ABSTRACT
BACKGROUND: Tears of the abdominal obliques have previously been reported in the vicinity of the lower ribs but they have not been reported in the vicinity of the iliac crest. The purpose of this case report is to describe the mechanism of injury and diagnosis of a distal abdominal oblique tear and subsequent rehabilitation programming. CASE DESCRIPTION: A 21-year-old male Australian football player experienced acute right-sided abdominal pain during a game while performing a commonly executed rotation skill. He was assessed clinically before being further examined with ultrasound and magnetic resonance imaging which revealed a rupture of the abdominal oblique wall at its insertion onto the iliac crest. The player then underwent a structured and graduated rehabilitation program with clear key performance indicators to optimize return to play and prevent recurrence. OUTCOMES: The player was able to return to play at 35 days post injury and had no recurrence or complications at 12 month follow up post injury. DISCUSSION: This is the first time an abdominal oblique wall rupture at its insertion onto the iliac crest has been reported. In players with acute abdominal pain following twisting an insertional oblique tear should be considered as a differential diagnosis. A structured rehabilitation program may also help optimize an athlete's return to play after distal abdominal oblique rupture.
ABSTRACT
BACKGROUND: Tendon-bone healing after rotator cuff repair directly correlates with a successful outcome. Biological therapies that elevate local growth-factor concentrations may potentiate healing after surgery. PURPOSE: To ascertain whether postoperative and repeated application of platelet-rich plasma (PRP) to the tendon repair site improves early tendon healing and enhances early functional recovery after double-row arthroscopic supraspinatus repair. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 60 patients underwent arthroscopic double-row supraspinatus tendon repair. After randomization, half the patients received 2 ultrasound-guided injections of PRP to the repair site at postoperative days 7 and 14. Early structural healing was assessed with MRI at 16 weeks, and cuff appearances were graded according to the Sugaya classification. Functional scores were recorded with the Oxford Shoulder Score; Quick Disability of the Arm, Shoulder and Hand; visual analog scale for pain; and Short Form-12 quality-of-life score both preoperatively and at postoperative weeks 6, 12, and 16; isokinetic strength and active range of motion were measured at 16 weeks. RESULTS: PRP treatment did not improve early functional recovery, range of motion, or strength or influence pain scores at any time point after arthroscopic supraspinatus repair. There was no difference in structural integrity of the supraspinatus repair on MRI between the PRP group (0% full-thickness retear; 23% partial tear; 77% intact) and the control group (7% full-thickness retear; 23% partial tear; 70% intact) at 16 weeks postoperatively (P = .35). CONCLUSION: After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery.
