An Analysis of Symptomatic Meniscal Re-Tear Incidence in Two Age Populations: Differences in Older versus Younger Adults.

A symptomatic meniscal tear is one of the most common problems treated by an orthopaedic surgeon. Treatment ranges from observation to complete meniscectomy. Prior research has shown that contact stresses increase within the joint compartment after partial meniscectomy, thus leading to arthritis of the compartment. The purpose of the current study was to determine the incidence of meniscal re-tears in two populations of patients and identify potential factors predisposing to re-tear. A retrospective review of our relational database identified 1,930 arthroscopic partial meniscectomies from 1993 to 2003. Meniscectomies were divided into two groups, 430 patients < 45 years of age (YOUNG) and 712 patients ≥ 45 (OLD). Age, onset date, Lysholm, Tegner, tear type, radial and circumferential location, as well as degree and location of chondromalacia, were analyzed. Of the YOUNG group, 1.16% experienced re-tears, versus 0.42% of the OLD group. From the younger re-tear group, 80% were chronic and 20% had grade 2 chondromalacia in one compartment. The YOUNG re-tear group was slightly more active with higher Tegner (5.6 vs. 4.3) and Lysholm (66.2 vs. 60) scores than the rest of the YOUNG group. The OLD re-tear group was less active with a lower Tegner (2.5 vs. 4.1) and Lysholm (62 vs. 66) score compared with the rest of the older group. In this study, patients under 45 years and with chronic tears had slightly higher incidence of re-tears. Results indicated that the lateral meniscus is more likely to re-tear.

A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair.

PURPOSE: To prospectively evaluate the safety and effectiveness of arthroscopic acellular human dermal matrix augmentation of large rotator cuff tear repairs. METHODS: A prospective, institutional review board-approved, multicenter series of patients undergoing arthroscopic repair of 2-tendon rotator cuff tears measuring greater than 3 cm were randomized by sealed envelopes opened at the time of surgery to arthroscopic single-row rotator cuff repair with GraftJacket acellular human dermal matrix (Wright Medical Technology, Arlington, TN) augmentation (group 1) or without augmentation (group 2). Preoperative and postoperative functional outcome assessments were obtained by use of the American Shoulder and Elbow Surgeons (ASES), Constant, and University of California, Los Angeles scales. Gadolinium-enhanced magnetic resonance imaging (MRI) evaluation of these repairs was obtained at a mean of 14.5 months (range, 12 to 24 months). Adverse events were recorded. RESULTS: There were 22 patients in group 1 and 20 in group 2 with a mean age of 56 years. The mean follow-up was 24 months (range, 12 to 38 months). The ASES score improved from 48.5 to 98.9 in group 1 and from 46.0 to 94.8 in group 2. The scores in group 1 were statistically better than those in group 2 (P = .035). The Constant score improved from 41.0 to 91.9 in group 1 and from 45.8 to 85.3 in group 2. The scores in group 1 were statistically better than those in group 2 (P = .008). The University of California, Los Angeles score improved from 13.3 to 28.2 in group 1 and from 15.9 to 28.3 in group 2 (P = .43). Gadolinium-enhanced MRI scans showed intact cuffs in 85% of repairs in group 1 and 40% in group 2 (P < .01). No adverse events were attributed to the presence of the matrix grafts. CONCLUSIONS: Acellular human dermal matrix augmentation of large (>3 cm) cuff tears involving 2 tendons showed better ASES and Constant scores and more frequent intact cuffs as determined by gadolinium-enhanced MRI. Intact repairs were found in 85% of the augmented group and 40% of the nonaugmented group (P < .01). No adverse events related to the acellular human dermal matrix were observed. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.

Arthroscopic technique for patch augmentation of rotator cuff repairs.

The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears.

Prevalence of ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study.

PURPOSE: To determine the prevalence of proximal tibiofibular ganglion cysts in patients undergoing outpatient magnetic resonance imaging (MRI) of the knee. TYPE OF STUDY: Observational cross-sectional study. METHODS: From November 2000 to June 2001, every MRI of the knee performed at an outpatient imaging center was reviewed by a single examiner for the presence of a proximal tibiofibular ganglion cyst. In addition to the reason for ordering the MRI, demographic information on all patients was gathered. RESULTS: A total of 654 knee MRI scans were performed at the outpatient imaging center during the study period. This study population consisted of 310 men and 344 women, with an average age of 43.4 years (range, 11 to 88 years). There were 308 left and 346 right knees imaged. The most common clinical diagnosis in these 654 patients was meniscal tear (42.8%). A total of 5 patients had a proximal tibiofibular ganglion cyst detected on MRI, yielding a prevalence of 0.76% (95% confidence interval [CI] = 0.1% to 1.4%). These cysts ranged in size from 1.0 to 2.8 cm in maximum diameter. Three were found in men and 2 in women. The mean age of these patients was 47.6 years (range, 42 to 54 years). The most common preimaging diagnosis in these patients was a medial meniscal tear (in 3 of 5). CONCLUSIONS: This study is the first to provide data on the prevalence of proximal tibiofibular ganglion cysts in a population of patients with knee pain significant enough to warrant MRI. Over half of the patients found to have proximal tibiofibular ganglion cysts had no symptoms or signs attributable to them.

Variants of the anterosuperior glenoid labrum and associated pathology.

PURPOSE: The study goal was to determine the incidence of the sublabral foramen and the Buford complex and to assess their association with superior labral pathology. TYPE OF STUDY: Prospective case series. METHODS: The surgical findings of 108 consecutive shoulder arthroscopies performed by the same surgeon were collected, along with patient demographics. During surgery, special attention was directed towards the anterosuperior labrum. The presence of a sublabral foramen or Buford complex was correlated with the morphology of the superior, middle, and inferior glenohumeral ligaments and the presence of superior labral pathology. RESULTS: A total of 20 shoulders (18.5%) were found to have a sublabral foramen, and 7 (6.5%) had the Buford complex. The incidence of significant SLAP lesions was significantly higher in these 27 shoulders than in the rest of the study population (56% v 12%, P <.005). A thick, cord-like middle glenohumeral ligament was significantly associated with the presence of a sublabral foramen (P <.005). CONCLUSIONS: The sublabral foramen and the Buford complex may be more common than previously thought. Furthermore, these variants of anterosuperior glenoid labrum anatomy appear to be associated with superior labral pathology. The presence of a cord-like middle glenohumeral ligament is associated with a sublabral foramen variant as well as the Buford complex.