Operative treatment of failed repairs of the rotator cuff.

Thirty-one patients had a repeat repair after a failure of a previously performed repair of the rotator cuff, and the causes of the original failure and the results of the repeat repair were analyzed. The clinical situation was complex, with multiple factors contributing to the failures. A large or massive tear of the cuff in thirty patients (97 per cent) and persistent subacromial impingement in twenty-eight patients (90 per cent) were the most common factors associated with failure. The over-all result of the repeat repair was satisfactory in sixteen patients (52 per cent) and unsatisfactory in fifteen (48 per cent). Twenty-five patients (81 per cent) had satisfactory relief of pain. However, fourteen patients (45 per cent) had persistent weakness that led to an unsatisfactory result. The factors that were associated with a better result were an intact acromion, an intact origin of the deltoid muscle, and the finding that the remaining tissue of the rotator cuff was of good quality. The factors that were associated with an inferior result were a previous lateral acromionectomy, a previously detached origin of the deltoid muscle, and the finding that the tissue of the rotator cuff that was available at the time of the repeat operation was of poor quality. Persistent pain is the primary indication for a repeat repair. The functional results are not as predictable, especially when the tissue of the cuff is poor and the deltoid origin has been detached previously.

Operative repair of massive rotator cuff tears: Long-term results.

Sixty-one patients had operative repair of a massive rotator cuff tear and were followed an average of 7 years (range 3 to 13 years). The mean age of the patients was 62 years; there were 40 male and 21 female patients. All patients had significant pain, 31 patients had insidious onset of pain, and 30 patients recalled a traumatic event. Preoperatively, average active forward elevation was 88°, and average active external rotation was 27°. Forty-nine (80%) patients had marked atrophy of the supraspinatus and infraspinatus muscles. All patients had subacromial decompression as well as mobilization and transposition of rotator cuff tendons with tendon repair to bone. Fifty-two (85%) patients had satisfactory results, with 32 (52%) rated excellent and 20 (33%) rated good. Nine (15%) patients had unsatisfactory results, with four (7%) rated fair and five (8%) rated poor. Ninety-two percent of patients had satisfactory pain relief. The mean gain in forward elevation was 76%, and in active external rotation it was 30°. Adequate pain relief and the ability to raise the arm above the horizontal plane were achieved in 56 (92%) patients. Two patients tore their rotator cuff again after significant trauma.

Results of conservative management of osteonecrosis of the femoral head. A retrospective review.

This retrospective review of 50 osteonecrotic femoral heads in 36 young patients demonstrates the general futility of conservative treatment in slowing progression to total hip arthroplasty (THA). Etiologic factors, i.e., alcoholism, steroids, and idiopathic, did not appear to modify the rate or pattern of clinical deterioration. Pathogenetic stages, i.e., Ficat II to IV, seemed unrelated to the degree of disability. Despite modified weight-bearing, analgesics, and antiinflammatory agents, only three of 50 hips (6%) remained clinically stable and none improved. Thirty-four of the 50 osteonecrotic hips (68%) had been treated by THA after a mean interval of 16 months. In an additional four hips (8%) THA had been recommended, but not carried out. Progressive femoral head collapse was documented in 67% of the hips, the remainder, having reached an end stage (Ficat IV). This study confirms previous reports of the inability of bed rest, crutches, or other ambulatory aids to arrest the progression of femoral head collapse and increasing disability in young individuals with osteonecrosis of the hip.