unsuspected torn menisci. Bone scintigraphy contributes to accurate diagnostic evaluation and appropriate surgical planning for adult sports medicine patients with chronic anterior knee pain

  6. Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

    Directory of Open Access Journals (Sweden)

    Mohammad Hosein Ebrahimzadeh

    2014-09-01

    Full Text Available Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH, Constant, University of California Los Angeles (UCLA, ROWE and Visual Analogue Scale (VAS for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months.  The average time to follow-up was 47.2±6.8 months (14 to 60 months. Diabetes mellitus (38% and history of shoulder trauma (23% were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and

  7. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai

    2018-01-01

    . In total, nine participants experienced 11 adverse events; six in the surgery group and three in the skin-incisions-only group. CONCLUSION: We found greater improvement from arthroscopic partial meniscectomy compared with skin incisions only at 2 years, with the statistical uncertainty of the between......-group difference including what could be considered clinically relevant. Because of the study being underpowered, nearly half in the sham group being non-blinded and one-third crossing over to surgery, the results cannot be generalised to the greater patient population. TRIAL REGISTRATION NUMBER: NCT01264991....

  8. Arthroscopic Management of Triangular Fibrocartilage Complex Peripheral Injury.

    Science.gov (United States)

    Haugstvedt, Jan Ragnar; Søreide, Endre

    2017-11-01

    Patients suffering from ulnar-sided wrist pain after trauma may develop tenderness, clicking, a positive fovea sign, or instability of the distal radioulnar joint. If the pain is persistent, conservative treatment does not help, and the patient agrees to surgery, arthroscopy may reveal a triangular fibrocartilage complex (TFCC) injury with capsular detachment, foveal avulsion, or a combination thereof. Capsular reattachment is possible using an arthroscopic assisted technique. The reattachment can be performed with an inside-out, outside-in, or all-inside technique, providing good to excellent results, which tend to persist over time, in 60% to 90% of cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Arthroscopic Management of Triangular Fibrocartilage Complex Foveal Injury.

    Science.gov (United States)

    Fujio, Keiji

    2017-11-01

    The deep component of triangular fibrocartilage complex (TFCC) inserts onto the fovea of the ulnar head. This component is critical to provide distal radioulnar joint stability. The surgical techniques and results of transosseous inside-out TFCC foveal repair are discussed. The rewarding results encouraged the repair of TFCC to the fovea arthroscopically. Although the results are good, the factors of age (traumatic or degenerative) and quality of stump and TFCC proper, which relate to the results should be considered in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Dynamic enhanced MRI of the subacromial bursa: correlation with arthroscopic and histological findings

    International Nuclear Information System (INIS)

    Matsuzaki, S.; Yoneda, M.; Kobayashi, Y.; Fukushima, S.; Wakitani, S.

    2003-01-01

    Objective: To assess dynamic MRI with Gd-DTPA enhancement for evaluating inflammatory changes in the subacromial bursa. Design and patients: We detected the signal intensity changes in dynamic MRI of the subacromial bursa, and confirmed these macroscopically by arthroscopy and histologically. The signal intensity was measured using built-in software, and the enhancement ratio (E ratio) was calculated from dynamic MR images. In addition, as a parameter of the rate of the increase in the signal intensity from 0 to 80 s, the mean increase per second in the E ratio was obtained as the coefficient of enhancement (CE). The correlation was studied of the E ratio and CE with the arthroscopic findings (redness, villous formation, thickening and adhesion), and of the E ratio and CE with the histological findings (capillary proliferation, papillary hyperplasia, fibrosis and inflammatory cell infiltration) of the subacromial bursa. Of patients with shoulder pain, this study included those with rotator cuff injury; patients with rheumatoid arthritis or pitching shoulder disorders were excluded. There were 27 patients (15 men, 12 women) ranging in age from 25 to 73 years (mean 49.1 years). Dynamic MRI of the shoulder was also performed on the healthy side of 10 patients and in five normal young volunteers. Results and conclusions: Changes in signal intensity on dynamic MRI were measured in the subacromial bursa. The E ratio (80 s) and CE (0-80 s) were significantly correlated with redness and villous formation as arthroscopic findings, positively correlated with capillary proliferation and papillary hyperplasia as histological findings (p < 0.05), and negatively correlated with fibrosis as a histological finding (p < 0.05) in the subacromial bursa. The patterns of dynamic curves were well correlated with the bursoscopic and histological findings of the synovium of the subacromial bursa. Dynamic MRI appears to correlate with inflammatory activity of synovium of the subacromial

  11. Diagnostic imaging of shoulder rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Nogueira-Barbosa Marcello Henrique

    2002-01-01

    Full Text Available Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US and magnetic resonance imaging (MRI. Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001. We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

  12. Arthroscopic assessment of stifle synovitis in dogs with cranial cruciate ligament rupture.

    Science.gov (United States)

    Little, Jeffrey P; Bleedorn, Jason A; Sutherland, Brian J; Sullivan, Ruth; Kalscheur, Vicki L; Ramaker, Megan A; Schaefer, Susan L; Hao, Zhengling; Muir, Peter

    2014-01-01

    Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3(+) T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (ppairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy.

  13. Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair.

    Science.gov (United States)

    Phillips, Lisa; Cheung, Jeffrey J H; Whelan, Daniel B; Murnaghan, Michael Lucas; Chahal, Jas; Theodoropoulos, John; Ogilvie-Harris, Darrell; Macniven, Ian; Dwyer, Tim

    2017-07-01

    Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills in a safe environment. The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model. Cross-sectional study; Level of evidence, 3. A total of 47 participants including orthopaedic surgery residents (n = 37), sports medicine fellows (n = 5), and staff surgeons (n = 5) performed arthroscopic hip labral repair on a dry model. Prior arthroscopic experience was noted. Participants were evaluated by 2 orthopaedic surgeons using a task-specific checklist, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task completion time, and a final global rating scale. All procedures were video-recorded and scored by an orthopaedic fellow blinded to the level of training of each participant. The internal consistency/reliability (Cronbach alpha) using the total ASSET score for the procedure was high (intraclass correlation coefficient > 0.9). One-way analysis of variance for the total ASSET score demonstrated a difference between participants based on the level of training ( F 3,43 = 27.8, P 0.9). The results of this study demonstrate that the use of dry models to assess the performance of arthroscopic hip labral repair by trainees is both valid and reliable. Further research will be required to demonstrate a correlation with performance on cadaveric specimens or in the operating room.

  14. Management of failed rotator cuff repair: a systematic review

    Science.gov (United States)

    Lädermann, Alexandre; Denard, Patrick J; Burkhart, Stephen S

    2016-01-01

    Importance Recurrent tear after rotator cuff repair (RCR) is common. Conservative, and open and arthroscopic revisions, have been advocated to treat these failures. Aim or objective The purpose of this systematic review was to evaluate the different options for managing recurrent rotator cuff tears. Evidence review A search was conducted of level I through 4 studies from January 2000 to October 2015, to identify studies reporting on failed RCR. 10 articles were identified. The overall quality of evidence was very low. Findings Mid-term to long-term follow-up of patients treated conservatively revealed acceptable results; a persistent defect is a well-tolerated condition that only occasionally requires subsequent surgery. Conservative treatment might be indicated in most patients, particularly in case of posterosuperior involvement and poor preoperative range of motion. Revision surgery might be indicated in a young patient with a repairable lesion, a 3 tendon tear, and in those with involvement of the subscapularis. Conclusions and relevance The current review indicates that arthroscopic revision RCR can lead to improvement in functional outcome despite a high retear rate. Further studies are needed to develop specific rehabilitation in the case of primary rotator cuff failure, to better understand the place of each treatment option, and, in case of repair, to optimise tendon healing. PMID:27134759

  15. PRP as an Adjunct to Rotator Cuff Tendon Repair.

    Science.gov (United States)

    Barber, F Alan

    2018-06-01

    Arthroscopic rotator cuff repair is a commonly performed repair. Technical developments provide surgeons the tools to create biomechanically robust repairs. How can the biological response mirror the strong and stable surgery? Platelet-rich plasma (PRP) is a supraphysiological platelet concentration which may positively augment rotator cuff healing. Not all PRPs are the same. High leukocyte levels and thrombin activation may be detrimental to tendon healing. Thrombin activation triggers an immediate release of growth factors and may actually inhibit some parts of the healing response. Clear differences exist between liquid PRP (products released within hours after activation) and solid fibrin PRP which slowly releases factors over days. The heterogenicity data and grouping liquid and solid PRP together make systematic reviews confusing. Solid PRP fibrin constructs are often associated with increased tendon healing. PRP fibrin matrix offers the greatest promise for improving clinical success after rotator cuff tendon repair.

  16. Rotating preventers

    International Nuclear Information System (INIS)

    Tangedahl, M.J.; Stone, C.R.

    1992-01-01

    This paper reports that recent changes in the oil and gas industry and ongoing developments in horizontal and underbalanced drilling necessitated development of a better rotating head. A new device called the rotating blowout preventer (RBOP) was developed by Seal-Tech. It is designed to replace the conventional rotating control head on top of BOP stacks and allows drilling operations to continue even on live (underbalanced) wells. Its low wear characteristics and high working pressure (1,500 psi) allow drilling rig crews to drill safely in slightly underbalanced conditions or handle severe well control problems during the time required to actuate other BOPs in the stack. Drilling with a RBOP allows wellbores to be completely closed in tat the drill floor rather than open as with conventional BOPs

  17. (Dry) arthroscopic partial wrist arthrodesis: tips and tricks.

    Science.gov (United States)

    del Piñal, F; Tandioy-Delgado, F

    2014-10-01

    One of the options for performing a partial wrist arthrodesis is the arthroscopic technique. As a first advantage arthroscopy allows us to directly assess the state of the articular surface of the carpal bones and define the best surgical option during the salvage operation. Furthermore, it allows performance of the procedure with minimal ligament damage and minimal interference with the blood supply of the carpals. These will (presumably) entail less capsular scarring and more rapid healing. Lastly, there is cosmetic benefit by reducing the amount of external scarring. The procedure has a steep learning curve even for accomplished arthroscopists but can be performed in a competitive manner to the open procedure if the dry technique is used. The aim of this paper is to present the technical details, tricks and tips to make the procedure accessible to all hand specialists with an arthroscopic interest. As it is paramount that the surgeon is acquainted with the "dry" technique, some technical details about it will also be presented. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Arthroscopic Treatment of Lateral Epicondylitis: Tenotomy Versus Debridement.

    Science.gov (United States)

    Solheim, Eirik; Hegna, Janne; Øyen, Jannike; Inderhaug, Eivind

    2016-04-01

    To compare the outcome of 2 arthroscopic techniques for treating recalcitrant lateral epicondylitis. The study included patients undergoing arthroscopic treatment of lateral epicondylitis during 2 different time periods: April 2005 to October 2007 (tenotomy) and May 2009 to June 2010 (debridement). By using a patient-administered form, baseline information including QuickDASH (disabilities of the arm, shoulder and hand) score (primary outcome), visual analog scale (VAS) of pain, and VAS of function was recorded prospectively. To have the same follow-up period of minimum 4 years in the 2 groups, the follow-up was conducted at 2 different points of time. Of a total of 326 patients fulfilling the requirements for inclusion in the study, 283 patients (87%) were followed up (144 male and 139 female, median age 46 [21 to 65] years), 204 (87%) in the tenotomy group and 79 (88%) in the debridement group. In both groups, a significant improvement in the QuickDASH was found at the follow-up compared with baseline: from 60 to 12 in the debridement group (P lateral epicondylitis Debridement only is a potentially less costly procedure, and the current finding of a mean 2 weeks shorter sick leave in the debridement only group proposes a substantial cost saving in a societal perspective. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  19. Efficacy of Arthroscopic Teaching Methods: A Prospective Randomized Controlled Study.

    Science.gov (United States)

    Robinson, Luke; Spanyer, Jonathon; Yenna, Zachary; Burchell, Patrick; Garber, Andrew; Riehl, John

    Arthroscopic education research recently has been focused on the use of skills labs to facilitate resident education and objective measure development to gauge technical skill. This study evaluates the effectiveness of three different teaching methods. Medical students were randomized into three groups. The first group received only classroom-based lecture. The second group received the same lecture and 28 minutes of lab-based hands-off arthroscopy instruction using a cadaver and arthroscopy setup. The final group received the same lecture and 7 minutes of hands-on arthroscopy instruction in the lab on a cadaver knee. The arthroscopic knee exam that followed simulated a diagnostic knee exam and subjects were measured on task completion and by the number of look downs. The number of look downs and the number of tasks completed did not achieve statistical significance between groups. Posttest survey results revealed that the hands-on group placed significantly more value on their educational experience as compared with the other two groups. (Journal of Surgical Orthopaedic Advances.

  20. Earth Rotation

    Science.gov (United States)

    Dickey, Jean O.

    1995-01-01

    The study of the Earth's rotation in space (encompassing Universal Time (UT1), length of day, polar motion, and the phenomena of precession and nutation) addresses the complex nature of Earth orientation changes, the mechanisms of excitation of these changes and their geophysical implications in a broad variety of areas. In the absence of internal sources of energy or interactions with astronomical objects, the Earth would move as a rigid body with its various parts (the crust, mantle, inner and outer cores, atmosphere and oceans) rotating together at a constant fixed rate. In reality, the world is considerably more complicated, as is schematically illustrated. The rotation rate of the Earth's crust is not constant, but exhibits complicated fluctuations in speed amounting to several parts in 10(exp 8) [corresponding to a variation of several milliseconds (ms) in the Length Of the Day (LOD) and about one part in 10(exp 6) in the orientation of the rotation axis relative to the solid Earth's axis of figure (polar motion). These changes occur over a broad spectrum of time scales, ranging from hours to centuries and longer, reflecting the fact that they are produced by a wide variety of geophysical and astronomical processes. Geodetic observations of Earth rotation changes thus provide insights into the geophysical processes illustrated, which are often difficult to obtain by other means. In addition, these measurements are required for engineering purposes. Theoretical studies of Earth rotation variations are based on the application of Euler's dynamical equations to the problem of finding the response of slightly deformable solid Earth to variety of surface and internal stresses.

  1. Proximity of the Triangular Fibrocartilage Complex to Key Surrounding Structures and Safety Assessment of an Arthroscopic Repair Technique: A Cadaveric Study.

    Science.gov (United States)

    Kuremsky, Marshall A; Habet, Nahir; Peindl, Richard D; Gaston, R Glenn

    2016-12-01

    To quantify the distance of the dorsal ulnar sensory branch, floor of the extensor carpi ulnaris (ECU) subsheath, and ulnar neurovascular bundles from the triangular fibrocartilage complex (TFCC), and secondarily to assess the safety of an all-inside arthroscopic repair of the TFCC with a commonly used meniscal repair device with respect to the aforementioned structures. A custom K-wire with 1-mm gradation was used to determine the distance of at-risk structures from the periphery of the TFCC in 13 above-elbow human cadaver specimens. An all-inside repair of the TFCC at the location of a Palmer 1B tear was then performed using a commonly employed meniscal repair device. The distance from the deployed devices to the structure in closest proximity was then measured using digital calipers. The mean distance from the deployed device to the nearest structure of concern for iatrogenic injury was 9.4 mm (range, 5-15 mm). The closest structure to iatrogenic injury was usually, but not always, the dorsal ulnar sensory nerve in 9 of 13 wrists (69.2%) at 9.3 mm (range, 5-15 mm); on 3 occasions it was instead the ulnar nerve (23.1%) at 9.5 mm (range, 9-10 mm), and on 1 occasion 6 mm from the flexor digitorum profundus to the little finger (7.7%). Forearm rotation had no significant effect on measured distances (ulnar nerve: P = .98; dorsal sensory: P = .89; ECU: P = .90). The largest influence of forearm rotation was a 0.4-mm difference between pronation and supination with respect to the distance of the TFCC periphery on the ECU subsheath. An all-inside arthroscopic TFCC repair using a commonly used meniscal repair device appears safe with respect to nearby neurovascular structures and tendons under typical arthroscopic conditions. An all-inside arthroscopic TFCC repair using a commonly employed meniscal repair device appears safe in terms of proximity to important structures although further clinical investigation is warranted. Copyright © 2016 Arthroscopy

  2. MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy

    Science.gov (United States)

    Bhandary, Sudarshan; Khandige, Ganesh; Kabra, Utkarsh

    2017-01-01

    Introduction Rotator cuff tears are quite common and can cause significant disability. Magnetic Resonance Imaging (MRI) has now emerged as the modality of choice in the preoperative evaluation of patients with rotator cuff injuries, in view of its improved inherent soft tissue contrast and resolution. Aim To evaluate the diagnostic accuracy of routine MRI in the detection and characterisation of rotator cuff tears, by correlating the findings with arthroscopy. Materials and Methods This prospective study was carried out between July 2014 and August 2016 at the AJ Institute of Medical Sciences, Mangalore, Karnataka, India. A total of 82 patients were diagnosed with rotator cuff injury on MRI during this period, out of which 45 patients who underwent further evaluation with arthroscopy were included in this study. The data collected was analysed for significant correlation between MRI diagnosis and arthroscopic findings using kappa statistics. The sensitivity, specificity, predictive value and accuracy of MRI for the diagnosis of full and partial thickness tears were calculated using arthroscopic findings as the reference standard. Results There were 27 males and 18 females in this study. The youngest patient was 22 years and the oldest was 74 years. Majority of rotator cuff tears (78%) were seen in patients above the age of 40 years. MRI showed a sensitivity of 89.6%, specificity of 100%, positive predictive value of 100% and negative predictive value of 83.3% for the diagnosis of full thickness rotator cuff tears. For partial thickness tears, MRI showed a sensitivity of 100%, specificity of 86.6%, positive predictive value of 78.9% and negative predictive value of 100%. The accuracy was 93.1% for full thickness tears and 91.1% for partial thickness tears. The p-value was less than 0.01 for both full and partial thickness tears. There was good agreement between the MRI and arthroscopic findings, with kappa value of 0.85 for full thickness tears and 0.81 for partial

  3. Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-07-01

    Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

  4. Programming with Intervals

    Science.gov (United States)

    Matsakis, Nicholas D.; Gross, Thomas R.

