Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort.

BACKGROUND: Although being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears. METHODS: One hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction. RESULTS: Thirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16. CONCLUSIONS: Arthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).

Catastrophic failure of femoral stem modular junction when combined with metal-on-metal bearing in comparison to ceramic-on-ceramic: A retrospective cohort study.

BACKGROUND: Metal ion release from total hip arthroplasty's (THA) metal-on-metal (MoM) bearing surfaces or head-neck modular junction (trunnionosis) has been identified as a major cause of adverse reaction to metal debris (ARMD). No study has compared the effects of these bearing couples when combined with modular neck femoral stems (MNFS) (i.e. did a modular CoCr have a higher effect than large MoM bearings on whole blood ion concentrations and ARMD). Therefore we did a retrospective comparative analysis of prospectively collected data aiming to: (1) assess the difference in metal ion release between a group of MoM and CoC bearings implanted with a non-cemented MNFS; (2) compare the ARMD and the related revision rates between the two bearing types; (3) compare the patients' HOOS and Harris Hip scores. HYPOTHESIS: Metal ion levels and complications rate will be higher in MoM group. METHODS: Thirty hips received the same short MNFS with modular CoCr. Seventeen had CoC bearing (16=36mm) and 13 large diameter head (LDH) MoM bearing (mean=50mm, 44-54mm) Both groups had whole blood Cobalt (Co) and Chromium (Cr) concentrations measurements at last follow up or before revision surgery (if any) and were compared to 41 control individuals without implants. ARMD, revision rates and other complications were censed. Functional outcome differences between operative groups were assessed with HOOS and Harris Hip scores. RESULTS: Mean whole blood Co and Cr were 1.9µg/L (0.1-10.6 min-max) and 1.2µg/L (0.2-4.6 min-max) in the CoC group and 12.7µg/L (2.5-40.7 min-max) and 8.2µg/L (2.8-40.6 min-max) for MoM group. Controls presented whole blood Co and Cr levels of 0.2µg/L (0.04-0.2 min-max) and 0.6µg/L (0.1-0.7 min-max) respectively. CoC had significantly higher whole blood metal ion concentrations than controls, while MoM had significantly higher concentrations than both (p<0.001). MoM had a 9/13 (69%) revision rate due to ARMD (with stem-neck junction corrosion and wear were present in all cases) while the CoC had none. Functional scores at last follow up did not statistically differ between groups (Harris: CoC=94.1±8.4 vs MoM 91.8±14.8 (p=0.22) and CoC HOOS 90.2±10.7 vs 75.6±21.7 (p=0.08)). CONCLUSION: In our study, MNFS with CoCr modular neck released metal ion systemically, as shown in CoC THAs, but when combined with MoM LDH bearings, that elevation was significantly higher. In MNFS MoM, these high metal ion levels translated into a dramatic ARMD related revision rate where stem-neck junction corrosion and wear were present in all cases. More research is required to understand the effects of MoM bearing on neck-stem junctions, and its mechanisms of corrosion. LEVEL OF EVIDENCE: III; retrospective comparative study.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed the following clinical questions. Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? TYPES OF STUDIES REVIEWED: Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. RESULTS: The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. CLINICAL IMPLICATIONS: These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.