Revision surgery after failed subacromial decompression.

The purpose of this study was to assess the results of revision subacromial decompression and identify clinical and psychological factors that influence its outcome. Thirty-five patients with intact rotator cuffs who underwent surgery for recurrent stage II impingement were studied at a mean follow-up time of 43 months post-surgery. Twenty-seven patients were satisfied with their surgery. The UCLA Scoring System rated 18 of 35 with good/excellent results and 17 of 35 poor/fair results, 22 patients had worker's compensation injuries, which correlated with poor outcome (P=0.0067). Patients with concomitant brachial plexopathy and/or compressive neuropathies were associated with unsatisfactory results (P=0.02).

Quantification of mechanoreceptors in the canine anterior cruciate ligament.

Ten canine anterior cruciate ligaments (ACLs) were harvested while preserving their bony attachments. Specimens were stained using a modified gold chloride technique, divided into thirds, and serially sliced at 0.5 microns. The slides were viewed to count the mechanoreceptors present. The average numbers of receptors found were: proximal 67, middle 43, and distal 18 (ANOVA: P < 0.001). The statistical test (Sheffé) revealed that the proximal third contained a greater mean number of receptors (S = 3.8). No significant difference was found between the number of receptors in the middle and distal thirds (S = 0.85).

The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management.

The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.