Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons

Background@#We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). @*Methods@#Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval betweenprimary surgery and revisional ARCR, degree of “acromial scuffing,” number of anchors, RCR technique, retear pattern, fatty infiltration,retear size, operating time, and clinical outcome were recorded. @*Results@#During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the “cut-through pattern” was observedsignificantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. @*Conclusions@#Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in thehigh- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observedbetween the groups.

Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons

Background@#We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). @*Methods@#Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval betweenprimary surgery and revisional ARCR, degree of “acromial scuffing,” number of anchors, RCR technique, retear pattern, fatty infiltration,retear size, operating time, and clinical outcome were recorded. @*Results@#During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the “cut-through pattern” was observedsignificantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. @*Conclusions@#Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in thehigh- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observedbetween the groups.

Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

PURPOSE: This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture. MATERIALS AND METHODS: Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed. RESULTS: The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0–20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4–12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2–15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4–9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear. CONCLUSION: LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

In children with open physis, avulsion fracture of the tibia eminence, as an anterior cruciate ligament (ACL) injury, is more commonly observed than an ACL rupture. Pure cartilaginous avulsions of the ACL tibia insertion seldom occurs. In such case, cartilaginous lesion is frequently overlooked or misdiagnosed on plain radiograph and may result in a less favorable treatment outcome. We report two cases of cartilaginous tibia eminence fractures of the children that were initially overlooked from plain radiographs, and then diagnosed by magnetic resonance imaging, which was ultimately treated by arthroscopyassisted headless compression screw fixation.

Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

In children with open physis, avulsion fracture of the tibia eminence, as an anterior cruciate ligament (ACL) injury, is more commonly observed than an ACL rupture. Pure cartilaginous avulsions of the ACL tibia insertion seldom occurs. In such case, cartilaginous lesion is frequently overlooked or misdiagnosed on plain radiograph and may result in a less favorable treatment outcome. We report two cases of cartilaginous tibia eminence fractures of the children that were initially overlooked from plain radiographs, and then diagnosed by magnetic resonance imaging, which was ultimately treated by arthroscopyassisted headless compression screw fixation.