    Intervals are a new, higher-level primitive for parallel programming with which programmers directly construct the program schedule. Programs using intervals can be statically analyzed to ensure that they do not deadlock or contain data races. In this paper, we demonstrate the flexibility of intervals by showing how to use them to emulate common parallel control-flow constructs like barriers and signals, as well as higher-level patterns such as bounded-buffer producer-consumer. We have implemented intervals as a publicly available library for Java and Scala.

  5. Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears.

    Science.gov (United States)

    Mihata, Teruhisa; Watanabe, Chisato; Fukunishi, Kunimoto; Ohue, Mutsumi; Tsujimura, Tomoyuki; Fujiwara, Kenta; Kinoshita, Mitsuo

    2011-10-01

    Although previous biomechanical research has demonstrated the superiority of the suture-bridge rotator cuff repair over double-row repair from a mechanical point of view, no articles have described the structural and functional outcomes of this type of procedure. The structural and functional outcomes after arthroscopic rotator cuff repair may be different between the single-row, double-row, and combined double-row and suture-bridge (compression double-row) techniques. Cohort study; Level of evidence, 3. There were 206 shoulders in 201 patients with full-thickness rotator cuff tears that underwent arthroscopic rotator cuff repair. Eleven patients were lost to follow-up. Sixty-five shoulders were repaired using the single-row, 23 shoulders using the double-row, and 107 shoulders using the compression double-row techniques. Clinical outcomes were evaluated at an average of 38.5 months (range, 24-74 months) after rotator cuff repair. Postoperative cuff integrity was determined using Sugaya's classification of magnetic resonance imaging (MRI). The retear rates after arthroscopic rotator cuff repair were 10.8%, 26.1%, and 4.7%, respectively, for the single-row, double-row, and compression double-row techniques. In the subcategory of large and massive rotator cuff tears, the retear rate in the compression double-row group (3 of 40 shoulders, 7.5%) was significantly less than those in the single-row group (5 of 8 shoulders, 62.5%, P row group (5 of 12 shoulders, 41.7%, P row and suture-bridge techniques, which had the lowest rate of postoperative retear, is an effective option for arthroscopic repair of the rotator cuff tendons because the postoperative functional outcome in patients with a retear is inferior to that without retear.

  6. Arthroscopic double row cuff repair with suture-bridging and autologous conditioned plasma injection: Functional and structural results.

    Science.gov (United States)

    Werthel, Jean-David; Pelissier, Alexandre; Massin, Philippe; Boyer, Patrick; Valenti, Philippe

    2014-10-01

    The double row cuff repair with suture bridging is commonly used for arthroscopic rotator cuff repair (RCR). Despite its biomechanical qualities, the rate of iterative tears with this technique is important. The aim of our study was to evaluate the effect of autologous conditioned plasma (ACP) on functional results and on the rate of iterative tears after RCR by suture bridging. A consecutive series of 65 patients who underwent arthroscopic double-row suture bridge (Speed-Bridge, Arthrex) primary cuff repair of symptomatic full-thickness supraspinatus tear (retraction 4 were considered as iterative tears. Mean follow-up was 19 months (+/-42) in the 2 groups. The mean quantity of ACP injected was 6ml. (+/-1.5) and no specific complication of the injection was found. Mean preoperative Constant-Murley scores were 41,2 (±7,7) and 38 (±11)in group B. Mean normalized Constant-Murley score increased from 41 points (±7) pre-operatively to 70 points (±8) post-operatively in group A and from 38 points (±11) to 73 points (±11) in group B. There were no significative differences between the two groups (P > 0.05). In group A, 31 repairs were Sugaya 1-3 (94%), vs. 30 in group B (93%), and 1 was type 4 in group A (5%) vs. 2 in group B (8%). In both groups, RCR with suture bridging gave successful functional outcomes, with a low rate of iterative tear. In this preliminary study, the adjuvant effect of ACP injections could not be showed on both functional and structural results. Longer follow-up is needed to evaluate potential differences.

  7. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Englund, Martin; Christensen, Robin

    2017-01-01

    OBJECTIVES: To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. DESIGN: Comparative prospective cohort study. SETTING: Four public......-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). INTERVENTIONS: Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information......% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically...

  8. Arthroscopic Repair of Ankle Instability With All-Soft Knotless Anchors.

    Science.gov (United States)

    Pereira, Hélder; Vuurberg, Gwen; Gomes, Nuno; Oliveira, Joaquim Miguel; Ripoll, Pedro L; Reis, Rui Luís; Espregueira-Mendes, João; Niek van Dijk, C

    2016-02-01

    In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints.

  9. ARTHROSCOPIC TREATMENT OF ACROMIOCLAVICULAR JOINT DISLOCATION BY TIGHT ROPE TECHNIQUE (ARTHREX®)

    Science.gov (United States)

    GÓmez Vieira, Luis Alfredo; Visco, Adalberto; Daneu Fernandes, Luis Filipe; GÓmez Cordero, Nicolas Gerardo

    2015-01-01

    Presenting the arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation and to evaluate results obtained with this procedure. Methods: Between August 2006 and May 2007, 10 shoulders of 10 patients with acute acromioclavicular dislocation were submitted to arthroscopic repair using the Tight Rope - Arthrex® system. Minimum follow-up was 12 months, with a mean of 15 months. Age ranged from 26 to 42, mean 34 years. All patients were male. Radiology evaluation was made by trauma series x-ray. The patients were assisted in the first month weekly and after three months after the procedure. Clinical evaluation was based on the University of California at Los Angeles (UCLA) criteria. Results: All patients were satisfied after the arthroscopic procedure and the mean UCLA score was 32,5. Conclusion: The arthroscopic treatment by Tight Rope – Arthrex® system for acute acromioclavicular dislocation showed to be an efficient technique. PMID:26998453

  10. Can arthroscopic revision surgery for shoulder instability be a fair option?

    Science.gov (United States)

    De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

    2014-04-01

    the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery.

  11. The effectiveness of arthroscopic stabilisation for failed open shoulder instability surgery.

    Science.gov (United States)

    Millar, N L; Murrell, G A C

    2008-06-01

    We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.

  12. MR accuracy and arthroscopic incidence of meniscal radial tears

    Energy Technology Data Exchange (ETDEWEB)

    Magee, Thomas; Shapiro, Marc; Williams, David [Department of Radiology, Neuroimaging Institute, 27 East Hibiscus Blvd., Melbourne, FL 32901 (United States)

    2002-12-01

    A meniscal radial tear is a vertical tear that involves the inner meniscal margin. The tear is most frequent in the middle third of the lateral meniscus and may extend outward in any direction. We report (1) the arthroscopic incidence of radial tears, (2) MR signs that aid in the detection of radial tears and (3) our prospective accuracy in detection of radial tears. Design and patients. Three musculoskeletal radiologists prospectively read 200 consecutive MR examinations of the knee that went on to arthroscopy by one orthopedic surgeon. MR images were assessed for location and MR characteristics of radial tears. MR criteria used for diagnosis of a radial tear were those outlined by Tuckman et al.: truncation, abnormal morphology and/or lack of continuity or absence of the meniscus on one or more MR images. An additional criterion used was abnormal increased signal in that area on fat-saturated proton density or T2-weighted coronal and sagittal images. Prospective MR readings were correlated with the arthroscopic findings.Results. Of the 200 consecutive knee arthroscopies, 28 patients had radial tears reported arthroscopically (14% incidence). MR readings prospectively demonstrated 19 of the 28 radial tears (68% sensitivity) when the criteria for diagnosis of a radial tear were truncation or abnormal morphology of the meniscus. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted or proton density weighted sequences, the prospective sensitivity was 25 of 28 radial tears (89% sensitivity). There were no radial tears described in MR reports that were not demonstrated on arthroscopy (i.e., there were no false positive MR readings of radial tears in these 200 patients). Radial tears are commonly seen at arthroscopy. There was a 14% incidence in this series of 200 patients who underwent arthroscopy. Prospective detection of radial tears was 68% as compared with arthroscopy when the criteria as

  13. MR accuracy and arthroscopic incidence of meniscal radial tears

    International Nuclear Information System (INIS)

    Magee, Thomas; Shapiro, Marc; Williams, David

    2002-01-01

    A meniscal radial tear is a vertical tear that involves the inner meniscal margin. The tear is most frequent in the middle third of the lateral meniscus and may extend outward in any direction. We report (1) the arthroscopic incidence of radial tears, (2) MR signs that aid in the detection of radial tears and (3) our prospective accuracy in detection of radial tears. Design and patients. Three musculoskeletal radiologists prospectively read 200 consecutive MR examinations of the knee that went on to arthroscopy by one orthopedic surgeon. MR images were assessed for location and MR characteristics of radial tears. MR criteria used for diagnosis of a radial tear were those outlined by Tuckman et al.: truncation, abnormal morphology and/or lack of continuity or absence of the meniscus on one or more MR images. An additional criterion used was abnormal increased signal in that area on fat-saturated proton density or T2-weighted coronal and sagittal images. Prospective MR readings were correlated with the arthroscopic findings.Results. Of the 200 consecutive knee arthroscopies, 28 patients had radial tears reported arthroscopically (14% incidence). MR readings prospectively demonstrated 19 of the 28 radial tears (68% sensitivity) when the criteria for diagnosis of a radial tear were truncation or abnormal morphology of the meniscus. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted or proton density weighted sequences, the prospective sensitivity was 25 of 28 radial tears (89% sensitivity). There were no radial tears described in MR reports that were not demonstrated on arthroscopy (i.e., there were no false positive MR readings of radial tears in these 200 patients). Radial tears are commonly seen at arthroscopy. There was a 14% incidence in this series of 200 patients who underwent arthroscopy. Prospective detection of radial tears was 68% as compared with arthroscopy when the criteria as

  14. ARTHROSCOPIC MENISCUS REPAIR WITH BIOABSORBABLE ARROWS IN LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Vladimir Senekovič

    2004-11-01

    Full Text Available Background. The menisci have important function in the knee joint. Because of this it is universally accepted that we have to preserve them as much as possible. After open and partially arthroscopic suture techniques new methods of all-inside meniscus repair with bioabsorbable arrows have been developed in the last decade. The meniscus repair using these arrows represents an easy task for a skilled surgeon. In addition, it can be performed in local anesthesia. We have evaluated the results of the first group of patients who were treated by this method.Methods. From February 2001 to August 2002 15 patients with torn meniscuses have been treated at the Clinical Department for Traumatology, University Medical centre, Ljubljana. We repaired their torn menisci arthroscopically with bioabsorbable arrows in local anesthesia. We divided patients in three groups: a group with isolated meniscus injury, a group with meniscus injury and anterior cruciate ligament injury and a group with associated pathology. Four patients had incarcerated meniscuses. Preoperative Lysholm score in the first group was 38, in the second 42 and in the third group 48. We repaired 12 medial and 3 lateral meniscuses. On average we need 45 minutes for therapeutic arthroscopy. Torn meniscus was fixated with minimum of 1 and maximum of 5 bioabsorbable arrows. All patients except one had the affected knee immobilized with cylinder plaster for 15 days on average.Results. At least three months after the arthroscopic fixation of the torn meniscus in local anesthesia another clinical evaluation was made. In all groups significant improvement was observed regarding the range of motions and absence of pain. Postoperative Lysholm score in the first group was 89, in the second 75 and in the third 71. Average deficit of flexion was 3 degrees while extension was full. One patient complained about the same pain in the joint, he underwent another arthroscopy which showed that the meniscus was

  15. Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.

    Science.gov (United States)

    Akoh, Craig C; Dibbern, Kevin; Amendola, Annuziato; Sittapairoj, Tinnart; Anderson, Donald D; Phisitkul, Phinit

    2017-10-01

    Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. OLTPs are

  16. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction

    Czech Academy of Sciences Publication Activity Database

    Machoň, V.; Šedý, Jiří; Klíma, K.; Hirjak, D.; Foltán, R.

    2012-01-01

    Roč. 41, č. 1 (2012), s. 109-113 ISSN 0901-5027 R&D Projects: GA MŠk(CZ) LC554; GA ČR GAP304/10/0320 Grant - others:GA MŠk(CZ) 1M0538 Program:1M Institutional research plan: CEZ:AV0Z50390703 Keywords : temporomandibular joint * arthroscopic lysis * arthroscopic lavage Subject RIV: FJ - Surgery incl. Transplants Impact factor: 1.521, year: 2012

  17. Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery

    DEFF Research Database (Denmark)

    Kemp, Joanne L; Collins, Natalie J; Roos, Ewa M.

    2013-01-01

    Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown.......Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown....

  18. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

    OpenAIRE

    Nakagawa, Shigeto; Mae, Tatsuo; Sato, Seira; Okimura, Shinichiro; Kuroda, Miki

    2017-01-01

    Background: Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. Purpose: This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this stu...

  19. Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization.

    Science.gov (United States)

    Krueger, David; Kraus, Natascha; Pauly, Stephan; Chen, Jianhai; Scheibel, Markus

    2011-01-01

    The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. Cohort study; Level of evidence, 3. Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.

  20. Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Masashi Koide

    2015-01-01

    Full Text Available Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012.

  1. How Satisfied Are Patients with Arthroscopic Bankart Repair? A 2-Year Follow-up on Quality-of-Life Outcome.

    Science.gov (United States)

    Saier, Tim; Plath, Johannes E; Waibel, Sabrina; Minzlaff, Philipp; Feucht, Matthias J; Herschbach, Peter; Imhoff, Andreas B; Braun, Sepp

    2017-10-01

    To report general life and health satisfaction after arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability and to investigate postoperative time lost to return to work at 2-year follow-up. Between 2011 and 2013 patients treated with arthroscopic Bankart repair in the beach chair position for acute shoulder instability were included in this study. Questions on Life Satisfaction Modules (FLZ M ) and the Short Form 12 (SF-12) were used as quality-of-life outcome scales. Oxford Instability Score (OIS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and self-reported American Shoulder and Elbow Surgeons (ASES) shoulder index were used as functional outcome scales. Return to work (months) was monitored and analyzed depending on physical workload. Data were assessed the day before surgery and prospectively monitored until 24 months postoperatively. Quality-of-life outcome was correlated with functional shoulder outcome and compared with normative age-adjusted data. Paired t-test, Wilcoxon test, Mann-Whitney U-Test, and Spearman's correlation coefficient were used for statistical analysis. Fifty-three patients were prospectively included. The mean age at surgery was 29.4 years. Satisfaction with general life and satisfaction with health (FLZ M ) as well as physical component scale (SF-12) improved significantly to values above normative data within 6 to 12 months after surgery (each P quality of life and functional outcome scores (P work was 2 months (range, 0-10; standard deviation, 1.9), with significantly longer time intervals observed in patients with heavy physical workload (3.1 months; range, 0 to 10; standard deviation, 2.4; P = .002). Following arthroscopic Bankart repair, quality of life was impaired during early course after surgery and increased significantly above preoperative levels within 6 to 12 months after the procedure. A steady state of excellent quality-of-life and

  2. Arthroscopic assessment of stifle synovitis in dogs with cranial cruciate ligament rupture.

    Directory of Open Access Journals (Sweden)

    Jeffrey P Little

    Full Text Available Cranial cruciate ligament rupture (CR is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+ macrophages, CD3(+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p0.34, p0.31, p<0.05. Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy.

  3. Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear.

    Science.gov (United States)

    Lee, Sung Hyun; Nam, Dae Jin; Kim, Se Jin; Kim, Jeong Woo

    2017-09-01

    The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Cohort study; Level of evidence, 3. Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically

  4. Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs.

