Arthroscopic removal of the impinging acromio-clavicular joint spur

29 patients with impingement syndrome of the shoulder were studied between January 2005 and February 2006. Main cause of impingement of the supraspinatus tendon was undersurface spurs of the acromioclavicular joint, as demonstrated on X-rays and essentially coronal cuts of MRI. Arthroscopic subacromial decompression together with shaving of the undersurface acromioclavicular joint spurs was performed for all patients. Results were evaluated according to UCLA rating score at an average of 15 months, which, was raised at an average of 50 points. We conclude that pre-operative evaluation of exact cause of impingement syndrome is essential as well as removal of offending cause at arthroscopy

Tibio-femoral attachment site combinations as a determinant for Acl graft impingement

The purpose of this study was to assess graft impingement both qualitatively and quantitatively, with different tibio-femoral combinations. Three tibial [T1-T3] and three femoral [F1-F3] attachment sites resulting in nine different tibio-femoral combinations were studied on 8 fresh frozen cadaveric knees. Bungee cords coated with barium paste were used to simulate the grafts used clinically. Lateral knee radiographs in full extension were done for the cord with each combination. Radiographic impingement was graded according to the following classification: Type [I] no contact with roof. Type [II] contact with roof but no deformation of the cord. Type [III] contact with roof with deformation of the cord. Superlow Fuji films inserted in the femoral notch lying between the roof and the cord with the knee positioned in full extension were used to quantitatively assess graft impingement for each combination. Anterior tibial cord placement consistently led to graft impingement with cord deformation type III radio-graphic classification. Tibial tunnels central in the ACL stump [T2] demonstrated 3 knees classified as type II and 5 as type I. Posterior tibial tunnels [T3] were consistently classified as type I with no contact with the roof. In conclusion, tibial tunnels central in the ACL stump and 7mm anterior to the PCL were non-impinging radiographically, with insignificant contact pressure developing between the roof and graft. It was also apparent that graft impingement was mainly dependent on the tibial rather than the femoral attachment site or combination of both

Arthoroscopic Bankart repair in first time shoulder dislocation in athletes

A prospective arthroscopic anatomical Bankart repair was conducted on 16 athletes with an acute first-time anterior shoulder dislocation. The patients were aged between 18 and 29 years. The mean age was 23 years. None had a history of shoulder problems beforehand. All were evaluated after an average of 30 months after surgery. The modified Rowe and Zarins score, recurrence rate, and instability rate were evaluated, as well as patient satisfaction and sports participation. 14 patients were back to sports at an athletic level, 2 had another episode of dislocation. Arthroscopic management for shoulder instability has gained wider acceptance among both patients and orthopedic surgeons during the past 15 years. An acute, initial traumatic anterior shoulder dislocation sustained by a young athlete provides the optimal situation to both repair the pathologic Bankart lesion and minimize the development of secondary joint pathology that comes with recurrent instability. This study stresses the reestablishment of the anatomic repair of the Bankart lesion and any concomitant pathology noted at arthroscopy in athletes after the initial shoulder dislocation

Closed reduction and percutaneous pinning in three-part fractures of the proximal humerus

Three and four- part fractures of the proximal humerus occurring in the elderly population usually result from low energy trauma in osteoporotic patients. Closed reduction and percutaneous fixation of three- part fractures may offer a stable fixation to allow early rehabilitation. An attempt is made to study the results of this minimally invasive procedure. Thirty patients with three- part fractures of the proximal humerus were treated with closed reduction and percutaneous pinning of the shoulder. All patients were above 50 years of age. They were seventeen women and thirteen men. Patients were followed for a minimum of six months after surgery. Physiotherapy was initiated on the second day after surgery. The results were evaluated radiographically for union and clinically for pain and range of motion. The results were evaluated using the Constant score and the complications were minimal. The average Constant score was 80 at six months postoperatively. The procedure is minimally invasive in this old age group and offers an alternative to the more invasive open procedures. This study demonstrates that this procedure provides very good results with very little complications

Arthroscopic reconstruction of ACL by quadruple semitendinosus tendon graft

In this study a quadrupled semitendinosus [ST] graft alone sparing the gracilis tendon was used for reconstruction of the torn anterior cruciate ligament in 36 patients with ACL injury. Femoral fixation was obtained with rigid fix [two transverse bioabsorbable pins] and tibial fixation with U loop [of Professor AhmedAbd EI-Aziz] prof. ofortho. Cairo University. At an average follow-up time of 19 months [range, 14-27 months], patients were evaluated using standard knee Lysholm score preoperatively and at 3, 6, and 12 months postoperative. At final evaluation, subjective knee rating was 90 points according to this score. Lachman test was negative in 33 patients [91.6%]. 80 percent of patients returned to the samepre-injury sports level. The quadrupled semitendinosus graft is.a robust graft for ACL reconstruction; provides a clinically stable construct, allows recovery of normal limb strength, gives high patient satisfaction with early return to active sports, and involve lower donor-site morbidity.

Arthroscopic stabilization of SLAP II [superior labrum anterior to posterior] tears of the shoulder

The results of arthroscopic SLAP II repair with use of suture anchors in 9 professional athletes with traumatic SLAP II the shoulder were evaluated. The mean age at the time of the operation was 24 years. Preoperatively and at the time of follow-up [at a mean of II months], the patients were assessed with the modified Rowe and Zarins shoulder rating scale. The relief of symptoms during sports and full range of motion were the main goal. Shoulder score improved after surgery. According to the modified scale of Rowe and Zarins, 6 patients [66.6%0 had an excellent score; 2 [22.2%], a good score; 1 shoulder [11.1%] was not satisfied, i.e. failure. Diagnosis and arthroscopic repair of SLAP tears is difficult, technically demanding and tedious owing to their quite rarity. It was found that the results of arthroscopic stabilization of SLAP II lesion using suture anchors provide satisfactory results in terms of relief of symptoms and range of motion

Magnetic resonance arthrography in shoulder instability: comparison with arthroscopic findings

Antero-inferior dislocation is the most frequent cause of shoulder instability. Since different types of anterior labro-ligamentous lesions require different surgical procedures, preoperative distinction of lesions is important. In this series 40 patients with chronic shoulder instability had preoperative Magnetic Resonance Arthrography [MRA]. MRA demonstrated 35 antero-inferior tears; of which, 28 Bankart lesions, 5 chronic ALPSA lesions, and 2 HAGL lesions. There were 3 posterior lesions. Arthroscopy showed 37 antero-inferior lesions with its different types, and 2 posterior lesions. MR arthrography has 94.8% sensitivity in detecting ligamento-labral lesions in cases of shoulder instability, and a positive predictive value of 0.975 in diagnosing a lesion in recurrent shoulder instability. These results show that MRA is a highly sensitive tool for investigation of recurrent shoulder instability