Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures.

PURPOSE: Arthroscopic repair of type II superior labrum anterior to posterior (SLAP) tears yields variable results. In this study, the clinical outcomes of arthroscopic knotless horizontal mattress repair were compared to those of conventional vertical knot repair. METHODS: Forty-six patients treated arthroscopically for isolated SLAP lesions were assessed. Forty-one of those patients underwent follow-up evaluations for a minimum of 2 years: 21 received vertical knot (group 1), while 20 received horizontal mattress (group 2). In group 1, an anchor was inserted at the superior glenoid. After relaying the sutures, knotting over the labral tissue was performed. In group 2, two strands were passed through the labrum and fixed into the glenoid with a bioabsorbable knotless anchor. Functional scores were evaluated preoperatively and at the final follow-up assessment. A visual analogue scale (VAS) for pain and range of motion (ROM) were assessed preoperatively, 2 months postoperatively and at the last follow-up visit. RESULTS: There were no significant differences in functional scores between groups (n.s.). However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2 at the last follow-up visit. At 2 months postoperatively, the VAS for pain and ROM of internal rotation at abduction were better in group 2. CONCLUSION: At the final assessment, there were no significant differences in functional scores between the two groups. However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2. LEVEL OF EVIDENCE: Case-control study, Level III.

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears.

PURPOSE: To compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs). METHODS: We prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (n = 50). Completion of the remaining cuff tissue and repair were performed in group 2 (n = 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging. RESULTS: Eight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (P = .001 for VAS; P < .001 for ASES score; P < .001 for CS score; P = .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (P = .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (P = .02). CONCLUSIONS: Arthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different. LEVEL OF EVIDENCE: Level II, prospective comparative study.

In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography.

BACKGROUND: The clavicle hook plate can be used to treat acromioclavicular and coracoclavicular ligament injury or distal clavicular fracture with comminution. However, the hook plate can induce subacromial impingement, resulting in discomfort from the hardware. METHODS: Our inclusion criteria were (1) men and women aged older than 20 years and (2) the presence of comminuted distal clavicular fractures (Neer type IIB) fixed with a hook plate (Synthes, Oberdorf, Switzerland). Three-dimensional computed tomography was obtained before removal of the hook plate. Seven patients were enrolled prospectively. The mean age was 42 years (range, 24-60 years). Zero degree images and abduction images were obtained. The sagittal cut surface was obtained 5 mm medial from the distal clavicle. The equator of the cut surface of the clavicle was compared with the full abduction model to analyze rotation. The center of the cut surface of the clavicle was compared with the full abduction model to analyze translation. RESULTS: The average difference in rotation of the distal clavicle between both shoulders was 16° (range, 3°-22°; P = .001). The mean difference in anterior translation of the distal clavicle was 2.2 mm (range, -0.7 to 5.6 mm; P = .030). CONCLUSION: Hook plate fixation at the acromioclavicular joint causes decreased internal rotation and increased anterior translation of the distal clavicle with respect to the medial acromion, indicating that the scapula relative to the thorax has decreased posterior tilting and increased external rotation in shoulders fixed using a hook plate.