    Science.gov (United States)

    Le, Brian T N; Wu, Xiao L; Lam, Patrick H; Murrell, George A C

    2014-05-01

    The rate of retears after rotator cuff repair varies from 11% to 94%. A retear is associated with poorer subjective and objective clinical outcomes than intact repair. This study was designed to determine which preoperative and/or intraoperative factors held the greatest association with retears after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. This study retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity. Exclusion criteria included previous rotator cuff repair on the same shoulder, incomplete repair, and repair using a synthetic polytetrafluoroethylene patch. All patients had completed the modified L'Insalata Questionnaire and underwent a clinical examination before surgery. Measurements of tear size, tear thickness, associated shoulder injury, tissue quality, and tendon mobility were recorded intraoperatively. The overall retear rate at 6 months after surgery was 17%. Retears occurred in 27% of full-thickness tears and 5% of partial-thickness tears (P < .0001). The best independent predictors of retears were anteroposterior tear length (correlation coefficient r = 0.41, P < .0001), tear size area (r = 0.40, P < .0001), mediolateral tear length (r = 0.34, P < .0001), tear thickness (r = 0.29, P < .0001), age at surgery (r = 0.27, P < .0001), and operative time (r = 0.18, P < .0001). These factors produced a predictive model for retears: logit P = (0.039 × age at surgery in years) + (0.027 × tear thickness in %) + (1 × anteroposterior tear length in cm) + (0.76 × mediolateral tear length in cm) - (0.17 × tear size area in cm(2)) + (0.018 × operative time in minutes) -9.7. Logit P can be transformed into P, which is the chance of retears at 6 months after surgery. A rotator cuff retear is a multifactorial process

  5. Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair.

    Science.gov (United States)

    Ostrander, Roger V; McKinney, Bart I

    2012-10-01

    Studies suggest that arthroscopic repair techniques may have high recurrence rates for larger rotator cuff tears. A more anatomic repair may improve the success rate when performing arthroscopic rotator cuff repair. We hypothesized that a triple-row modification of the suture-bridge technique for rotator cuff repair would result in significantly more footprint contact area and pressure between the rotator cuff and the humeral tuberosity. Eighteen ovine infraspinatus tendons were repaired using 1 of 3 simulated arthroscopic techniques: a double-row repair, the suture-bridge technique, and a triple-row repair. The triple-row repair technique is a modification of the suture-bridge technique that uses an additional reducing anchor between the medial and lateral rows. Six samples were tested per group. Pressure-indicating film was used to measure the footprint contact area and pressure after each repair. The triple-row repair resulted in significantly more rotator cuff footprint contact area and contact pressure compared with the double-row technique and the standard suture-bridge technique. No statistical difference in contact area or contact pressure was found between the double-row technique and the suture-bridge technique. The triple-row technique for rotator cuff repair results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. This more anatomic repair may improve the healing rate when performing arthroscopic rotator cuff repair. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Structural damage and chemical contaminants on reprocessed arthroscopic shaver blades.

    Science.gov (United States)

    Kobayashi, Masahiko; Nakagawa, Yasuaki; Okamoto, Yukihiro; Nakamura, Shinichiro; Nakamura, Takashi

    2009-02-01

    on the reprocessed arthroscopic shaver blades. Surgeons should keep in mind that mechanical damage and chemical contamination are found on reprocessed arthroscopic blades.

  7. Interactive stereotaxic teleassistance of remote experts during arthroscopic procedures.

    Science.gov (United States)

    Wagner, Arne; Undt, Gerhard; Schicho, Kurt; Wanschitz, Felix; Watzinger, Franz; Murakami, Kenichiro; Czerny, Christian; Ewers, Rolf

    2002-01-01

    This article describes the technical setup for stereotaxic telesurgical assistance for arthroscopic procedures. It also outlines the current state, limitations, and feasibility of this technical development. Teleassistance or teleconsultation implemented in endoscopic or arthroscopic procedures have not yet been reported. In this study, 7 computer-assisted arthroscopies of the temporomandibular joint were supported by extramural experts via interactive stereotaxic teleconsultation from distant locations. The external experts were supplied with close to real-time video, audio, and stereotaxic navigation data directly from the operation site. This setup allows the surgeons and external experts to interactively determine portals, target structures, and instrument positions relative to the patient's anatomy and to discuss any step of the procedures. Optoelectronic tracking interfaced to computer- based navigation technology allowed precise positioning of instruments for single or multiple temporomandibular joint punctures. The average error of digitizing probe measurements was 1.3 mm (range, 0.0 to 2.5 mm) and the average standard deviation was 0.7 mm (range, 0.4 to 0.9 mm). Evaluation of the reliability and accuracy of this technique suggests that it is sufficient for controlled navigation, even inside the small temporomandibular joint, a fact that encourages further applications for arthroscopy in general. The minimum requirement for high-quality video transmission for teleassisted procedures are integrated services digital network (ISDN) connections. Conventional ISDN-based videoconferencing can be combined with computer-aided intraoperative navigation. Transmission control protocol/internet protocol (TCP/IP)-based stereotaxic teleassistance data transmission via ATM or satellite seem to be promising techniques to considerably improve the field of arthroscopy.

  8. Arthroscopic Bankart repair and subscapularis augmentation: an alternative technique treating anterior shoulder instability with bone loss.

    Science.gov (United States)

    Maiotti, Marco; Russo, Raffaele; Zanini, Antonio; Schröter, Steffen; Massoni, Carlo; Bianchedi, Diana

    2016-06-01

    This study presents the preliminary results of a new arthroscopic technique consisting of the association of 2 procedures, capsulolabral repair and subscapularis augmentation tenodesis, in the treatment of traumatic anterior shoulder instability with both glenoid bone loss and a Hill-Sachs lesion. Eighty-nine patients engaged in sports were enrolled in this retrospective case-series study with 2 to 5 years' follow-up. All patients underwent a computed tomography scan to assess the percentage of glenoid bone loss by the Pico method. A prior stabilization procedure had failed in 20 patients, who were then segregated into a different group. Visual analog scale (VAS), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess the results. Only 3 of 89 patients had a post-traumatic redislocation. The mean length of follow-up was 31.5 months (range, 25-60 months). The VAS, Rowe, and ASES scores showed significant improvements: The VAS score decreased from a mean of 3.1 to 0.5 (P = .0157), the Rowe score increased from 58.9 to 94.1 (P = .0215), and the ASES score increased from 68.5 to 95.5 (P = .0197). The mean deficit of external rotation was 6° with the arm at the side of the trunk, and the mean deficit was 3° with the arm in 90° of abduction. The described procedure is a reproducible and effective technique used to restore joint stability in patients engaged in sports who have incurred anterior recurrent shoulder dislocation associated with glenoid bone loss (Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play.

    Science.gov (United States)

    Young, Simon W; Dakic, Jodie; Stroia, Kathleen; Nguyen, Michael L; Safran, Marc R

    2017-07-01

    To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. Retrospective case series. Tertiary academic centre. The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. Level IV-Case Series.

  10. Arthroscintigraphy in suspected rotator cuff rupture

    International Nuclear Information System (INIS)

    Gratz, S.; Behr, T.; Becker, W.; Koester, G.; Vosshenrich, R.; Grabbe, E.

    1998-01-01

    Aim: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n=20), contrast arthrography (n=20) and arthroscopy (n=10) of the shoulder joint. Methods: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 μCi/5 ml). The application was performed either in direct combination with contrast arthrography (n=10) or ultrasound conducted mixed with a local anesthetic (n=10). Findings at arthroscopical surgery (n=10) were used as the gold standard. Results: In case of complete rotator cuff rupture (n=5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistant. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Conclusion: Arthroscinitgraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures. (orig.) [de

  11. Manual therapy and exercise for rotator cuff disease.

    Science.gov (United States)

    Page, Matthew J; Green, Sally; McBain, Brodwen; Surace, Stephen J; Deitch, Jessica; Lyttle, Nicolette; Mrocki, Marshall A; Buchbinder, Rachelle

    2016-06-10

    43 trials. We were unable to perform any meta-analyses because of clinical heterogeneity or incomplete outcome reporting. One trial compared manual therapy and exercise with placebo (inactive ultrasound therapy) in 120 participants with chronic rotator cuff disease (high quality evidence). At 22 weeks, the mean change in overall pain with placebo was 17.3 points on a 100-point scale, and 24.8 points with manual therapy and exercise (adjusted mean difference (MD) 6.8 points, 95% confidence interval (CI) -0.70 to 14.30 points; absolute risk difference 7%, 1% fewer to 14% more). Mean change in function with placebo was 15.6 points on a 100-point scale, and 22.4 points with manual therapy and exercise (adjusted MD 7.1 points, 95% CI 0.30 to 13.90 points; absolute risk difference 7%, 1% to 14% more). Fifty-seven per cent (31/54) of participants reported treatment success with manual therapy and exercise compared with 41% (24/58) of participants receiving placebo (risk ratio (RR) 1.39, 95% CI 0.94 to 2.03; absolute risk difference 16% (2% fewer to 34% more). Thirty-one per cent (17/55) of participants reported adverse events with manual therapy and exercise compared with 8% (5/61) of participants receiving placebo (RR 3.77, 95% CI 1.49 to 9.54; absolute risk difference 23% (9% to 37% more). However adverse events were mild (short-term pain following treatment).Five trials (low quality evidence) found no important differences between manual therapy and exercise compared with glucocorticoid injection with respect to overall pain, function, active shoulder abduction and quality of life from four weeks up to 12 months. However, global treatment success was more common up to 11 weeks in people receiving glucocorticoid injection (low quality evidence). One trial (low quality evidence) showed no important differences between manual therapy and exercise and arthroscopic subacromial decompression with respect to overall pain, function, active range of motion and strength at six and

  12. Open versus arthroscopic approach in the treatment of femoroacetabular impingement: a case–control study with two-years follow up

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    Bruno Dutra Roos

    Full Text Available Abstract Objective To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement (FAI who underwent either anterior open surgery or an arthroscopic approach, with a minimum follow-up of two years. Methods This retrospective case–control study included patients submitted to FAI surgical treatment between November 2007 and March 2012. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were clinically assessed by the modified Harris Hip Score, Non-Arthritic Hip Score, and internal hip rotation. Patients were radiographically assessed by the center-edge angle, joint space width, alpha angle, neck-head index, degree of arthrosis, and presence of heterotopic ossification of the hip. Results In the study period, 56 patients (58 hips with FAI were included; 16 underwent open surgery and 40 underwent arthroscopy. The 40 patients treated by the arthroscopic route had a mean follow-up of 29.1 months, and 75.6% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. The 16 patients who underwent open surgery had a mean follow-up of 52 months, and 70.58% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. Postoperative clinical and radiographic results were considered similar in both groups. Conclusions Arthroscopy and open surgery treatments for FAI provided comparable clinical and radiographic results. However, a higher rate of complications was observed in the open surgery group.

  13. ARTHROSCOPIC REPAIR OF BANKART’S LESION USING SUTURE ANCHORS IN RECURRENT ANTERIOR SHOULDER INSTABILITY

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    Santosh Kumar

    2015-06-01

    Full Text Available BACKGROUND : Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A suture anchor is a tiny screw with a thread attached to it. The screw is inserted into the bone over the glenoid rim while the sutures hold onto the labral tissue. These anchors provide a stable base for reattachment of the capsulolabral complex. We conducted a study on evaluation of long term effe ct of arthroscopic repair of Bankart’s lesion using suture anchors and compared our results with other studies published in literature . MATERIALS & METHODS : Since June 2012, arthroscopic Bankart’s repair using suture anchors was performed on 35 patients, who presented with recurrent anterior dislocation of shoulder. 34 man and 1 woman patients were included in the study. METHOD OF COLLECTION OF DATA: Adult patients with recurrent dislocations of shoulder with . INCLUSION CRITERIA: All patients > 15 years but =2 . EXCLUSION CRITERIA: Age group 60 years. Clinical evidence of multidirectional instability. Surgery of injured shou lder before 1 st episode of traumatic shoulder dislocation. Number o f dislocations <2 . Generalised ligamentous laxity. Presence of neuromuscular disorders. Presence of other comorbid conditions . Majority of patients were in the age group between 17 years to 49years, with mean age of 27.43 years. Most patients were young active individuals in the age group of 25 to 35 years. 20 patients (57% were involved in significant occupation requiring overhead activity such as students with sporting activities, agricul turists. 21(60% patients had their Right shoulder involved

  14. Calcific tendinitis of the rotator cuff: management options.

    Science.gov (United States)

    Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

    2014-11-01

    Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  15. [Arthroscopically assisted transcapsular refixation of the triangular fibrocartilage complex of the wrist].

    Science.gov (United States)

    Pillukat, T; Fuhrmann, R A; Windolf, J; van Schoonhoven, J

    2016-08-01

    Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist. Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability. Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential. Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment. Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months. In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68-152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0-10), pain at rest was 1 ± 1 (range 0-2) and pain during exercise 2 ± 2 (range 0-5); the DASH score averaged 10 ± 14 points (range 0-39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series. Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.

  16. Rotator Cuff Repair in Adolescent Athletes.

    Science.gov (United States)

    Azzam, Michael G; Dugas, Jeffrey R; Andrews, James R; Goldstein, Samuel R; Emblom, Benton A; Cain, E Lyle

    2018-04-01

    Rotator cuff tears are rare injuries in adolescents but cause significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with few data to guide treatment. Adolescent patients would have excellent functional outcome scores and return to the same level of sports participation after rotator cuff repair but would have some difficulty with returning to overhead sports. Case series; Level of evidence 4. A retrospective search of the practice's billing records identified all patients participating in at least 1 sport who underwent rotator cuff repair between 2006 and 2014 with an age Rotator Cuff Index. Thirty-two consecutive adolescent athletes (28 boys and 4 girls) with a mean age of 16.1 years (range, 13.2-17.9 years) met inclusion criteria. Twenty-nine patients (91%) had a traumatic event, and 27 of these patients (93%) had no symptoms before the trauma. The most common single tendon injury was to the supraspinatus (21 patients, 66%), of which 2 were complete tendon tears, 1 was a bony avulsion of the tendon, and 18 were high-grade partial tears. Fourteen patients (56%) underwent single-row repair of their rotator cuff tear, and 11 (44%) underwent double-row repair. All subscapularis injuries were repaired in open fashion, while all other tears were repaired arthroscopically. Twenty-seven patients (84%) completed the outcome questionnaires at a mean 6.2 years after surgery (range, 2-10 years). The mean ASES score was 93 (range, 65-100; SD = 9); mean Western Ontario Rotator Cuff Index, 89% (range, 60%-100%; SD = 13%); and mean numeric pain rating, 0.3 (range, 0-3; SD = 0.8). Overall, 25 patients (93%) returned to the same level of play or higher. Among overhead athletes, 13 (93%) were able to return to the same level of play, but 8 (57%) were forced to change positions. There were no surgical complications, but 2 patients did undergo a subsequent operation. Surgical repair of high-grade partial

  17. Overconfidence in Interval Estimates

    Science.gov (United States)

    Soll, Jack B.; Klayman, Joshua

    2004-01-01

    Judges were asked to make numerical estimates (e.g., "In what year was the first flight of a hot air balloon?"). Judges provided high and low estimates such that they were X% sure that the correct answer lay between them. They exhibited substantial overconfidence: The correct answer fell inside their intervals much less than X% of the time. This…

  18. Open, Arthroscopic, and Percutaneous Surgical Treatment of Lateral Epicondylitis: A Systematic Review.

    Science.gov (United States)

    Burn, Matthew B; Mitchell, Ronald J; Liberman, Shari R; Lintner, David M; Harris, Joshua D; McCulloch, Patrick C

    2017-03-01

    Approximately 10% of patients with lateral epicondylitis go on to have surgical treatment; however, multiple surgical treatment options exist. The purpose of this study was to review the literature for the clinical outcomes of open, arthroscopic, and percutaneous treatment of lateral epicondylitis. The authors hypothesized that the clinical outcome of all 3 analyzed surgical treatments would be equivalent. A systematic review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar in July 2016 to compare the functional outcome, pain, grip strength, patient satisfaction, and return to work at 1-year follow-up for open, arthroscopic, and percutaneous treatment of lateral epicondylitis. Six studies (2 Level I and 4 Level II) including 179 elbows (83 treated open, 14 arthroscopic, 82 percutaneous) were analyzed. Three outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH] score, visual analog scale [VAS], and patient satisfaction) were reported for more than one category of surgical technique. Of these, the authors noted no clinically significant differences between the techniques. This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.

  19. The "All-Inside" Arthroscopic Broström Procedure Augmented With a Proximal Suture Anchor: An Innovative Technique.

    Science.gov (United States)

    Cottom, James M; Richardson, Phillip E

    Arthroscopic treatments of chronic lateral ankle stability have been reported in the literature. The authors report on an innovative technique augmenting the "All- Inside" Arthroscopic Broström procedure with an additional suture anchor. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. MR arthrography gadolinium versus standard MR imaging in rotator cuff pathology

    International Nuclear Information System (INIS)

    Hodler, J.; Brahme, S.K.; Karzel, R.; Cervilla, V.; Snyder, S.; Schweitzer, M.; Flannigan, B.; Resnick, D.

