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