Superior Capsular Reconstruction using the Long Head of the Biceps Tendon: The Biceps Loop Technique.

Irreparable rotator cuff tears can be treated in several ways. Superior capsular reconstruction has been reported as an excellent option, particularly for the young and active patients. We propose capsule reconstruction using the long head of the biceps tendon in a modified way. After its tenotomy at the musculotendinous junction, the long head is rerouted through a humeral bone tunnel and attached to a suture anchor in the posterior aspect of the superior glenoid rim. Further investigation is required, but this modified technique appears promising.

Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging.

OBJECTIVE: To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements. SUBJECTS AND METHODS: Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18-55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3-200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9-73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard. RESULTS: Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient = 0.80-0.82; r = 0.81-0.86). The first and second observers' measurements showed strong (r = 0.76) and moderate (r = 0.69) interreader correlation, respectively, with arthroscopic measurements. CONCLUSIONS: Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist.

Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis / Avaliacao dos resultados do tratamento cirurgico artroscopico da capsulite adesiva

OBJECTIVE: Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure. METHODS: Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery. RESULTS: According to UCLA shoulder score (p < 0.01) it increased from 9.8 preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result. CONCLUSION: This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.

OBJETIVO: Descrever os resultados dos pacientes com capsulite adesiva submetidos ao tratamento cirúrgico artroscópico. MÉTODOS : Estudo prospectivo com nove pacientes (10 casos) de capsulite adesiva submetidos ao tratamento cirúrgico entre janeiro e setembro de 2009. Cinco pacientes eram do sexo feminino e quatro do masculino (um bilateral), com faixa etária média de 51 anos (27-63). O tempo médio entre o início dos sintomas e a cirurgia foi 23,4 meses (6-38). Foram usados os escores da UCLA e Constant para avaliar os resultados e o ganho do arco de movimento com uma semana e seis meses. RESULTADOS : Houve aumento no escore da UCLA (p < 0,01) de 9,8 no pré-operatório (6-14) para 31,6 no pós-operatório (26-35) e no de Constant (p < 0,01) de 20 (13-27) para 79,2 (66-91). As médias da mobilidade articular passiva no período pré-operatório foram de 89º de flexão anterior (80º-100º), 12,5º de rotação lateral (0º-30º) e L5 de rotação medial (T12-Glúteo), com aumento médio significante estatisticamente na primeira semana para 150º/46º/T11 e para 153º/56º/T9 com seis meses. Não existiu significância estatística com relação ao tempo de evolução da doença e o resultado pós-operatório. CONCLUSÃO : Este estudo demonstrou que o tratamento cirúrgico para capsulite adesiva com liberação capsular artroscópica associada à manipulação é um procedimento seguro e que resulta em alívio da dor e recuperação do arco de movimento.

Treatment of complex acute proximal humerus fractures using hemiarthroplasty / Tratamento das fraturas complexas agudas da extremidade proximal do úmero com o uso de hemiartroplastia

OBJECTIVE: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures. METHODS: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05. RESULTS: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104º of forward flexion and 36º of external rotation. In group A, with 33 patients, we found a mean of 122º forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87º and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001). CONCLUSION: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

OBJETIVO: Avaliar os resultados funcionais e radiográficos dos pacientes submetidos à hemiartroplastia para tratamento das fraturas complexas da extremidade proximal do úmero. MÉTODOS: Foram incluídos 67 pacientes, com seguimento que variou entre 12 e 62 meses. A média de idade foi de 65 anos (44 a 88) e 47 pacientes eram do sexo feminino (70%). Os pacientes foram avaliados clinicamente por meio da avaliação da amplitude de movimentos (ADM) e do escore funcional da University of California Los Angeles (UCLA). A avaliação radiográfica foi feita de forma padronizada com divisão dos pacientes em dois grupos: A (consolidação do tubérculo maior em posição anatômica) e B (ausência de consolidação anatômica do tubérculo maior). Na análise estatística consideramos significativos os achados com p < 0,05. RESULTADOS: A pontuação média do UCLA foi de 26 pontos, com média de oito pontos para dor e 64 pacientes satisfeitos subjetivamente (96%). Na avaliação da amplitude de movimento (ADM) ativa encontramos uma média de 104º de flexão anterior e 36º de rotação lateral. No grupo A, com 33 pacientes, encontramos uma média de 122º de flexão anterior e pontuação média da UCLA de 29,5. No grupo B as médias foram de 87º para flexão anterior e de 22,7 pontos para a UCLA. Comparando esses parâmetros encontramos diferenças estatisticamente significativas tanto para a flexão anterior (p < 0,001) quanto para a UCLA (p < 0,001). CONCLUSÃO: A hemiartroplastia no tratamento das fraturas complexas da extremidade proximal do úmero apresenta alto índice de satisfação subjetiva e um resultado favorável com relação à dor. Um resultado funcional satisfatório é menos previsível e depende do restabelecimento preciso da morfologia da extremidade proximal do úmero, especialmente da consolidação anatômica do tubérculo maior.

Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis.

Objective: Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure. Methods: Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery. Results: According to UCLA shoulder score (p < 0.01) it increased from preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result. Conclusion: This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.

Treatment of complex acute proximal humerus fractures using hemiarthroplasty.

OBJECTIVE: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures. METHODS: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05. RESULTS: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104° of forward flexion and 36° of external rotation. In group A, with 33 patients, we found a mean of 122° forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87° and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001). CONCLUSION: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

Osteossíntese das fraturas da extremidade proximal do úmero com sistema de placa de ângulo fixo com parafusos bloqueados: técnica e resultados / Osteosynthesis of proximal humeral end fractures with fixed angle plate and locking screws: technique and results

OBJETIVO: Descrever os resultados do tratamento cirúrgico das fraturas da extremidade proximal do úmero com a placa de sistema bloqueado Philos. MÉTODOS: Entre março de 2003 e outubro de 2004 foram avaliados, de forma prospectiva, 24 de 26 pacientes com fratura da extremidade proximal do úmero tratados com a placa Philos. A média de seguimento foi de 12 meses e da idade dos pacientes, de 57 anos. Seis pacientes tinham fraturas em quatro partes, 11 em três partes e nove em duas partes. A avaliação clínica foi feita por meio dos critérios da University of California at Los Angeles (UCLA). RESULTADOS: A média do escore da UCLA foi de 30 pontos (17-35). Todas as fraturas consolidaram. Em três pacientes a fratura consolidou em varo. Nesses, o índice da UCLA médio foi de 27 pontos. CONCLUSÃO: A osteossíntese com a placa Philos permite fixação estável com bom resultado funcional.

OBJECTIVE: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. METHOD: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. RESULTS: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. CONCLUSION: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

OSTEOSYNTHESIS OF PROXIMAL HUMERAL END FRACTURES WITH FIXED-ANGLE PLATE AND LOCKING SCREWS: TECHNIQUE AND RESULTS.

UNLABELLED: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. METHOD: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. RESULTS: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. CONCLUSION: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

Tratamento da luxação acromioclavicular com amarrilhos coracoclaviculares por meio de duas miniincisões / Treatment of acromioclavicular dislocations with coracoclavicular sutures by two mini-incisions

A luxação acromioclavicular (LAC) pode ser tratada cirurgicamente com redução anatômica e fixação. Objetivo: Relatar 15 casos de LAC em 15 pacientes, todos do sexo masculino, com faixa etária média de 26,3 anos submetidos a tratamento cirúrgico por meio de uma técnica nova e menos agressiva. Técnica: Por meio de duas miniincisões é feito um amarrilho coracoclavicular com fios de sutura inabsorvíveis e resistentes, sem dano à origem do deltóide. A indicação cirúrgica foi feita em casos de luxacoes acromioclaviculares tipos 111, IV e V de Rockwood. Com tempo de seguimento mínimo de um ano, todos os pacientes apresentaram resultados satisfatórios. Comentários: A técnica mostrou-se reproduzível sem necessidade de material metálico de fixação e instrumental específico

Tratamento cirúrgico da fratura-luxação de Monteggia inveterada nas crianças / Surgical treatment of unreduced Monteggia fracture-dislocation in children

Pouco se sabe a respeito da evolução a longo prazo da fratura-luxação de Monteggia inveterada (FLMI). Deformidade em valgo progressiva, neurite ulnal, instabilidade, dor e alteraçães na articulação radioulnal distal e limitação da amplitude de movimento do cotovelo são alteraçães que podem surgir a longo prazo. O tratamento da FLMI nas crianças é controverso, mas indicado por diversos autores. Este estudo avalia o resultado do tratamento cirúrgico de 12 crianças com FLMI, operadas no Grupo de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Santa Casa Miseric¢rdia de São Paulo ( GOC- DOT-SCMSP) entre março de 1991 e janeiro de 2001. As indicaçães foram dor, deformidade e diminuição da amplitude de movimento do cotovelo. O procedimento utilizado foi a redução cruenta da articulação radioulnal proximal, associada à osteotomia da ulna em 11 casos e à reconstrução do ligamento anular em dois. Avaliados pelos critérios da Associação Médica Americana (AMA), obtiveram-se: cinco pacientes classificados como excelentes, três regulares e quatro ruins. Os autores concluem que o tratamento da FLMI proporciona melhora estética e da ADM em todos os arcos de movimento, exceto a pronação, e que a osteotomia da ulna é procedimento importante para restaurar a anatomia e manter a redução da luxação