RESUMO
Background@#The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. @*Methods@#Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. @*Results@#Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2–9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8–9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. @*Conclusions@#Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.
RESUMO
PURPOSE: We analyzed the surgical result of schwannoma occurring in the major peripheral nerves of the extremity and factors that influence these surgical results. MATERIALS AND METHODS: Fifty-one patients, who were followed for more than 1 year, were included. The mean age was 51 years. There were 23 male cases and 28 female cases. There were 27 cases of schwannoma in the upper extremity and 24 cases in the lower extremity. The involved nerves were classified. The maximal diameter of excised tumors was measured. Clinical and neurological symptoms were analyzed at preoperative, postoperative, and final follow-up. Risk factors of neurological complications were also analyzed. RESULTS: The mean follow-up period was 20 months. The average maximal diameter of tumors was 2.9 cm. The most affected nerve in the upper extremity was the ulnar nerve in 10 cases, and tibial nerve in the lower extremity in 10 cases. The most prevalent preoperative symptom was Tinel in 38 cases. Clinical symptoms were improved in more than 90% of patients following the surgery. There were 13 cases with preoperative sensory deficits. Symptom improvement after surgery was observed in 9 cases; and symptoms persisted in 4 cases following surgery. At the final follow-up, sensory deficits disappeared in 2 cases and persisted in 2 cases. There were 2 cases of preoperative motor deficits. There was improvement in 1 case following the surgery and persisted in 1 case until the final follow-up. There was a statistical significance between maximal diameter of schwannoma and postoperative neurological deficits (p<0.05). CONCLUSION: Schwannoma at the major peripheral nerves of the extremity can be excised with acceptable risk for neurological deficits. Meticulous dissection is required to avoid injuries of the involved nerves.