    1990-01-01

    This paper compares the accuracy of MR imaging with and without intraarticular gadolinium in the diagnosis of rotator cuff pathology, using arthroscopy as the gold standard. The authors examined 36 patients, first with T2-weighted sequences and then with T1-weighted sequences after the injection of 15-20 mL of diluted gadolinium. The images were read blindly by three radiologists experienced in musculoskeletal MR imaging. The results were compared with those of arthroscopy. In 16 of 19 arthroscopically intact rotator cuffs, both sequences demonstrated no evidence of rotator cuff tear. The remaining three cases were interpreted as partial or full-thickness tears. Of 12 partial tears, T1-weighted images with intraarticular gadolinium demonstrated a partial tear in five, degeneration in four, a full thickness tear in two, and a normal rotator cuff in one

  1. Region of Interest Selection Interface for Wide-Angle Arthroscope

    Directory of Open Access Journals (Sweden)

    Jung Kyunghwa

    2015-01-01

    Full Text Available We have proposed a new interface for an wide-angle endoscope for solo surgery. The wide-angle arthroscopic view and magnified region of interest (ROI within the wide view were shown simultaneously. With a camera affixed to surgical instruments, the position of the ROI could be determined by manipulating the surgical instrument. Image features acquired by the A-KAZE approach were used to estimate the change of position of the surgical instrument by tracking the features every time the camera moved. We examined the accuracy of ROI selection using three different images, which were different-sized square arrays and tested phantom experiments. When the number of ROIs was twelve, the success rate was best, and the rate diminished as the size of ROIs decreased. The experimental results showed that the method of using a camera without additional sensors satisfied the appropriate accuracy required for ROI selection, and this interface was helpful in performing surgery with fewer assistants.

  2. Applications of interval computations

    CERN Document Server

    Kreinovich, Vladik

    1996-01-01

    Primary Audience for the Book • Specialists in numerical computations who are interested in algorithms with automatic result verification. • Engineers, scientists, and practitioners who desire results with automatic verification and who would therefore benefit from the experience of suc­ cessful applications. • Students in applied mathematics and computer science who want to learn these methods. Goal Of the Book This book contains surveys of applications of interval computations, i. e. , appli­ cations of numerical methods with automatic result verification, that were pre­ sented at an international workshop on the subject in EI Paso, Texas, February 23-25, 1995. The purpose of this book is to disseminate detailed and surveyed information about existing and potential applications of this new growing field. Brief Description of the Papers At the most fundamental level, interval arithmetic operations work with sets: The result of a single arithmetic operation is the set of all possible results as the o...

  3. MR findings of chondromalacia Patella : correlation of the grade and associated lesions with arthroscopic findings

    International Nuclear Information System (INIS)

    Chung, Yon Su; Kwon, Soon Tae; Lee, Hwan Do; Kang, Yong Soo; Byun, Ki Yong; Rhee, Kwang Jin

    1998-01-01

    To assess the MR findings of chondromalacia patella and correlate the grade and associated lesions with the arthroscopic findings. Twenty-five patients with pain in the anterior part of the knee underwent fat-suppressed axial and coronal T2-weighted and T2-weighted imaging, using a 10-cm field of view, and a 5-inch general purpose coil. We retrospectively assessed these findings, and the locations, grades and associated lesions, and correlated these with arthroscopic findings. We evaluated the exact location and grade of chondromalacia patella and associated lesions, as seen on MR images. These and the arthroscopic findings showed close correlation, and in cases involving this condition, MRI is thus a useful indicator of an appropriate surgical method and plan. (author). 18 refs., 5 figs

  4. MR findings of chondromalacia Patella : correlation of the grade and associated lesions with arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Yon Su; Kwon, Soon Tae; Lee, Hwan Do; Kang, Yong Soo; Byun, Ki Yong; Rhee, Kwang Jin [Chungnam National Univ., Taejon (Korea, Republic of). Coll. of Medicine

    1998-02-01

    To assess the MR findings of chondromalacia patella and correlate the grade and associated lesions with the arthroscopic findings. Twenty-five patients with pain in the anterior part of the knee underwent fat-suppressed axial and coronal T2-weighted and T2-weighted imaging, using a 10-cm field of view, and a 5-inch general purpose coil. We retrospectively assessed these findings, and the locations, grades and associated lesions, and correlated these with arthroscopic findings. We evaluated the exact location and grade of chondromalacia patella and associated lesions, as seen on MR images. These and the arthroscopic findings showed close correlation, and in cases involving this condition, MRI is thus a useful indicator of an appropriate surgical method and plan. (author). 18 refs., 5 figs.

  5. Arthroscopic Treatment of a Case with Concomitant Subacromial and Subdeltoid Synovial Chondromatosis and Labrum Tear

    Directory of Open Access Journals (Sweden)

    Nevres Hurriyet Aydogan

    2013-01-01

    Full Text Available Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

  6. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery.

    Science.gov (United States)

    Lim, Se Hun; Lee, Wonjin; Park, JaeGwan; Kim, Myoung-Hun; Cho, Kwangrae; Lee, Jeong Han; Cheong, Soon Ho; Lee, Kun Moo

    2016-08-01

    Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P shoulder surgery.

  7. Morphology of large rotator cuff tears and of the rotator cable and long-term shoulder disability in conservatively treated elderly patients.

    Science.gov (United States)

    Morag, Yoav; Jamadar, David A; Miller, Bruce; Brandon, Catherine; Gandikota, Girish; Jacobson, Jon A

    2013-01-01

    The objective of this study was to describe the morphology of the rotator cuff tendon tears and long-term shoulder disability in conservatively treated elderly patients and determine if an association exists between these factors. Assessment of the rotator cuff tendon tear dimensions and depth, rotator interval involvement, rotator cable morphology and location, and rotator cuff muscle status was carried out on magnetic resonance studies of 24 elderly patients treated nonoperatively for rotator cuff tendon tears. Long-term shoulder function was measured using the Western Ontario Rotator Cuff (WORC) index; Disabilities of the Shoulder, Arm, and Hand questionnaire; and the American Shoulder Elbow Self-assessment form, and a correlation between the outcome scores and morphologic magnetic resonance findings was carried out. The majority of large rotator cuff tendon tears are limited to the rotator cuff crescent. Medial rotator interval involvement (isolated or in association with lateral rotator interval involvement) was significantly associated with WORC physical symptoms total (P = 0.01), WORC lifestyle total (P = 0.04), percentage of all WORC domains (P = 0.03), and American Shoulder Elbow Self-assessment total (P = 0.01), with medial rotator interval involvement associated with an inferior outcome. Medial rotator interval tears are associated with long-term inferior outcome scores in conservatively treated elderly patients with large rotator cuff tendon tears.

  8. MR arthrogram findings of luxatio erecta in a pediatric patient - arthroscopic confirmation and review of the literature

    International Nuclear Information System (INIS)

    Stensby, J.D.; Fox, Michael G.

    2014-01-01

    Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings. (orig.)

  9. MR arthrogram findings of luxatio erecta in a pediatric patient - arthroscopic confirmation and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Stensby, J.D.; Fox, Michael G. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States)

    2014-08-15

    Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings. (orig.)

  10. Study of correlation between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Subhash R Puri

    2013-01-01

    Full Text Available Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI, and arthroscopic findings in knee injuries. Materials and Methods: About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. Results: MRI had better sensitivity (0.95 vs. 0.85 and specificity (1.0 vs. 0.5 in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92 and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96 the sensitivity and specificity of MRI versus clinical examination showed minimal difference. Conclusion: Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis.

  11. Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis.

    Science.gov (United States)

    Gurnani, Navin; van Deurzen, Derek F P; van den Bekerom, Michel P J

    2017-10-01

    Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

  12. Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study.

    Science.gov (United States)

    Giza, Eric; Shin, Edward C; Wong, Stephanie E; Acevedo, Jorge I; Mangone, Peter G; Olson, Kirstina; Anderson, Matthew J

    2013-11-01

    Operative treatment of mechanical ankle instability is indicated for patients with multiple sprains and continued episodes of instability. Open repair of the lateral ankle ligaments involves exposure of the attenuated ligaments and advancement back to their anatomic insertions on the fibula using bone tunnels or suture implants. Open and arthroscopic fixation are equal in strength to failure for anatomic Broström repair. Controlled laboratory study. Seven matched pairs of human cadaveric ankle specimens were randomized into 2 groups of anatomic Broström repair: open or arthroscopic. The calcaneofibular ligament and anterior talofibular ligament were excised from their origin on the fibula. In the open repair group, 2 suture anchors were used to reattach the ligaments to their anatomic origins. In the arthroscopic repair group, identical suture anchors were used for repair via an arthroscopic technique. The ligaments were cyclically loaded 20 times and then tested to failure. Torque to failure, degrees to failure, initial stiffness, and working stiffness were measured. A matched-pair analysis was performed. Power analysis of 0.8 demonstrated that 7 pairs needed to show a difference of 30%, with a 15% standard error at a significance level of α = .05. There was no difference in the degrees to failure, torque to failure, or stiffness for the repaired ligament complex. Nine of 14 specimens failed at the suture anchor. There is no statistical difference in strength or stiffness of a traditional open repair as compared with an arthroscopic anatomic repair of the lateral ligaments of the ankle. An arthroscopic technique can be considered for lateral ligament stabilization in patients with mild to moderate mechanical instability.

  13. Arthroscopic coracoid transfer in the treatment of recurrent shoulder instability: a systematic review of early results.

    Science.gov (United States)

    Butt, Usman; Charalambous, Charalambos P

    2013-04-01

    Systematic review of the literature to characterize safety profile and complication rates associated with arthroscopic coracoid transfer procedures. We conducted a combined search of Medline, EMBASE, and the CINAHL databases from 1985 to November 2012. Articles were selected and data extracted according to standard criteria. Only 3 studies met the inclusion criteria, and these originated from the pioneers of this technique. These studies described the results of 172 arthroscopic coracoid transfer procedures with an overall complication rate of 19.8% ± 5.6%. Conversion to open surgery was necessary in 6/172 (3.5%) patients. Repeated surgery was described in 5/172 (2.9% ± 2.5%) cases, all for screw removal. The overall rate of recurrent instability was 3/172 cases (1.7% ± 2%). Hardware-related complications occurred in 4/172 patients (2.3% ± 2.3%). Coracoid grafts failed to unite in 14/172 patients (8.1% ± 4.1%); graft osteolysis was seen in 7/172 patients (4.1% ± 2.6%). The coracoid graft fractured in 2/172 cases (1.2% ± 1.6%); one of these occurred intraoperatively and one occurred early postoperatively. There was one transient nerve palsy (0.6% ± 1.1%). Results of arthroscopic coracoid transfer surgery for anterior shoulder instability are sparse, with the available studies originating from the pioneers of this technique. Early results suggest that arthroscopic coracoid transfer is a technically feasible procedure that is able to restore shoulder stability. However, this technique seems to be associated with a high complication rate and a steep learning curve. Results from the wider orthopaedic shoulder arthroscopic community are awaited. Extensive cadaveric training and experience with the open technique is recommended before performing the arthroscopic procedure. Systematic review of Level IV studies. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L. Stefan

    2017-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA...... and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18...... established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear....

  15. Surveillance test interval optimization

    International Nuclear Information System (INIS)

    Cepin, M.; Mavko, B.

    1995-01-01

    Technical specifications have been developed on the bases of deterministic analyses, engineering judgment, and expert opinion. This paper introduces our risk-based approach to surveillance test interval (STI) optimization. This approach consists of three main levels. The first level is the component level, which serves as a rough estimation of the optimal STI and can be calculated analytically by a differentiating equation for mean unavailability. The second and third levels give more representative results. They take into account the results of probabilistic risk assessment (PRA) calculated by a personal computer (PC) based code and are based on system unavailability at the system level and on core damage frequency at the plant level

  16. Rotator cuff exercises

    Science.gov (United States)

    ... 25560729 . Read More Frozen shoulder Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder pain Patient Instructions Rotator cuff - self-care Shoulder surgery - discharge Using your ...

  17. Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings.

    Science.gov (United States)

    Sela, Yaron; Eshed, Iris; Shapira, Shachar; Oran, Ariel; Vogel, Guy; Herman, Amir; Perry Pritsch, Moshe

    2015-02-01

    Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre- and postoperative clinical findings. Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. Rotator cuff disease – basics of diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Robert E. Boykin

    2010-03-01

    Full Text Available Rotator cuff (RTC disease is a particularly prevalent cause of shoulder pain and weakness presenting to primary care physicians, internists, rheumatologists, and orthopedists. An understanding of the anatomy of the RTC tendons and the underlying pathogenesis aids in the diagnosis, which is based largely on history and specific physical examination tests. Imaging may further define the pathology and aid in the evaluation of other sources of shoulder pain. Injuries to the RTC range from tendonitis to partial thickness tears to full thickness tears. The majority of patients with impingement and some cases of partial thickness tears may be managed effectively with non-operative measures including non-steroidal anti-inflammatory drugs, local injections, and physical therapy. Predictors of a good outcome with non-operative treatment include pre-injury strength, ability to raise the arm to the level of the shoulder, and a more acute presentation. Persistent symptoms may require operative intervention including debridement, subacromial decompression, and/or RTC repair. Acute full thickness tears in younger patients in addition to failed non-operative management of full thickness tears in older patients are the most likely to require surgery, which may be done open or arthroscopically. The majority of tears are amenable to the less invasive arthroscopic method, which yields good success rates and high patient satisfaction.

  19. Chaos on the interval

    CERN Document Server

    Ruette, Sylvie

    2017-01-01

    The aim of this book is to survey the relations between the various kinds of chaos and related notions for continuous interval maps from a topological point of view. The papers on this topic are numerous and widely scattered in the literature; some of them are little known, difficult to find, or originally published in Russian, Ukrainian, or Chinese. Dynamical systems given by the iteration of a continuous map on an interval have been broadly studied because they are simple but nevertheless exhibit complex behaviors. They also allow numerical simulations, which enabled the discovery of some chaotic phenomena. Moreover, the "most interesting" part of some higher-dimensional systems can be of lower dimension, which allows, in some cases, boiling it down to systems in dimension one. Some of the more recent developments such as distributional chaos, the relation between entropy and Li-Yorke chaos, sequence entropy, and maps with infinitely many branches are presented in book form for the first time. The author gi...

  20. Tears of the Supraspinatus Tendon: Assessment with Indirect Magnetic Resonance Arthrography in 67 Patients with Arthroscopic Correlation

    International Nuclear Information System (INIS)

    Dyck, P. van; Gielen, J.L.; Parizel, P.M.

    2009-01-01

    Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (κ) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (κ = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (κ = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of

  1. Tears of the Supraspinatus Tendon: Assessment with Indirect Magnetic Resonance Arthrography in 67 Patients with Arthroscopic Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, P. van; Gielen, J.L.; Parizel, P.M. (Dept. of Radiology, Univ. Hospital Antwerp and Univ. of Antwerp, Antwerp (Belgium)) (and others)

    2009-11-15

    Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (kappa) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (kappa = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (kappa = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the

  2. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging

    International Nuclear Information System (INIS)

    Tuite, M.J.; Yandow, D.R.; DeSmet, A.A.; Orwin, J.F.; Quintana, F.A.

    1994-01-01

    Most magnetic resonance (MR) studies evaluating the rotator cuff for tears have used T2-weighted imaging in the coronal oblique and sagittal oblique planes. T2 * -weighted gradient echo imaging, however, has advantages over spin echo imaging, including contiguous slices without cross-talk, high contrast around the cuff, and intrinsically shorter imaging times which can be used to increase the number of signals averaged and thus improve the signal-to-noise ratio. We reviewed the shoulder MR scans of 87 consecutive patients who underwent both a MR scan and a shoulder arthroscopy during which the size of tears, if present, was graded. The reviewers were blinded as to the history and arthroscopic results. The MR scans included oblique coronal T2 * -weighted gradient echo and oblique sagittal T2-weighted spin echo images. MR cuff grades were correlated with arthroscopic findings. For complete tears, the sensitivity of MR was 0.91 and the specificity 0.95. For partial tears, the sensitivity was 0.74 and the specificity 0.87. This accuracy is similar to two-plane T2-weighted imaging as previously reported in the literature. There was a statistically significant correlation (p < 0.0005) between the cuff grade as determined by MR and the arthroscopic findings. (orig.)

  3. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tuite, M J [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); Yandow, D R [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); DeSmet, A A [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); Orwin, J F [Div. of Orthopedic Surgery, Univ. of Wisconsin, Madison, WI (United States); Quintana, F A [Dept. of Biostatistics, Univ. of Wisconsin, Madison, WI (United States)

    1994-10-01

    Most magnetic resonance (MR) studies evaluating the rotator cuff for tears have used T2-weighted imaging in the coronal oblique and sagittal oblique planes. T2{sup *}-weighted gradient echo imaging, however, has advantages over spin echo imaging, including contiguous slices without cross-talk, high contrast around the cuff, and intrinsically shorter imaging times which can be used to increase the number of signals averaged and thus improve the signal-to-noise ratio. We reviewed the shoulder MR scans of 87 consecutive patients who underwent both a MR scan and a shoulder arthroscopy during which the size of tears, if present, was graded. The reviewers were blinded as to the history and arthroscopic results. The MR scans included oblique coronal T2{sup *}-weighted gradient echo and oblique sagittal T2-weighted spin echo images. MR cuff grades were correlated with arthroscopic findings. For complete tears, the sensitivity of MR was 0.91 and the specificity 0.95. For partial tears, the sensitivity was 0.74 and the specificity 0.87. This accuracy is similar to two-plane T2-weighted imaging as previously reported in the literature. There was a statistically significant correlation (p < 0.0005) between the cuff grade as determined by MR and the arthroscopic findings. (orig.)

