ABSTRACT
Seventy-two full thickness rotator cuff tears (72 patients) were treated with an open rotator cuff repair between 1986 and 1993. The average postoperative followup was 54 months (range, 24-102 months; standard deviation, 22 months). Fifty-three (74%) patients had no pain, 16 (22%) patients had slight pain without restriction of activities, and three (4%) patients had moderate pain with activity compromise. Women with an associated biceps tendon rupture tended to have worse results. Women had a negative, statistically significant relationship between age and shoulder scoring scales, but age at the time of surgery was not related to any outcome variables for men. A rotator cuff tear greater than or equal to 5 cm2 as determined at the time of surgery was associated with a poorer outcome. The average University of California at Los Angeles score was 32 points (range, 7-35 points; standard deviation, 5 points). The average Constant-Murley score was 78 of 100 points (range, 12-95 points; standard deviation, 15 points). A yes response was given for an average of 10 of 12 questions on the Simple Shoulder Test (range, 0-12 questions; standard deviation, 3 questions). More than 4 years after open rotator cuff repair, patients had a 94% patient satisfaction rate with lasting relief of pain and improved function.
Subject(s)
Rotator Cuff Injuries , Rotator Cuff/surgery , Adult , Age Factors , Aged , Aged, 80 and over , Arm , Female , Humans , Male , Middle Aged , Orthopedic Procedures/methods , Patient Satisfaction , Postoperative Complications , Range of Motion, Articular , Retrospective Studies , Rupture , Sex Factors , Shoulder Joint/physiopathology , Tendon Injuries/complications , Treatment OutcomeABSTRACT
We performed MRI on 16 patients who had had reconstruction of the anterior cruciate ligament (ACL) with a mid-third bone-patellar-tendon-bone autograft. Our aim was to assess the tendon and the site of its insertion at an average of seven years after the original operation. In four of these patients biopsies were taken from the donor site when they had revision of their original operation. MRI showed reconstitution of the tendon into the patellar defect with no evidence of bone formation. Six patients had a persistent defect in the patellar tendon itself. Histological examination of the biopsies of the donor site showed an indirect pattern of insertion with absence of the normal fibrocartilage zone. These morphological changes may adversely affect the biomechanical properties of the healed donor site and we suggest that another graft taken from this site may not be suitable for use in a further operation for reconstruction of the ACL.
Subject(s)
Anterior Cruciate Ligament/surgery , Joint Instability/pathology , Magnetic Resonance Imaging , Patella/transplantation , Tendon Transfer/adverse effects , Tendons/pathology , Adult , Anterior Cruciate Ligament Injuries , Biomechanical Phenomena , Biopsy , Case-Control Studies , Female , Humans , Joint Instability/etiology , Male , ReoperationABSTRACT
Distal biceps brachii tendon ruptures occur much less frequently than do their proximal counterparts. Distal tendon ruptures usually are associated with considerable function deficits and may require surgical treatment. Repair of chronic distal biceps brachii ruptures are extremely unusual. A free autogenous semitendinosus tendon graft was used to reconstruct the distal biceps tendon by reattaching the graft to the radial tuberosity via a 2-incision technique in a patient with symptoms and a chronic injury.
Subject(s)
Arm Injuries/surgery , Tendon Injuries/surgery , Tendons/transplantation , Chronic Disease , Elbow Joint/physiology , Humans , Male , Middle Aged , Range of Motion, Articular , Rupture , Suture Techniques , Tendon Injuries/rehabilitation , Transplantation, Autologous/methodsABSTRACT
Exposure to intense levels of noise has been identified as a potential workplace risk for the development of hearing impairment for health care workers. With this knowledge a noise level survey was performed on selected orthopedic equipment. Several instruments produced threshold levels of 95 dBA to 106 dBA. Often these levels remained as high as 90 dBA at 4 ft from the source. Based on the results of this survey, audiometric tests were conducted on five cast technicians to determine the prevalence of noise-induced hearing loss (NIHL). Audiometric measurements of the cast technicians indicated that, in the absence of other risk factors for hearing loss, there was an association between the presence of NIHL and the years of exposure. NIHL was most evident on the side of the dominant hand used for holding the cast cutter. These findings suggest there may be a risk of NIHL from the occupational exposure to various orthopedic instruments. Further, this level of risk may warrant the use of an individual hearing protection device or the development of quieter instruments.
Subject(s)
Hearing Loss, Noise-Induced/epidemiology , Noise, Occupational , Orthopedic Equipment , Adult , Audiometry , Humans , Male , Middle Aged , Noise, Occupational/adverse effects , Orthopedic Equipment/adverse effects , Prognosis , Risk AssessmentABSTRACT
As in this case study of a snowboarder, the typical history for distal biceps brachii rupture involves a single traumatic event, an audible popping sound, and intense pain. The physical exam will reveal ecchymosis in the antecubital area and weakness with both supination and elbow flexion; the distal biceps brachii tendon will not be palpable. Though distal biceps rupture is far less common than its proximal counterpart, primary care physicians should be aware of the diagnostic criteria. Referral for surgical treatment is necessary to preserve elbow flexion and supination strength.
