Influence of subscapularis tendon reattachment after reverse shoulder arthroplasty: clinical findings and ultrasonographic evaluation of the subscapularis at 89 months mean follow-up.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is commonly used to treat rotator cuff arthropathy. In the deltopectoral approach for RSA, the subscapularis tendon is (partly) detached. The clinical effects of subscapularis reattachment are still under debate. An observational study was performed to evaluate the clinical effects of subscapularis tendon reattachment on the mid- to long-term following RSA. METHODS: In this study, 40 patients for a total of 46 shoulders with a reverse shoulder prosthesis participated. Constant Murley Score (CMS), Oxford Shoulder Score (OSS), Range of Motion (ROM) and abduction and internal rotation strength were measured. The integrity of the subscapularis tendon at follow-up was assessed using ultrasound. Outcomes were compared between three groups: repair and intact at follow-up, repair and not intact, and no repair. RESULTS: Mean follow-up was 89 months with a minimum of three years. CMS, OSS, ROM and strength did not differ between groups. One-third of the initially reattached subscapularis tendons were still present at follow-up. No dislocations were reported. CONCLUSION: This study showed no clinical effects of subscapularis reattachment after reverse shoulder arthroplasty on the mid- to long-term.

Primary intra-articular epithelioid sarcoma of the knee: Unusual presentation of a rare entity.

We report a case of a 60-year-old female with severe and progressive pain of her right knee. Physical therapy, pain medication, and arthroscopic debridement were unsuccessful. Finally, pathological examination revealed an intra-articular epithelioid sarcoma, a rare tumor in an atypical location. Patient died within 5 months after initial admission. Despite this unusual clinical course and presentation, we would like to share the valuable clinical lessons we learned from this case. Introduction of a coordinating physician in combination with a multidisciplinary treatment regarding optimal pain management should optimize treatment results in future patients.

Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: Functional outcome and patients' satisfaction during a mean follow-up of 5 years.

INTRODUCTION: The aim of the present prospective clinical trial was to compare patient-oriented and surgeon-based outcomes after non-operative care with operative treatment of displaced midshaft clavicle fractures. PATIENTS/METHODS: Between January 2009 and July 2011, 97 consecutive patients presenting with a midshaft clavicle fracture were prospectively recorded and included in this study. The patients were placed in either of the treatment groups on their own preference. They were then seen in outpatient clinic at two, six and 24 weeks were all endpoints were investigated and motivation of choice of treatment was noted. Study follow-up was continued until Augustus 2014, being the time point that long-term functional outcome was measured through a DASH score by letter. RESULTS: 97 patients were included in the functional outcome analysis. The mean DASH and Constant scores were significant better in the operative (90.9±14.2 and 15.7±17.2) than in the conservative treatment group at six weeks (78.7±17.0 and 24.8±16.7). There was a significant improvement in the Constant (95.9±10.5 versus 94.5±5.9) and DASH scores (8.8±12.0 versus 7.1±10.7) for both groups at 24 weeks but there was no significant difference in functional scores between the groups. Four patients developed a non-union, one patient in the operative and three patients in the conservative group. Overall complications were significantly higher in the operative group (31%) compared to the conservative group (9%) (p<0.001). There was no significant difference in long-term functional outcome between the two treatment groups (5.2±9.8 versus 2.5±4.9 p=0.12). Patient's satisfaction was higher in the operative than in the conservative group (p<0.04). CONCLUSION: Significant superior outcome scores were seen at six weeks for the operative group. However, at 24 weeks and 5-year follow-up no difference was seen in functional outcome scores for both treatment groups. Therefore, the challenge for the future is to better identify the subgroup of patients who might benefit from primary surgical intervention.