  4. Effect of Facility Ownership on Utilization of Arthroscopic Shoulder Surgery.

    Science.gov (United States)

    Black, Eric M; Reynolds, John; Maltenfort, Mitchell G; Williams, Gerald R; Abboud, Joseph A; Lazarus, Mark D

    2018-03-01

    We examined practice patterns and surgical indications in the management of common shoulder procedures by surgeons practicing at physician-owned facilities. This study was a retrospective analysis of 501 patients who underwent arthroscopic shoulder procedures performed by five surgeons in our practice at one of five facilities during an 18-month period. Two of the facilities were physician-owned, and three of the five surgeons were shareholders. Demographics, insurance status, symptom duration, time from injury/symptom onset to the decision to perform surgery (at which time surgical consent is obtained), and time to schedule surgery were studied to determine the influence of facility type and physician shareholder status. Median duration of symptoms before surgery was significantly shorter in workers' compensation patients than in non-workers' compensation patients (47% less; P 0.05). Time between presentation and surgical consent was not influenced by facility ownership (P = 0.39) or shareholder status (P = 0.50). Time from consent to procedure was 13% faster in physician-owned facilities than in non-physician-owned facilities (P = 0.03) and 35% slower with shareholder physicians than with nonshareholder physicians (P < 0.0001). The role of physician investment in private healthcare facilities has caused considerable debate in the orthopaedic surgery field. To our knowledge, this study is the first to examine the effects of shareholder status and facility ownership on surgeons' practice patterns, surgical timing, and measures of nonsurgical treatment before shoulder surgery. Neither shareholder status nor facility ownership characteristics influenced the speed with which surgeons determined that shoulder surgery was indicated or surgeons' use of preoperative nonsurgical treatment. After the need for surgery was determined, patients underwent surgery sooner at physician-owned facilities than at non-physician-owned facilities and with nonshareholder physicians than

  5. Energy-Based Metrics for Arthroscopic Skills Assessment.

    Science.gov (United States)

    Poursartip, Behnaz; LeBel, Marie-Eve; McCracken, Laura C; Escoto, Abelardo; Patel, Rajni V; Naish, Michael D; Trejos, Ana Luisa

    2017-08-05

    Minimally invasive skills assessment methods are essential in developing efficient surgical simulators and implementing consistent skills evaluation. Although numerous methods have been investigated in the literature, there is still a need to further improve the accuracy of surgical skills assessment. Energy expenditure can be an indication of motor skills proficiency. The goals of this study are to develop objective metrics based on energy expenditure, normalize these metrics, and investigate classifying trainees using these metrics. To this end, different forms of energy consisting of mechanical energy and work were considered and their values were divided by the related value of an ideal performance to develop normalized metrics. These metrics were used as inputs for various machine learning algorithms including support vector machines (SVM) and neural networks (NNs) for classification. The accuracy of the combination of the normalized energy-based metrics with these classifiers was evaluated through a leave-one-subject-out cross-validation. The proposed method was validated using 26 subjects at two experience levels (novices and experts) in three arthroscopic tasks. The results showed that there are statistically significant differences between novices and experts for almost all of the normalized energy-based metrics. The accuracy of classification using SVM and NN methods was between 70% and 95% for the various tasks. The results show that the normalized energy-based metrics and their combination with SVM and NN classifiers are capable of providing accurate classification of trainees. The assessment method proposed in this study can enhance surgical training by providing appropriate feedback to trainees about their level of expertise and can be used in the evaluation of proficiency.

  6. BiPOD Arthroscopic Acromioclavicular Repair Restores Bidirectional Stability.

    Science.gov (United States)

    De Beer, Joe; Schaer, Michael; Latendresse, Kim; Raniga, Sumit; Moor, Beat K; Zumstein, Matthias A

    2017-01-01

    Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth. This study is a prospective review of the first 6 patients treated for high-grade acute acromioclavicular injury with the BiPOD technique. The study included 6 men who were 21 to 36 years old (mean, 27 years). At 6-month follow-up, complications were recorded and radiographic analysis was used to determine the coracoclavicular distance for vertical reduction and the amount of acromioclavicular translation on the Alexander axillary view was used to determine horizontal reduction. One patient had a superficial infection over the tape knot. The difference in coracoclavicular distance between the operated side and the uninvolved side was 9±2 mm preoperatively and 0.3±2 mm at 6-month follow-up. On Alexander axillary view, all 6 patients showed stable reduction, which is defined as a clavicle that is in line with the acromion. The findings show that BiPOD acromioclavicular reconstruction restores bidirectional stability of the acromioclavicular joint at 6 months. [Orthopedics. 2017; 40(1):e35-e43.]. Copyright 2016, SLACK Incorporated.

  7. All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique.

    Science.gov (United States)

    Vega, Jordi; Golanó, Pau; Pellegrino, Alexandro; Rabat, Eduard; Peña, Fernando

    2013-12-01

    Recently, arthroscopic-assisted techniques have been described to treat lateral ankle instability with excellent results. However, complications including neuritis of the superficial peroneal or sural nerve, and pain or discomfort due to a prominent anchor or suture knot have been reported. The aim of this study was to describe a novel technique, the "all-inside arthroscopic lateral collateral ankle ligament repair," and its results for treating patients with ankle instability. Sixteen patients (10 men and 6 women, mean age 29.3 years, 17-46) with lateral ankle instability were treated with an arthroscopic procedure. Using a suture passer and a knotless anchor, the ligaments were repaired with an all-inside technique. The right ankle was affected in 10 cases. Mean follow-up was 22.3 (12-35) months. On arthroscopic examination, 13 patients had an isolated anterior talofibular ligament (ATFL) injury, and in 3 patients, both the ATFL and calcaneofibular ligament (CFL) were affected. All-inside arthroscopic anatomic repair of the lateral collateral ligament complex was performed in all cases. All patients reported subjective improvement of their ankle instability. The mean AOFAS score increased from 67 preoperatively to 97 at final follow-up. No major complications were reported. The all-inside arthroscopic ligament repair was a safe, reliable, and reproducible technique that both provided an anatomic repair of the lateral collateral ligament complex and restored ankle stability while preserving all the advantages of an arthroscopic technique. Level IV, retrospective case series.

  8. Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model.

    Science.gov (United States)

    Makhni, Eric C; Lamba, Nayan; Swart, Eric; Steinhaus, Michael E; Ahmad, Christopher S; Romeo, Anthony A; Verma, Nikhil N

    2016-09-01

    To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair. An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature. Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective. Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation. Level IV, expected value decision analysis. Copyright © 2016. Published by Elsevier Inc.

  9. Medialized repair for retracted rotator cuff tears.

    Science.gov (United States)

    Kim, Young-Kyu; Jung, Kyu-Hak; Won, Jun-Sung; Cho, Seung-Hyun

    2017-08-01

    The purpose of this study was to evaluate the functional outcomes of medialized rotator cuff repair and the continuity of repaired tendon in chronic retracted rotator cuff tears. Thirty-five consecutive patients were selected from 153 cases that underwent arthroscopic rotator cuff repair for more than medium-sized posterosuperior rotator cuff tears between July 2009 and July 2012 performed with the medialized repair. All cases were available for at least 2 years of postoperative follow-up. The visual analog scale of pain, muscle strength, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California-Los Angeles score were evaluated. At the final follow-up, all clinical outcomes were significantly improved. The visual analog scale score for pain improved from 6 ± 1 preoperatively to 2 ± 1 postoperatively. The range of motion increased from preoperatively to postoperatively: active forward elevation, from 134° ± 49° to 150° ± 16°; active external rotation at the side, from 47° ± 15° to 55° ± 10°; and active internal rotation, from L3 to L1. The shoulder score also improved: Constant score, from 53.5 ± 16.7 to 79 ± 10; American Shoulder and Elbow Surgeons score, from 51 ± 15 to 82 ± 8; and University of California-Los Angeles score, from 14 ± 4 to 28 ± 4. The retear cases at the final follow-up were 6 (17%). Medialized repair may be useful in cases in which anatomic bone-to-tendon repair would be difficult because of the excessive tension of the repaired tendon and a torn tendon that does not reach the anatomic insertion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Arthroscopic shoulder surgery under general anesthesia with brachial plexus block: postoperative respiratory dysfunction of combined obstructive and restrictive pathology.

    Science.gov (United States)

    Gwak, M S; Kim, W H; Choi, S J; Lee, J J; Ko, J S; Kim, G S; Kim, Y I; Kim, M H

    2013-02-01

    Changes in respiratory parameters and pulmonary function tests were evaluated after shoulder arthroscopic surgery with brachial plexus block (BPB). The purpose of this study was to identify the mechanism of respiratory dysfunction after this type of surgery. Patients undergoing arthroscopic rotator cuff repair under general anesthesia (GA) with BPB were enrolled in the arthroscopy group (n = 30) while those undergoing open reduction of a clavicle or humerus fracture under GA were enrolled in the control group (n = 30). Forced vital capacity (FVC) and forced expiratory volume 1 s (FEV(1)) were measured at the outpatient clinic stage (#1) before (#2) and 20 min after BPB (#3) and 1 h after extubation (#4). Respiratory variable measurements along with the cuff leak test were performed 5 min after surgical positioning (T1) and at the start of skin closure (T2). Respiratory discomfort was evaluated after extubation. The upper airway diameters and soft tissue depth of chest wall were also measured by ultrasonography at stages #3 and #4. Static compliance decreased significantly at T2 in the arthroscopy group (50 ± 11 at T1 vs. 44 ± 9 ml/cm H(2)O at T2, p =0.035) but not in the control group. The incidence of positive cuff leak tests at T2 was significantly higher in the arthroscopy group than in the control group (47% in the arthroscopy group vs. 17% in controls, p =0.010). While FEV(1) and FVC remained stable at stages #1 and #2, FVC and FEV(1) decreased at stages #3 and #4 only in the arthroscopy group (FVC in arthroscopy group, #2: 3.26 ± 0.77 l; #3: 2.55 ± 0.63 l, p =0.015 vs. #2; #4: 2.66 ± 0.41 l, p =0.040 vs. #2). The subglottic diameter decreased at #4 in the arthroscopy group, while no changes occurred in the control group (0.70 ± 0.21 cm vs. 0.85 ± 0.23 cm in the arthroscopy and control groups, respectively, p =0.011). Depth of skin to pleura increased at both intercostal spaces 1-2 and 3-4 in the

  11. Interval methods: An introduction

    DEFF Research Database (Denmark)

    Achenie, L.E.K.; Kreinovich, V.; Madsen, Kaj

    2006-01-01

    This chapter contains selected papers presented at the Minisymposium on Interval Methods of the PARA'04 Workshop '' State-of-the-Art in Scientific Computing ''. The emphasis of the workshop was on high-performance computing (HPC). The ongoing development of ever more advanced computers provides...... the potential for solving increasingly difficult computational problems. However, given the complexity of modern computer architectures, the task of realizing this potential needs careful attention. A main concern of HPC is the development of software that optimizes the performance of a given computer....... An important characteristic of the computer performance in scientific computing is the accuracy of the Computation results. Often, we can estimate this accuracy by using traditional statistical techniques. However, in many practical situations, we do not know the probability distributions of different...

  12. Multichannel interval timer

    International Nuclear Information System (INIS)

    Turko, B.T.

    1983-10-01

    A CAMAC based modular multichannel interval timer is described. The timer comprises twelve high resolution time digitizers with a common start enabling twelve independent stop inputs. Ten time ranges from 2.5 μs to 1.3 μs can be preset. Time can be read out in twelve 24-bit words either via CAMAC Crate Controller or an external FIFO register. LSB time calibration is 78.125 ps. An additional word reads out the operational status of twelve stop channels. The system consists of two modules. The analog module contains a reference clock and 13 analog time stretchers. The digital module contains counters, logic and interface circuits. The timer has an excellent differential linearity, thermal stability and crosstalk free performance

  13. Experimenting with musical intervals

    Science.gov (United States)

    Lo Presto, Michael C.

    2003-07-01

    When two tuning forks of different frequency are sounded simultaneously the result is a complex wave with a repetition frequency that is the fundamental of the harmonic series to which both frequencies belong. The ear perceives this 'musical interval' as a single musical pitch with a sound quality produced by the harmonic spectrum responsible for the waveform. This waveform can be captured and displayed with data collection hardware and software. The fundamental frequency can then be calculated and compared with what would be expected from the frequencies of the tuning forks. Also, graphing software can be used to determine equations for the waveforms and predict their shapes. This experiment could be used in an introductory physics or musical acoustics course as a practical lesson in superposition of waves, basic Fourier series and the relationship between some of the ear's subjective perceptions of sound and the physical properties of the waves that cause them.

  14. Relationships between rotator cuff tear types and radiographic abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying [Dept. of Diagnostic Radiology, College of Medicine, Chungbuk National University, Cheongju (Korea, Republic of)

    2014-11-15

    To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

  15. Relationships between rotator cuff tear types and radiographic abnormalities

    International Nuclear Information System (INIS)

    Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying

    2014-01-01

    To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

  16. Arthroscopic surgical treatment of recalcitrant lateral epicondylitis - A series of 47 cases

    Directory of Open Access Journals (Sweden)

    Alexandre Tadeu do Nascimento

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. METHODS: A retrospective study of 44 patients (47 elbows who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS, and ShortForm 36 (SF-36. The mean age at surgery was 44.4 years (32-60. The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years. Mean follow-up was 18.6 months (range of 6-31.9 . RESULTS: The mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain and 3.0 points at activity, of which 31 (66% cases presented mild pain, 10 (21% moderate pain, and six (13% severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. CONCLUSIONS: Arthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

  17. Arthroscopic Findings of the Joint Distraction for the Patient With Chondrolysis of the Ankle

    OpenAIRE

    Katsuaki Kanbe; Atsushi Hasegawa; Kenji Takagishi; Hiroyuki Kaneko; Yasuyuki Nakajima

    1997-01-01

    This case report describes arthroscopic findings of the effect on articular distraction of ankle joint by means of external fixator for the patient with chondrolysis. Arthroscopy showed fibrocartilage tissue lying between the talus and tibia to protect damaged articular surfaces although apparent repair of surface cartilage failed to find.

  18. Probing forces of menisci : What levels are safe for arthroscopic surgery

    NARCIS (Netherlands)

    Tuijthof, G.J.M.; Horeman, T.; Schafroth, M.U.; Blankevoort, L.; Kerkhoffs, G.M.M.J.

    2010-01-01

    Purpose To facilitate effective learning, feedback on performance during arthroscopic training is essential. Less attention has been paid to feedback on monitoring safe handling of delicate tissues such as meniscus. The goal is to measure in vitro probing forces of menisci and compare them with a

  19. Probing forces of menisci: what levels are safe for arthroscopic surgery

    NARCIS (Netherlands)

    Tuijthof, Gabriëlle J. M.; Horeman, Tim; Schafroth, Matthias U.; Blankevoort, Leendert; Kerkhoffs, Gino M. M. J.

    2011-01-01

    To facilitate effective learning, feedback on performance during arthroscopic training is essential. Less attention has been paid to feedback on monitoring safe handling of delicate tissues such as meniscus. The goal is to measure in vitro probing forces of menisci and compare them with a

  20. Arthroscopic surgical treatment of recalcitrant lateral epicondylitis - A series of 47 cases.

    Science.gov (United States)

    Nascimento, Alexandre Tadeu do; Claudio, Gustavo Kogake

    2017-01-01

    To evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. A retrospective study of 44 patients (47 elbows) who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS), and ShortForm 36 (SF-36). The mean age at surgery was 44.4 years (32-60). The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years). Mean follow-up was 18.6 months (range of 6-31.9). The mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain) and 3.0 points at activity, of which 31 (66%) cases presented mild pain, 10 (21%) moderate pain, and six (13%) severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. Arthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

  1. Do nonsteroidal anti-inflammatory drugs affect the outcome of arthroscopic Bankart repair?

    Science.gov (United States)

    Blomquist, J; Solheim, E; Liavaag, S; Baste, V; Havelin, L I

    2014-12-01

    To achieve pain control after arthroscopic shoulder surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) are a complement to other analgesics. However, experimental studies have raised concerns that these drugs may have a detrimental effect on soft tissue-to-bone healing and, thus, have a negative effect on the outcome. We wanted to investigate if there are any differences in the clinical outcome after the arthroscopic Bankart procedure for patients who received NSAIDs prescription compared with those who did not. 477 patients with a primary arthroscopic Bankart procedure were identified in the Norwegian shoulder instability register and included in the study. 32.5% received prescription of NSAIDs post-operatively. 370 (78%) of the patients answered a follow-up questionnaire containing the Western Ontario Shoulder Instability index (WOSI). Mean follow-up was 21 months. WOSI at follow-up were 75% in the NSAID group and 74% in the control group. 12% of the patients in the NSAID group and 14% in the control group reported recurrence of instability. The reoperation rate was 5% in both groups. There were no statistically significant differences between the groups. Prescription of short-term post-operative NSAID treatment in the post-operative period did not influence on the functional outcome after arthroscopic Bankart procedures. © 2014 The Authors. Scandinavian Journal of Medicine & Science in Sports published by John Wiley & Sons Ltd.

