Partial repair of irreparable rotator cuff tears.

This study analyzes the results of a previously unreported technique of reconstruction for the massive irreparable rotator cuff tear. The technique involves repair of the margins of the tear to restore the force couples and "suspension bridge" system of force transmission in the shoulder. Complete coverage of the defect was not considered to be essential as long as the normal mechanics of the shoulder were restored and the rotator cuff tear was converted to a "functional cuff tear." This procedure was performed on 14 patients. Improvement in function was dramatic. Active elevation (elevation denotes the plane of motion midway between the planes of shoulder abduction and shoulder flexion; elevation is reported because it is the most functional plane in which to raise the arm) improved by 90.8 degrees: from a preoperative average of 59.6 degrees to a postoperative average of 150.4 degrees. Strength improved an average of 2.3 grades on a 0-to-5-point scale. The average score on the UCLA Shoulder Rating Scale improved from a preoperative value of 9.8 to a postoperative value of 27.6. All but one patient was very satisfied with his or her result. The authors are of the opinion that this technique is preferable to other reconstructive techniques, such as tendon transposition, that emphasize coverage of the defect at the expense of destroying the normal mechanics of the shoulder. The authors suggest that partial repair of massive irreparable rotator cuff tears should supplant tendon transposition as the procedure of choice for this condition.

Partial thickness rotator cuff tears: results of arthroscopic treatment.

Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.

Long-term results of valgus tibial osteotomy.

Valgus tibial osteotomy is a well-recognized procedure for medial compartment arthritis of the knee. The femorotibial angle must be adequately realigned; most unsatisfactory outcomes result from undercorrection. This study of 27 patients (38 knees) with a valgus tibial osteotomy for unicompartmental arthritis of the knee emphasizes the importance of correct alignment. Alignment outside the acceptable range did accelerate deterioration in these patients, followed for an average of 53 months. In 25 of the 38 knees (66%) results were good to excellent. An alignment of 6 degrees or more of valgus produced an excellent to good result in 21 of 23 knees (91%). Alignment of less than 6 degrees of valgus yielded excellent to good results in 4 of 15 knees (27%). Although at the end of one year, 31 of the 38 knees were rated as excellent to good, these knees progressively deteriorated. The knees in 6 degrees or more of valgus seldom deteriorated while those in less than 6 degrees of valgus deteriorated more frequently. A valgus tibial osteotomy is an excellent procedure provided the tibiofemoral angle is realigned to 6 degrees or more of valgus.