Mid-Term Outcomes after Arthroscopic "Tear Completion Repair" of Partial Thickness Rotator Cuff Tears.

Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the "critical zone" and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with "critical zone" removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.

Venous thromboembolism in patients undergoing shoulder surgery: findings from the RECOS Registry.

BACKGROUND: Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied. METHODS: RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE. RESULTS: From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65±15.3years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1+/3.49years vs 55,6+/-0,42years, respectively; p=0.024). Duration of surgery>60minutes (HR:10.99; 95CI% 1.26-95.89; p=0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n=457) of the patients, in 95.8% of whom for a duration >10days. CONCLUSIONS: The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation.

Management of the subscapularis contracture during shoulder arthroplasty for primary glenohumeral arthritis.

AIM: To evaluate the safety and effectiveness of a particular subscapularis release in shoulder arthroplasty for primary glenohumeral arthritis. MATERIALS AND METHODS: Twenty-eight patients (19F, 9M) underwent shoulder arthroplasty for primary glenohumeral arthritis. Preoperative average Constant Score (CS) was 31.2 points (range 14-52), active anterior elevation (AAE) 92 degrees (30-100 degrees ) and active external rotation (AER) 11 degrees (-40 to 20 degrees ). During arthroplasty for subscapularis contracture, patients underwent subscapularis release freeing the superior tubular tendon (STT) with a section of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL) and a deep release consisting of a section of the middle glenohumeral ligament (MGHL), very close to the glenoid labrum, and the inferior glenohumeral ligament (IGHL). An anatomic study was performed on 13 cadavers, verifying the structure of subscapularis tendon and its relationship with the capsule, the surrounding ligaments and the axillary nerve. Moreover, after having placed traction sutures on the subscapularis tendon, its lengthening was measured after STT release alone and after STT and deep release. The complete absence of neurological and vascular lesions was also verified. RESULTS: Average follow-up: 2.9 years. Postoperative mean CS was 70.5 (p[Symbol: see text]0.005), with an absolute gain of 39.1. AAE increased from 92 degrees to 142 degrees (p=0.001) while AER increased from 8 degrees to 48 degrees (p=0.002). At the last follow-up, 19 patients (67.8%) were very satisfied, 5 patients (17.8%) were satisfied, 3 patients (10.7%) partially satisfied and 1 patient (3.5%) unsatisfied. In the anatomic control, the average lengthening of subscapularis tendon was 0.9 cm after STT release alone and 2.5 cm after STT and deep release. No vascular and neurological lesions were observed. CONCLUSIONS: The subscapularis release during shoulder arthroplasty is extremely important to obtain the proper balance between anterior and posterior soft tissues and to achieve an optimal range of motion and joint stability. An adequate anatomical dissection could give good tendon mobilisation and lengthening, necessary for a good repair, and lead to a recovery of the range of motion, particularly for external rotation.

The role of concomitant biceps tenodesis in shoulder arthroplasty for primary osteoarthritis: results of a multicentric study.

This study evaluated the effects of concomitant biceps tenodesis in patients undergoing shoulder arthroplasty for primary osteoarthritis. Six hundred eighty-eight shoulders that had undergone replacement for primary glenohumeral arthritis were reviewed at a mean 43 months postoperatively. One hundred twenty-one patients had undergone a biceps tenodesis at arthroplasty, while the remaining patients did not. Tenodesis was significantly better than no tenodesis in most outcome parameters. No difference was found between the groups in complication rate. Biceps tenodesis is a useful adjunct to shoulder arthroplasty in the treatment of primary osteoarthritis.