  2. Computed tomography of the patellofemoral alignment after arthroscopic reconstruction following patella dislocation

    International Nuclear Information System (INIS)

    Schroeder, R.J.; Hidajat, N.; Maeurer, J.; Felix, R.; Weiler, A.; Hoeher, J.

    2003-01-01

    Purpose: To evaluate the diagnostic impact of different CT-based measurements to analyze the patellofemoral alignment after arthroscopic reconstruction in patients with patella dislocation. Materials and Methods: In 18 patients with dislocation of the patella, CT of the patellofemoral joint was performed after arthroscopic reconstruction. Various methods recommended in the literature were used to analyze the structure and the alignment of the patellofemoral joint with a relaxed quadriceps muscle. Axial CT scans were taken in four different knee flexion angles (15 , 30 , 45 , 60 ). Results: After arthroscopic stabilization in patients with patella dislocation, only the lateral patellofemoral angle (15 and 30 knee flexion) and the congruence angle (15 knee flexion) showed significant differences between the CT-measurements in the normal and the operated group. The differences of the remaining mean values were not significant due to a high standard deviation. With increasing flexion of the knee, the differences between the normal and the dislocation group almost disappeared. Only the lateral patellofemoral angle, the patella tilt and the lateral patella shift revealed differences between the normal and the group with recurrent dislocation in every degree of knee flexion. With increasing knee flexion above 30 and especially at 60 , the majority of the measured values returned to the normal range. Conclusions: For CT-measurements of the patellofemoral joint after arthroscopic stabilization, the patellofemoral angle and the congruence angle seemed to be most useful. The measurements of the patellofemoral joint should be taken in various degrees of knee flexion. (orig.) [de

  3. Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

    Directory of Open Access Journals (Sweden)

    Seher Altinel

    2017-06-01

    Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000: 91-95

  4. Unicameral bone cyst of the humeral head: arthroscopic curettage and bone grafting.

    Science.gov (United States)

    Randelli, Pietro; Arrigoni, Paolo; Cabitza, Paolo; Denti, Matteo

    2009-01-01

    Arthroscopic surgery has improved greatly over the past decade. Treatment of various juxta-articular disorders around the shoulder have benefited from endoscopic approaches. Cystic lesions of the shoulder on the scapular side have been treated in this way. This article describes a case of a 29-year-old patient with a unicameral bone cyst on the posterior aspect of the humeral head. Arthroscopic visualization using an accessory posteroinferior portal localized the cyst through the bare area of the humeral head. A cannulated burr was used to create an opening through the cortical wall between the cyst and the joint, and a careful curettage was performed. The cavity was filled with a demineralized bone matrix enriched with autologous blood packed into an arthroscopic cannula and delivered through the accessory portal. The patient reported pain relief immediately postoperatively and at follow-up. This case demonstrates the feasibility of arthroscopic treatment of a simple bone cyst of the humeral head. We believe that the knowledge of the juxta-articular anatomy allows the applications of scope-assisted procedures to be expanded, maximizing the results of a technique that allows a shorter recovery and less painful rehabilitation.

  5. Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture.

    Science.gov (United States)

    García-Ruano, Á A; Najarro-Cid, F; Jiménez-Martín, A; Gómez de los Infantes-Troncoso, J G; Sicre-González, M

    2015-01-01

    Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0±8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. Functional results reached a mean of 83.4±16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16±48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. Arthroscopic knotless anchor repair of 1B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Osteonecrosis of the knee following arthroscopic meniscectomy; Osteoenecrosis de rodilla tras meniscectomia artrosocpica

    Energy Technology Data Exchange (ETDEWEB)

    Dobado, M. C.; Mota, J.; Roca, M. [Instituto Clinico Corachan. Barcelona (Spain)

    2000-07-01

    Primary osteonecrosis of the knee is characterized by acute onset of pain in elderly individuals who present no risk factors. Osteonecrosis following arthroscopic surgery for meniscal repair is a rare occurrence, the etiology of which remains to be determined. The authors present the magnetic resonance findings in a new case and a review of the related literature. (Author) 7 refs.

  7. Rotational motion in nuclei

    International Nuclear Information System (INIS)

    Bohr, A.

    1977-01-01

    History is surveyed of the development of the theory of rotational states in nuclei. The situation in the 40's when ideas formed of the collective states of a nucleus is evoked. The general rotation theory and the relation between the single-particle and rotational motion are briefly discussed. Future prospects of the rotation theory development are indicated. (I.W.)

  8. Rotational motion in nuclei

    International Nuclear Information System (INIS)

    Bohr, A.

    1976-01-01

    Nuclear structure theories are reviewed concerned with nuclei rotational motion. The development of the deformed nucleus model facilitated a discovery of rotational spectra of nuclei. Comprehensive verification of the rotational scheme and a successful classification of corresponding spectra stimulated investigations of the rotational movement dynamics. Values of nuclear moments of inertia proved to fall between two marginal values corresponding to rotation of a solid and hydrodynamic pattern of an unrotating flow, respectively. The discovery of governing role of the deformation and a degree of a symmetry violence for determining rotational degrees of freedon is pointed out to pave the way for generalization of the rotational spectra

  9. Optimal suture anchor direction in arthroscopic lateral ankle ligament repair.

    Science.gov (United States)

    Yoshimura, Ichiro; Hagio, Tomonobu; Noda, Masahiro; Kanazawa, Kazuki; Minokawa, So; Yamamoto, Takuaki

    2017-05-26

    In this study, the distance between the insertion point of the suture anchors and posterior surface of the fibula during arthroscopic lateral ankle ligament repair was investigated on computed tomography (CT) images. The hypothesis of this study was that there is an optimal insertional direction of the suture anchor to avoid anchor-related complications. One hundred eleven ankles of 98 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (59 males, 52 females; median age 25.5 years; age range 12-78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of the fossa/top of the convex aspect of the fibula was measured on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The distance from the insertion point of the suture anchor to the posterior surface of the fibula was also measured in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in the parallel direction was 15.0 ± 3.4 mm at 90°, 17.5 ± 3.2 mm at 75°, 21.7 ± 3.3 mm at 60°, and 25.7 ± 3.6 mm at 45°. The posterior points in the parallel direction were located on the posterior fossa in 36.0% of cases at 90°, in 12.6% at 75°, and in 0.0% at 60° and 45°. The suture anchor should be directed from anterior to posterior at an angle of <45° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, to avoid passing through the fibula. Cohort study, Level III.

  10. Effectiveness Of Plain Shoulder Radiograph In Detecting Degenerate Rotator Cuff Tears.

    Science.gov (United States)

    Hussain, Adnan; Muzzammil, Muhammad; Butt, Faisal; Valsamis, Epaminondas Markos; Dwyer, Amitabh J

    2018-01-01

    Studies have demonstrated radiographic findings of sclerosis and cortical irregularity at the greater tuberosity can suggest a rotator cuff tear. Plain radiographs are the most easily attainable first-line investigations in evaluating shoulder injuries. This study determines the effectiveness in predicting degenerate rotator cuff tears by detecting radiographic changes on shoulder x-rays. Retrospective cross-sectional study with a consecutive series of patients conducted in Hinchingbrooke Hospital, Huntingdon, United Kingdom from January 2015 to June 2017. Anteroposterior shoulder radiographs of 150 symptomatic patients who underwent shoulder arthroscopy were independently analysed by surgeons who were blinded from the arthroscopic results. Patients aged fewer than 30 and over 70 years were excluded. Patients with advanced osteoarthritis and cuff tear arthropathy evident on x-rays were also excluded. Sixty-five patients included in the study had rotator cuff tears on arthroscopy. Radiographic changes were correlated with arthroscopic findings to determine this test's ability to predict degenerate rotator cuff tears. When both cortical irregularity and sclerosis were present on the plain radiograph, these signs had a sensitivity of 78.8% [95% CI 65.7, 87.8%] and specificity 77.4% [95% CI 67.2, 85.0%] with a positive predictive value of 68.3%, using contingency table analysis. The presence of cortical irregularity was found to be a better predictor of a tear as compared to sclerosis. This study concludes that plain radiograph are good modality for initial evaluation of rotator cuff tears and detecting when both cortical irregularity and sclerosis. Consideration of these radiographic findings serves as a useful adjunct in diagnostic workup and can guide subsequent investigations and treatment when evaluating rotator cuff tears of the shoulder.

  11. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.

    Science.gov (United States)

    Barber, F Alan; Hrnack, Scott A; Snyder, Stephen J; Hapa, Onur

    2011-08-01

    To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging (MRI) and clinical outcome of arthroscopic rotator cuff repair. A comparative series of patients undergoing arthroscopic rotator cuff repair was studied. Two matched groups of patients (20 each) were included: rotator cuff repairs without PRPFM augmentation (group 1) and rotator cuff repairs augmented with 2 sutured platelet-rich plasma (PRP) constructs (group 2). A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon. Postoperative rehabilitation was held constant. Postoperative MRI scans were used to evaluate rotator cuff healing. Outcome measures included American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Constant scores. We followed up 40 patients (2 matched groups with 20 patients each) with a mean age of 57 years (range, 44 to 69 years) for a mean of 31 months (range, 24 to 44 months). Postoperative MRI studies showed persistent full-thickness tendon defects in 60% of controls (12 of 20) and 30% of PRPFM-augmented repairs (6 of 20) (P = .03). Of the control group tears measuring less than 3 cm in anteroposterior length, 50% (7 of 14) healed fully, whereas 86% of the PRPFM group tears measuring less than 3 cm in anteroposterior length (12 of 14) healed fully (P rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs. Other than the Rowe scores, there was no postoperative clinical difference by use of standard outcome measures. Level III, case-control study. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Rotator cuff injury: fat suppression MR image

    International Nuclear Information System (INIS)

    Won, Jong Yoon; Suh, Jin Suck; Park, Chang Yun; Lee, Yeon Hee; Kim, Yong Soo

    1994-01-01

    We performed the study prospectively to evaluate the advantage of fat suppression MR in the diagnosis of rotator cuff injury. Ten symptomatic patients were studied with both conventional T2WI and FST2WI using chemical shift technique. Each image was analyzed for the assessment of injuries, conspicuity of the lesion, the presence of effusion in subacromical bursae and joint space, and presence of humeral head injury. Arthroscopy was done in 4 patients following MRI. We could made presumptive diagnoses on FSMR as identical as on conventional MR in six cases(1 normal, 2 tendinitis, 2 partial thickness tear, 1 full thickness tear), two of them were confirmed by arthroscopic procedures. Two cases of partial thickness tear proved by arthroscopy were detected on FST2WI, whereas they were considered tendinitis on conventional T2WI. There were another 2 cases who showed tendinitis on FSMR, but normal on conventional T2WI. They, however, were not confirmed by either arthroscopy or surgical procedure. We found the FSMR were superior to conventional T2WI in the conspicuity of lesions and detection of joint effusion and abnormalities on the humeral head. We think FSMR of the shoulder could have significant diagnostic advantages over the conventional spin-echo MR imaging

  13. Rotator cuff injury: fat suppression MR image

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yoon; Suh, Jin Suck; Park, Chang Yun; Lee, Yeon Hee [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo [Inje University College of Medicine, Busan (Korea, Republic of)

    1994-04-15

    We performed the study prospectively to evaluate the advantage of fat suppression MR in the diagnosis of rotator cuff injury. Ten symptomatic patients were studied with both conventional T2WI and FST2WI using chemical shift technique. Each image was analyzed for the assessment of injuries, conspicuity of the lesion, the presence of effusion in subacromical bursae and joint space, and presence of humeral head injury. Arthroscopy was done in 4 patients following MRI. We could made presumptive diagnoses on FSMR as identical as on conventional MR in six cases(1 normal, 2 tendinitis, 2 partial thickness tear, 1 full thickness tear), two of them were confirmed by arthroscopic procedures. Two cases of partial thickness tear proved by arthroscopy were detected on FST2WI, whereas they were considered tendinitis on conventional T2WI. There were another 2 cases who showed tendinitis on FSMR, but normal on conventional T2WI. They, however, were not confirmed by either arthroscopy or surgical procedure. We found the FSMR were superior to conventional T2WI in the conspicuity of lesions and detection of joint effusion and abnormalities on the humeral head. We think FSMR of the shoulder could have significant diagnostic advantages over the conventional spin-echo MR imaging.

  14. Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle.

    Science.gov (United States)

    Matsui, Kentaro; Takao, Masato; Miyamoto, Wataru; Innami, Ken; Matsushita, Takashi

    2014-10-01

    Although several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently, some concern remains over their procedural complexity, complications, and unclear clinical outcomes. We have simplified the arthroscopic technique of Broström repair with Gould augmentation. This technique requires only two small skin incisions for two ports (medial midline and accessory anterolateral ports), without needing a percutaneous procedure or extension of the skin incisions. The anterior talofibular ligament is reattached to its anatomical footprint on the fibula with suture anchor, under arthroscopic view. The inferior extensor retinaculum is directly visualized through the accessory anterolateral port and is attached to the fibula with another suture anchor under arthroscopic view via the anterolateral port. The use of two small ports offers a procedure that is simple to perform and less morbid for patients.

  15. Capability of MRI for the indication at arthroscopic staple capsulorrhaphy on traumatic anterior instability of the shoulder

    International Nuclear Information System (INIS)

    Horii, Motoyuki; Kurokawa, Masao; Kubo, Toshikazu; Yamashita, Taku; Hirasawa, Yasusuke; Katsumi, Yasukazu.

    1996-01-01

    We compared MRI findings in the shoulder with arthroscopic findings of the anterior part of inferior gleno-humeral ligament (AIGHL) in 49 shoulders showing traumatic anterior instability (TAI). Arthroscopic findings were classified into two types according to whether the AIGHL is adequately wide and thick for arthroscopic staple capsulorrhaphy (ASC). MRI findings were graded into two types according to the continuity of the articular capsule in 23 shoulders examined by MR arthrograms and according to the morphology of the anterior labrum in 26 examined by conventional MRI. In each shoulder, two or three different sections containing the anteroinferior area of the glenoid were evaluated. MRI findings were significantly correlated with arthroscopic findings. Both MR arthrograms and conventional MRI are useful for determining the indications for ASC. (author)

  16. Ear Acupuncture for Post-Operative Pain Associated with Ambulatory Arthroscopic Knee Surgery: A Randomized Controlled Trial

    Science.gov (United States)

    2014-01-14

    E7(/(3+21(180%(5 ,QFOXGHDUHDFRGH 14 Jan 2014 Final Report Ear acupuncture for post-operative pain associated with ambulatory arthroscopic...DISTRIBUTION A. Approved for public release: distribution unlimited. The purpose of this study is to compare ear acupuncture plus standard therapy versus...3298 Ear Acupuncture for Post-operative Pa111 Assoc1ated With Ambulatory Arthroscopic Knee Surgery A Randomized Controlled Trial ’• V ’’ ’-’ I

  17. Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

    DEFF Research Database (Denmark)

    Rasmussen, S; Kehlet, H

    2000-01-01

    In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone, bupivac......In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...

  18. All-inside arthroscopic modified Broström operation for chronic ankle instability: a biomechanical study.

    Science.gov (United States)

    Lee, Kyung Tai; Kim, Eung Soo; Kim, Young Ho; Ryu, Je Seong; Rhyu, Im Joo; Lee, Young Koo

    2016-04-01

    The all-inside arthroscopic modified Broström operation has been developed for lateral ankle instability. We compared the biomechanical parameters of the all-inside arthroscopic procedure to the open modified Broström operation. Eleven matched pairs of human cadaver specimens [average age 71.5 (range 58-98) years] were subject to the arthroscopic modified Broström operation using a suture anchor and the open modified Broström operation. The ligaments were loaded cyclically 20 times and then tested to failure. Torque to failure, degrees to failure, and stiffness were measured. A matched-pair analysis was performed. There was no significant difference in torque to failure between the open and arthroscopic modified Broström operation (19.9 ± 8.9 vs. 23.3 ± 12.1 Nm, n.s). The degrees to failure did not differ significantly between the open and arthroscopic modified Broström operations (46.8 ± 9.9° vs. 46.7 ± 7.6°, n.s). The working construct stiffness (or stiffness to failure) was no significant difference in the two groups (0.438 ± 0.21 vs. 0.487 ± 0.268 Nm/deg for the open and arthroscopic modified Broström operations, respectively, n.s). The all-inside arthroscopic modified Broström operation and the open modified Broström operation resulted in no significantly different torque to failure, degrees to failure, and working construct stiffness with no significant differences (n.s, n.s, and n.s, respectively). Our results indicate that the arthroscopic modified Broström operation is a reasonable alternative procedure for chronic ankle instability.

  19. Arthroscopic pubic symphysis debridement and adductor enthesis repair in athletes with athletic pubalgia: technical note and video illustration.

    Science.gov (United States)

    Hopp, Sascha; Tumin, Masjudin; Wilhelm, Peter; Pohlemann, Tim; Kelm, Jens

    2014-11-01

    We elaborately describe our novel arthroscopic technique of the symphysis pubis in athletes with osteitis pubis and concomitant adductor enthesopathy who fail to conservative treatment modalities. The symphysis pubis is debrided arthroscopically and the degenerated origin of adductor tendon (enthesis) is excised and reattached. With our surgical procedure the stability of the symphysis pubis is successfully preserved and the adductor longus enthesopathy simultaneously addressed in the same setting.

  20. Study on electromagnetic constants of rotational bands

    International Nuclear Information System (INIS)

    Abdurazakov, A.A.; Adib, Yu.Sh.; Karakhodzhaev, A.K.

    1991-01-01

    Values of electromagnetic constant S and rotation bands of odd nuclei with Z=64-70 within the mass number change interval A=153-173 are determined. Values of γ-transition mixing parameter with M1+E2 multipolarity are presented. ρ parameter dependence on mass number A is discussed

  1. Rotationally invariant correlation filtering

    International Nuclear Information System (INIS)

    Schils, G.F.; Sweeney, D.W.

    1985-01-01

    A method is presented for analyzing and designing optical correlation filters that have tailored rotational invariance properties. The concept of a correlation of an image with a rotation of itself is introduced. A unified theory of rotation-invariant filtering is then formulated. The unified approach describes matched filters (with no rotation invariance) and circular-harmonic filters (with full rotation invariance) as special cases. The continuum of intermediate cases is described in terms of a cyclic convolution operation over angle. The angular filtering approach allows an exact choice for the continuous trade-off between loss of the correlation energy (or specificity regarding the image) and the amount of rotational invariance desired

  2. Rotator cuff injury in patients over the age of 65 years: evaluation of function, integrity and strength

    Directory of Open Access Journals (Sweden)

    Marco Antonio de Castro Veado

    2015-06-01

    Full Text Available OBJECTIVE: To retrospectively evaluate the results from patients who underwent arthroscopic treatment for rotator cuff injuries, among those aged over 65 years, observing integrity, function and strength.METHODS: Thirty-five shoulders were operated between July 2005 and July 2010, and 28 shoulders were re-evaluated regarding elevation strength and external rotation, using a digital dynamometer. Integrity was evaluated by means of ultrasound examinations. The patients, whose mean age was 70.54 years (ranging from 65 to 82 years, were followed up for a minimum of 26 months and mean of 51.18 months (ranging from 26 to 82 months. To evaluate function, the UCLA score, the Simple Shoulder Test (SST and a visual analog scale (VAS for pain were used.RESULTS: In analyzing the ultrasound scans, it was observed that the integrity of the rotator cuff was maintained in 75% of the cases at the end of the follow-up, along with the improvement in the UCLA score, which evolved from 17.46 to 32.39, i.e. excellent and good results in 89.28%. The mean SST and VAS indices were 9.86 and 1.5 respectively.CONCLUSION: Arthroscopic surgery to repair rotator cuff injuries in patients over the age of 65 years leads to improved function and pain relief, with maintenance of the integrity of the repair. The data on muscle strength were inconclusive.

  3. Energy correlations for mixed rotational bands

    International Nuclear Information System (INIS)

    Doessing, T.

    1985-01-01

    A schematic model for the mixing of rotational bands above the yrast line in well deformed nuclei is considered. Many-particle configurations of a rotating mean field form basis bands, and these are subsequently mixed due to a two body residual interaction. The energy interval over which a basis band is spread out increases with increasing excitation energy above the yrast line. Conversely, the B(E2) matrix element for rotational decay out of one of the mixed band states is spread over an interval which is predicted to become more narrow with increasing excitation energy. Finally, the implication of band mixing for γ-ray energy correlations is briefly discussed. (orig.)

  4. Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

    Science.gov (United States)

    Kum, Dong Ho; Kim, Jun Ho; Park, Keun Min; Lee, Eun Su; Park, Yong Bok; Yoo, Jae Chul

    2017-06-01

    Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups ( p rotator cuff tears in a Korean population.

  5. Validation of a global assessment of arthroscopic skills in a cadaveric knee model.

    Science.gov (United States)

    Slade Shantz, Jesse A; Leiter, Jeff R; Collins, John B; MacDonald, Peter B

    2013-01-01

    The purpose of this study was to determine whether a global assessment of arthroscopic skills was valid for blinded assessment of cadaveric diagnostic knee arthroscopy. A global skills assessment for arthroscopy was created using a published theory of the development of expertise. Faculty surgeons, fellows, and residents were consented and enrolled in this institutional review board-approved validation study. All participants were oriented to the equipment and procedures for diagnostic arthroscopy of the knee. After reviewing the anatomic structures to be visualized, participants were allowed 10 minutes to complete a diagnostic arthroscopy of the knee. The hands and arthroscopic view were recorded during this attempt. Resident participants completed a second filmed diagnostic arthroscopy 1 week after the initial attempt. Five blinded reviewers watched the synchronized videos and assessed arthroscopic skills with a procedure-specific checklist and the newly developed global skills assessment. The agreement between reviewers was determined by intraclass correlation coefficient. Internal consistency was determined with Cronbach's α. Test-retest reliability was measured by correlating repeated arthroscopies by residents. The ability of the global assessment to discriminate skill levels was determined with between-group Mann-Whitney U tests. The agreement between global assessment scores was strong (I.C.C. = 0.80, 95% C.I. 0.68-0.92). The internal consistency of evaluations was excellent (Cronbach's α = 0.97), and the test-retest reliability was strong (r = 0.52). The global assessment score was shown to be able to discriminate between skill levels by an analysis of variance indicating the difference in means among the various levels of training (P Assessment of Arthroscopic Skills is a useful adjunct to arthroscopic educators and learners and could be used for in-training evaluations. The Objective Assessment of Arthroscopic Skills is an instrument that can be

  6. Influence of a cylindrical column of rotating plasma on stability

    International Nuclear Information System (INIS)

    Rossato, L.C.

    1975-01-01

    The kink instability of a cylindrical column of rotating plasma, liable to a perturbation of the form f (r) exp [i(m -kz) + wt], under a condition kr<< m, was studied. It was concluded that as we increase the rotation, the interval of possible instabilities decreases. When the speed of rotation in the outlines of the plasma is equal to the speed of Alfven we will surely have stability. (author)

  7. Preoperative CT planning of screw length in arthroscopic Latarjet.

    Science.gov (United States)

    Hardy, Alexandre; Gerometta, Antoine; Granger, Benjamin; Massein, Audrey; Casabianca, Laurent; Pascal-Moussellard, Hugues; Loriaut, Philippe

    2018-01-01

    The Latarjet procedure has shown its efficiency for the treatment of anterior shoulder dislocation. The success of this technique depends on the correct positioning and fusion of the bone block. The length of the screws that fix the bone block can be a problem. They can increase the risk of non-union if too short or be the cause of nerve lesion or soft tissue discomfort if too long. Suprascapular nerve injuries have been reported during shoulder stabilisation surgery up to 6 % of the case. Bone block non-union depending on the series is found around 20 % of the cases. The purpose of this study was to evaluate the efficiency of this CT preoperative planning to predict optimal screws length. The clinical importance of this study lies in the observation that it is the first study to evaluate the efficiency of CT planning to predict screw length. Inclusion criteria were patients with chronic anterior instability of the shoulder with an ISIS superior to 4. Exclusion criteria were patients with multidirectional instability or any previous surgery on this shoulder. Thirty patients were included prospectively, 11 of them went threw a CT planning, before their arthroscopic Latarjet. Optimal length of both screws was calculated, adding the size of the coracoid at 5 and 15 mm from the tip to the glenoid. Thirty-two-mm screws were used for patients without planning. On a post-operative CT scan with 3D reconstruction, the distance between the screw tip and the posterior cortex was measured. A one-sample Wilcoxon test was used to compare the distance from the tip of the screw to an acceptable positioning of ±2 mm from the posterior cortex. In the group without planning, screw 1 tended to differ from the acceptable positioning: mean 3.44 mm ± 3.13, med 2.9 mm, q1; q3 [0.6; 4.75] p = 0.1118, and screw 2 differed significantly from the acceptable position: mean 4.83 mm ± 4.11, med 3.7 mm, q1; q3 [1.7; 5.45] p = 0.0045. In the group with planning, position of

  8. Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of the rotator cuff.

    Science.gov (United States)

    Brockmeyer, Matthias; Schmitt, Cornelia; Haupert, Alexander; Kohn, Dieter; Lorbach, Olaf

    2017-12-01

    The reliable diagnosis of partial-thickness tears of the rotator cuff is still elusive in clinical practise. Therefore, the purpose of the study was to determine the diagnostic accuracy of MR imaging and clinical tests for detecting partial-thickness tears of the rotator cuff as well as the combination of these parameters. 334 consecutive shoulder arthroscopies for rotator cuff pathologies performed during the time period between 2010 and 2012 were analyzed retrospectively for the findings of common clinical signs for rotator cuff lesions and preoperative MR imaging. These were compared with the intraoperative arthroscopic findings as "gold standard". The reports of the MR imaging were evaluated with regard to the integrity of the rotator cuff. The Ellman Classification was used to define partial-thickness tears of the rotator cuff in accordance with the arthroscopic findings. Descriptive statistics, sensitivity, specificity, positive and negative predictive value were calculated. MR imaging showed 80 partial-thickness and 70 full-thickness tears of the rotator cuff. The arthroscopic examination confirmed 64 partial-thickness tears of which 52 needed debridement or refixation of the rotator cuff. Sensitivity for MR imaging to identify partial-thickness tears was 51.6%, specificity 77.2%, positive predictive value 41.3% and negative predictive value 83.7%. For the Jobe-test, sensitivity was 64.1%, specificity 43.2%, positive predictive value 25.9% and negative predictive value 79.5%. Sensitivity for the Impingement-sign was 76.7%, specificity 46.6%, positive predictive value 30.8% and negative predictive value 86.5%. For the combination of MR imaging, Jobe-test and Impingement-sign sensitivity was 46.9%, specificity 85.4%, positive predictive value 50% and negative predictive value 83.8%. The diagnostic accuracy of MR imaging and clinical tests (Jobe-test and Impingement-sign) alone is limited for detecting partial-thickness tears of the rotator cuff. Additionally

  9. Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

    Directory of Open Access Journals (Sweden)

    Swierstra Bart A

    2011-09-01

    Full Text Available Abstract Background The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively. Methods In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up. Results The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively. Conclusions To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

  10. Influence of Preoperative Musculotendinous Junction Position on Rotator Cuff Healing After Double-Row Repair.

    Science.gov (United States)

    Tashjian, Robert Z; Erickson, Gregory A; Robins, Richard J; Zhang, Yue; Burks, Robert T; Greis, Patrick E

    2017-06-01

    The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals. Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed. Patients undergoing repairs with other constructs or receiving augmented repairs (platelet-rich fibrin matrix) who had postoperative MRI scans were excluded. Preoperative MRI scans were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid in the coronal plane. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI scans were evaluated for healing, tendon length, and MTJ position. Of 42 tears, 36 (86%) healed, with 27 of 31 small to medium tears (87%) and 9 of 11 large to massive tears (82%) healing. Healing occurred in 94% of tears that had a preoperative MTJ lateral to the face of the glenoid but only 56% of tears that had a preoperative MTJ medial to the glenoid face (P = .0135). The measured tendon length increased an average of 14.4 mm in patients whose tears healed compared with shortening by 6.4 mm in patients with tears that did not heal (P rotator cuff repair. The position of the MTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing. Level IV, retrospective review of case series; therapeutic study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Parameterization of rotational spectra

    International Nuclear Information System (INIS)

    Zhou Chunmei; Liu Tong

    1992-01-01

    The rotational spectra of the strongly deformed nuclei with low rotational frequencies and weak band mixture are analyzed. The strongly deformed nuclei are commonly encountered in the rare-earth region (e. g., 150 220). A lot of rotational band knowledge are presented

  12. Rotating reactors : a review

    NARCIS (Netherlands)

    Visscher, F.; Schaaf, van der J.; Nijhuis, T.A.; Schouten, J.C.

    2013-01-01

    This review-perspective paper describes the current state-of-the-art in the field of rotating reactors. The paper has a focus on rotating reactor technology with applications at lab scale, pilot scale and industrial scale. Rotating reactors are classified and discussed according to their geometry:

  13. Reparo artroscópico das lesões completas isoladas do subescapular Arthroscopic repair of complete, isolated lesions of the subscapularis tendon

    Directory of Open Access Journals (Sweden)

    Niso Eduardo Balsini

    2008-12-01

    Full Text Available OBJETIVO: Avaliar o resultado retrospectivo de 12 pacientes submetidos ao reparo artroscópico de lesões completas isoladas do tendão do subescapular com seguimento mínimo de um ano. MÉTODOS: De 11 de abril de 2002 a 24 de setembro de 2004, realizou-se o reparo artroscópico de lesões completas do manguito rotador em 95 pacientes no Instituto Balsini. Pacientes com subescapular lesado somavam 31; 12 lesões isoladas compunham o grupo de estudo. Foram reavaliados com seguimento mínimo de um ano da cirurgia, considerando grau de elevação anterior ativa, escala da UCLA e satisfação do paciente. RESULTADOS: A elevação anterior ativa pré-operatória atingiu a média de 102º, o grau de elevação anterior ativa pós-operatória obteve a média de 175º. O ganho médio na elevação anterior ativa foi de 73º (p OBJECTIVE: To evaluate the retrospective result of 12 patients submitted to arthroscopic repair of complete, isolated lesions of the subscapularis tendon with minimum follow-up of one year. METHODS: From April 11, 2002 to September 24, 2004, the authors performed the arthroscopic repair of complete rotator cuff lesions in 95 patients at the Balsini Institute. Patients with lesioned subscapularis amounted to 31, and 12 isolated lesions were included in the study group. They were re-analyzed with a minimum follow-up of one year after surgery to evaluate the degree of active anterior elevation, according to the UCLA scale and to patient satisfaction. RESULTS: Pre-operative active anterior elevation had a mean of 102º, and the degree of active anterior elevation after surgery presented a mean of 175º. The mean gain in active anterior elevation was 73º (p < 0.0001. Preoperative UCLA had a mean of 15.25 score points, and after surgery, a mean of 31.66 score points. The mean UCLA index was 16 score points (p < 0.0001; 10 excellent results, one good, and one poor. Satisfactory results: 10, unsatisfactory: 1. CONCLUSION: 1 The

  14. Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release.

    Science.gov (United States)

    Korkala, O L; Isotalo, T M; Lavonius, M I; Niskanen, R O

    1995-01-01

    In a follow-up study of 67 patients with an arthroscopically diagnosed patellar chondromalacia, we compared the results of plain conservative treatment with those after an open lateral retinacular release. The mean follow-up was 35 months. In Grade I chondromalacia the lateral release did not affect the result, which was in all cases good or excellent. In Grade II to IV chondromalacia the lateral release appeared beneficial, although the difference did not reach statistical significance. We also examined the validity of three clinical signs in arthroscopically verified patellar chondromalacia. Patellar inhibition and tracking tests were clearly more sensitive than the lateral apprehension test, which often gave a false negative result. If the patellar inhibition test is positive and a Grade II to IV chondromalacia of the patella is found at arthroscopy, lateral release should be considered among other procedures, like patellar shaving or patellar resurfacing.

  15. Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery

    DEFF Research Database (Denmark)

    Espelund, M; Grevstad, U; Jaeger, P

    2014-01-01

    BACKGROUND: The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery. METHODS: Fifty...... subjects with moderate to severe pain after arthroscopic knee surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB...... score difference was 32 (23 to 41) mm, P moderate to severe pain after...

  16. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje

    2016-01-01

    Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy...... clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial....... Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option. Trial registration www.clinicaltrials.gov (NCT01002794)....

  17. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje

    2016-01-01

    OBJECTIVE: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN: Randomised controlled superiority trial. SETTING: Orthopaedic departments at two public hospitals and two physiotherapy...... clinics in Norway. PARTICIPANTS: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS: 12 week supervised exercise therapy alone or arthroscopic partial....... Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.Trial registration www.clinicaltrials.gov (NCT01002794)....

  18. ARTHROSCOPIC METHOD OF THE RADIAL HEAD FRACTURE OSTEOSYNTHESIS (СASE REPORT

    Directory of Open Access Journals (Sweden)

    I. A. Kuznetsov

    2016-01-01

    Full Text Available Radial head fractures constitute about 3% of all fractures and 30% within the group of elbow joint injuries. Conventional open surgical treatment is accompanied by an extensive soft tissue incision and sometimes by capsule release for adequate visualization. Arthroscopic methods feature relatively insignificant soft tissue trauma, allow to reduce pain syndrome in postoperative period and to accelerate rehabilitation. Besides, arthroscopy improves surgical view in cases of intraarticular fractures and facilitates a better anatomical reduction of articular surface. The authors demonstrate a clinical case of a patient with closed fractures of radial head and ulna coronoid process with displacement of left elbow joint fragments where arthroscopic surgery provided for good anatomical and functional results.

  19. Arthroscopic treatment of impingement of the ankle reduces pain and enhances function

    DEFF Research Database (Denmark)

    Rasmussen, S; Hjorth Jensen, C

    2002-01-01

    A consecutive series of 105 patients with a median age of 35 (16-62) years who were operated on with arthroscopic resection for impingement of the ankle using standardized technique without distraction is presented. All patients complained of painful dorsiflexion and had failed to respond to cons...... synovectomy and intravenous antibiotics. In one patient persistent symptoms were recorded. Ankle arthroscopy yielded good results in the treatment of anterior impingement of the ankle as it effectively reduced pain and enhanced function....... of pain. Gait was improved in 30/41 patients and 22 resumed sporting activities. The results were graded excellent in 67, good in 25, fair in six and poor in seven patients. There were four deep infections and one synovial fistula in this series. The deep infections all responded well to arthroscopic...

  20. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Roos, Ewa M; Nissen, Nis

    2016-01-01

    Background and purpose - Patients' expectations of outcomes following arthroscopic meniscus surgery are largely unknown. We investigated patients' expectations concerning recovery and participation in leisure-time activities after arthroscopic meniscus surgery and the postoperative fulfillment...... of these. Patients and methods - The study sample consisted of 491 consecutively recruited patients (mean age 50 (SD 13) years, 55% men) who were assigned for arthroscopy on suspicion of meniscus injury and later verified by arthroscopy. Before surgery, patients completed questionnaires regarding...... meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure...

  1. ARTHROSCOPIC FIXATION OF ANTERIOR CRUCIATE LIGAMENT TIBIAL AVULSION FRACTURES USING FIBRE WIRE WITH OR WITHOUT ENDOBUTTON

    Directory of Open Access Journals (Sweden)

    Satyajeet Jagtap

    2017-06-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament (ACL avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to various modalities in arthroscopic fixation. The aim of our study is to assess the clinical and radiological results of arthroscopic fixation using fibre wire with or without Endobutton in the management of ACL avulsion fractures using a simpler technique. MATERIALS AND METHODS Fifteen patients (10 males and 5 females who underwent arthroscopic fixation with standard anteromedial and anterolateral ports using fibre wire with or without Endobutton (9 cases only fibre wire was used, 6 cases Endobutton was used in addition for displaced ACL avulsion fractures (Meyers and McKeever’s classification grade 2, grade 3 and grade 4 were analysed. The average age was 26.1 years with a mean follow up of 1 year. All patients were assessed clinically by calculating their Lysholm scores, Lachman test and the radiological union was assessed in the follow up radiographs. Study Design- Retrospective observational case series. RESULTS The mean Lysholm score was 94.93 ± 2.81 (mean ± SD. In 14 patients, Lachman test was negative at the end of final follow up while 1 patient had grade I laxity compared to normal knee. At final followup, all the patients were able to return to their preinjury activity level except one who had an extension lag, underwent arthrolysis subsequently and is improving. CONCLUSION Arthroscopic fixation using this technique of using fibre wire with or without Endobutton is a safe and reliable technique for producing clinicoradiological outcome in displaced ACL avulsion fractures.

  2. Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes.

    Science.gov (United States)

    Domb, Benjamin G; Yuen, Leslie C; Ortiz-Declet, Victor; Litrenta, Jody; Perets, Itay; Chen, Austin W

    2017-10-01

    Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. Case series; Level of evidence, 4. Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied). Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

  3. ARTHROSCOPIC REPAIR OF BANKART’S LESION USING SUTURE ANCHORS IN RECURRENT ANTERIOR SHOULDER INSTABILITY

    OpenAIRE

    Santosh Kumar; Anant Kumar; Sanjay

    2015-01-01

    BACKGROUND : Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A sut...

  4. Arthroscopic Anterior Shoulder Stabilization With Incorporation of a Comminuted Bony Bankart Lesion

    OpenAIRE

    Lansdown, Drew; Bernardoni, Eamon D.; Cotter, Eric J.; Romeo, Anthony A.; Verma, Nikhil N.

    2017-01-01

    Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not be...

  5. A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair: Beyond Stability.

    Science.gov (United States)

    Tjong, Vehniah K; Devitt, Brian M; Murnaghan, M Lucas; Ogilvie-Harris, Darrell J; Theodoropoulos, John S

    2015-08-01

    Arthroscopic shoulder stabilization is known to have excellent functional results, but many patients do not return to their preinjury level of sport, with return to play rates reported between 48% and 100% despite good outcome scores. To understand specific subjective psychosocial factors influencing a patient's decision to return to sport after arthroscopic shoulder stabilization. Case series; Level of evidence, 4. Semistructured qualitative interviews were conducted with patients aged 18 to 40 years who had undergone primary arthroscopic shoulder stabilization and had a minimum 2-year follow-up. All patients participated in sport before surgery without any further revision operations or shoulder injuries. Qualitative data analysis was performed in accordance with the Strauss and Corbin theory to derive codes, categories, and themes. Preinjury and current sport participation was defined by type, level of competition, and the Brophy/Marx shoulder activity score. Patient-reported pain and shoulder function were also obtained. A total of 25 patients were interviewed, revealing that fear of reinjury, shifts in priority, mood, social support, and self-motivation were found to greatly influence the decision to return to sport both in patients who had and had not returned to their preinjury level of play. Patients also described fear of sporting incompetence, self-awareness issues, recommendations from physical therapists, and degree of confidence as less common considerations affecting their return to sport. In spite of excellent functional outcomes, extrinsic and intrinsic factors such as competing interests, kinesiophobia, age, and internal stressors and motivators can have a major effect on a patient's decision to return to sport after arthroscopic shoulder stabilization. The qualitative methods used in this study provide a unique patient-derived perspective into postoperative recovery and highlight the necessity to recognize and address subjective and psychosocial

  6. Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

    Directory of Open Access Journals (Sweden)

    Tae-Soo Park

    2016-01-01

    Full Text Available Background: Symptomatic acromioclavicular joint (ACJ lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years. The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months. The results were evaluated using the University of California Los Angeles (UCLA shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly ( P < 0.001. There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

  7. A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery.

    Science.gov (United States)

    Musso, D; Flohr-Madsen, S; Meknas, K; Wilsgaard, T; Ytrebø, L M; Klaastad, Ø

    2017-10-01

    Interscalene brachial plexus block is currently the gold standard for intra- and post-operative pain management for patients undergoing arthroscopic shoulder surgery. However, it is associated with block related complications, of which effect on the phrenic nerve have been of most interest. Side effects caused by general anesthesia, when this is required, are also a concern. We hypothesized that the combination of superficial cervical plexus block, suprascapular nerve block, and infraclavicular brachial plexus block would provide a good alternative to interscalene block and general anesthesia. Twenty adult patients scheduled for arthroscopic shoulder surgery received a combination of superficial cervical plexus block (5 ml ropivacaine 0.5%), suprascapular nerve block (4 ml ropivacaine 0.5%), and lateral sagittal infraclavicular block (31 ml ropivacaine 0.75%). The primary aim was to find the proportion of patients who could be operated under light propofol sedation, without the need for opioids or artificial airway. Secondary aims were patients' satisfaction and surgeons' judgment of the operating conditions. Nineteen of twenty patients (95% CI: 85-100) underwent arthroscopic shoulder surgery with light propofol sedation, but without opioids or artificial airway. The excluded patient was not comfortable in the beach chair position and therefore received general anesthesia. All patients were satisfied with the treatment on follow-up interviews. The surgeons rated the operating conditions as good for all patients. The novel combination of a superficial cervical plexus block, a suprascapular nerve block, and an infraclavicular nerve block provides an alternative anesthetic modality for arthroscopic shoulder surgery. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  8. A novel technique of rotator cuff repair using spinal needle and suture loop

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    Muzaffar Nasir

    2010-11-01

    Full Text Available Abstract Background We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient.

  9. Rotating Stars in Relativity

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    Stergioulas Nikolaos

    2003-01-01

    Full Text Available Rotating relativistic stars have been studied extensively in recent years, both theoretically and observationally, because of the information they might yield about the equation of state of matter at extremely high densities and because they are considered to be promising sources of gravitational waves. The latest theoretical understanding of rotating stars in relativity is reviewed in this updated article. The sections on the equilibrium properties and on the nonaxisymmetric instabilities in f-modes and r-modes have been updated and several new sections have been added on analytic solutions for the exterior spacetime, rotating stars in LMXBs, rotating strange stars, and on rotating stars in numerical relativity.

  10. Functional Results in Arthroscopic Treatment in Patients with Chronic Lateral Elbow Pain.

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    Phorkhar, Termphong; Chanlalit, Cholawish

    2015-11-01

    Modern surgery as elbow arthroscopic surgery is an accepted operation due to benefit in precise intra-articular lesion detection and minimally invasive surgery. To report the functional results when using arthroscopic surgery to treat chronic lateral elbow pain. The data was collected from 25 patients with chronic lateral elbow pain that failed in non-operative treatment and treated with elbow arthroscopic surgery. Five patients were excluded from this study due to diagnosed as instability that needed the ligament reconstruction. The etiology of pain were grouped in to tennis elbow (4 pts), plica (9 pts), tennis elbow combined with plica (4 pts) and cartilage lesion (3 pts). Thai quick DASH questionnaire was used to evaluate the functional results by comparing pre and post operation score and calculated statistic results with paired t-test by level of significance p tennis elbow mean score was 74 and 33, in plica lesion mean score was 65 and 11, combined lesions mean score was 60 and 18 and cartilage lesion mean score was 60 and 20. Approaching chronic lateral elbow pain with arthroscopy can maintain the signficant improvement of functional result in midterm follow-up.

  11. Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain.

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    Rajeev, Aysha; Pooley, Joesph

    2015-04-01

    To review the outcome of 121 patients who underwent arthroscopic resection of a humeroradial synovial plica for persistent lateral elbow pain. 92 men and 29 women aged 24 to 56 (mean, 38) years with chronic lateral elbow pain underwent arthroscopic resection of a humeroradial synovial plica using a motorised soft tissue shaver, followed by intensive physiotherapy. The modified elbow score and range of motion were assessed, as were wound healing, infection, soft tissue swelling or effusion, tenderness, ligamentous instability, and motor strength. No patient had any ligamentous instability. 80 patients were pain-free at 3 months; only 3 patients were taking pain medication at 6 months. All patients had full pronation and supination; the mean range of motion was 3º to 135º of flexion. The mean modified elbow score at 12 months was 93.2 (range, 72-100). The percentages of patients with excellent, good, fair, and poor score were 70%, 17%, 8%, and 5% at 3 months, 74%, 20%, 3%, and 3% at 6 months, and 76%, 18%, 3%, and 3% at 12 months, respectively. A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome.

  12. Relationship of physical examination test of shoulder instability to arthroscopic findings in dogs.

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    Devitt, Chad M; Neely, Marlon R; Vanvechten, Brian J

    2007-10-01

    To determine the diagnostic validity of commonly used physical examination maneuvers for shoulder instability. Retrospective study. Dogs (n=24) referred for shoulder arthroscopy. Results of physical maneuvers and arthroscopic findings were recorded and sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) were calculated for each of 4 physical examination test findings for arthroscopic changes in the medial, lateral, cranial, or caudal compartments of the shoulder joint viewed in dorsal recumbency by lateral and craniomedial portals. Distribution of compartment changes was: medial (17 dogs), caudal (15), cranial (12), and lateral (5). The biceps test had a moderate effect (LR+=9) on post-test probability of cranial compartment changes and a small effect on post-test probability of lateral and caudal compartment changes (LR+=3 and 2.4, respectively). Hyperabduction had a minimal effect and mediolateral instability test had a small effect (LR+=1.64 and 2.68, respectively) on post-test probability of medial compartment changes. Craniocaudal instability test had little to no effect on post-test probability of changes in any compartment. Physical examination tests evaluated were limited in their ability to predict the type of arthroscopic pathology in this study population. Clinicians should understand that a diagnostic test performs inconsistently based on prevalence of a condition in a given patient population. The use of likelihood ratios can assist clinicians in determining the probability of intraarticular changes from a group with a differing prevalence than the patient population presented.

  13. Arthroscopic approach and intraarticular anatomy of the stifle in South American camelids.

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    Pentecost, Rebecca L; Niehaus, Andrew J; Santschi, Elizabeth

    2012-05-01

    To describe a cranial arthroscopic approach to the stifle of South American camelids and to report our clinical experience with camelid stifle arthroscopy. Experimental study and retrospective case series. (1) Cadaveric alpaca hindlimbs (n = 18; 9 alpacas); (2) 1 alpaca and 1 llama Polymethylmethacrylate joint casts (n = 2) were made to define stifle joint dimensions. Cadaveric stifle joints (n = 16) were evaluated arthroscopically to determine arthroscopic portal locations, describe the intraarticular anatomy, and report potential complications. An alpaca and a llama with stifle joint disease had diagnostic arthroscopy. Successful entry into the stifle joint was achieved in 16 cadaver limbs. Observed structures were: the suprapatellar pouch, articular surface of the patella, femoral trochlear ridges and groove, cranial aspect of the femoral condyles (n = 16); distal aspect of the cranial and proximal aspect of the caudal cruciate ligaments (14); and cranial aspects of the medial and lateral menisci (11), and cranial meniscotibial and intermeniscal ligaments (8). Stifle arthroscopy allowed for joint evaluation and removal of osteochondral fragments in 1 alpaca and 1 llama with naturally occurring stifle disease. Complications of cadaver or live procedures included minor cartilage scoring (3 stifles) and subcutaneous periarticular fluid accumulation (8 stifles). Arthroscopy provides a safe approach for diagnosis and treatment of stifle lesions in South American camelids. Copyright 2012 by The American College of Veterinary Surgeons.

  14. Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement.

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    Devgan, Ashish; Rohilla, Rajesh; Tanwar, Milind; Jain, Aditya; Siwach, Karan; Devgan, Radika

    2016-01-01

    Arthroscopic debridement has been a gold standard procedure for anterior ankle impingement, both in cases of osseous and soft tissue impingement. There is sparse literature on comparative outcome with respect to functional results between the two types of impingement post-arthroscopic debridement. Our study included 14 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination. They were segregated into two groups (on the basis of cause of impingement (osseous versus soft tissue)). Both groups were treated by arthroscopic debridement. Primary outcome was patient satisfaction, which was assessed by Likert scale and clinical outcomes were measured using AOFAS ankle-hind foot scale, VAS score, range of motion and time to return to pre-injury activity level in both groups. Mean follow-up was of 15 months where eleven patients reported an excellent recovery, two patients had good recovery while one patient reported poor outcome. Mean AOFAS ankle hind foot scale improved from 50.5 preoperatively to 85.71 postoperatively (statistically significant; p value - 0.0001). Mean Likert scale value post-operative was 4.21. VAS score showed significant improvement in patients of both the groups. Range of motion was slightly better in soft tissue impingement type with a relatively shorter time to return to sports or preinjury activity level as compared to osseous impingement group. The patients in both the groups had comparable outcomes with no statistically significant difference with regard to patient satisfaction and clinical outcome.

  15. Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes.

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    Ranalletta, Maximiliano; Rossi, Luciano A; Sirio, Adrian; Dilernia, Fernando Diaz; Bertona, Agustin; Maignon, Gastón D; Bongiovanni, Santiago L

    2017-09-01

    The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes. To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors. Case series; Level of evidence, 4. A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated. The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery ( P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%. In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.

  16. Arthroscopic sternoclavicular joint resection arthroplasty: a technical note and illustrated case report.

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    Warth, Ryan J; Lee, Jared T; Campbell, Kevin J; Millett, Peter J

    2014-02-01

    Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.

  17. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

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    Satish Shervegar

    2015-10-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  18. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

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    Satish Shervegar

    2015-09-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  19. Primary versus revision arthroscopic reconstruction with remplissage for shoulder instability with moderate bone loss.

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    McCabe, Michael P; Weinberg, Douglas; Field, Larry D; O'Brien, Michael J; Hobgood, E Rhett; Savoie, Felix H

    2014-04-01

    This study aims to evaluate our outcomes of arthroscopic remplissage in this setting. A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score. Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure r