Are Rotator Muscle Performance and Posterior Shoulder Capsule Tightness Related to Glenohumeral Internal Rotation Deficit in Male College Baseball Players?

Background: Posterior inferior capsule (PIC) tightness in the shoulder joint, a known risk factor for shoulder injury, can be assessed using shear-wave ultrasound elastography (SWE). However, to date, the correlation between PIC elasticity and shoulder rotator muscle performance in college baseball players with glenohumeral internal rotation deficit (GIRD) has not been reported. This study aimed to analyze the differences in PIC elasticity measured using SWE and shoulder rotator muscle performance between male college baseball players with and without GIRD. Methods: Twenty-four male college baseball players participated in this study: 10 with GIRD (G group) vs. 14 without GIRD (NG group). PIC elasticity was measured using SWE in the lateral decubitus position. Shoulder rotator muscle performance tests were performed for the internal rotators (IRs) and external rotators (ERs) at an angular velocity of 180°/sec with 90° shoulder abduction using an isokinetic test device. Results: Mean PIC elasticity was significantly greater in the throwing shoulders of the G group than in those of the NG group (4.8 ± 1.2 kPa vs. 3.7 ± 1.2 kPa, p = 0.036). In the throwing shoulders of the G group, compared with those of the NG-group, the ER/IR ratio was significantly lower (35.7% ± 5.0% vs. 55.5% ± 6.2%, p < 0.001) and IR muscle strength was significantly greater (75.0 ± 7.6 Nm kg-1 × 100 vs. 55.7 ± 6.4 Nm kg-1 × 100, p = 0.002). The mean elasticity of the PIC showed a significant negative correlation with the ER/IR ratio in the throwing shoulders of the G group (r = -0.640, p = 0.046). Conclusions: Among the male college baseball players with GIRD, SWE could quantitatively assess PIC tightness, and an imbalance in shoulder rotator muscle strength was found in these baseball players. Therefore, clinicians and therapists need to focus on the restoration of shoulder rotator muscle imbalance in addition to improving internal rotation in these players.

Importance of Initial Peak Torque of the Supraspinatus Muscle during Shoulder Flexion.

Background: Most previous studies have evaluated flexion strength to assess recovery after arthroscopic rotator cuff (RC) repair. However, limited data are available regarding peak torque at the initial angle (iPT) because most studies have measured flexion strength for peak torque (PT), particularly in small- and medium-sized supraspinatus tears. The purpose of this study was to compare conventional PT and iPT to evaluate supraspinatus muscle strength after arthroscopic RC repair in patients with small- and medium-sized supraspinatus tears. Methods: Isokinetic muscle performance testing was performed in 42 patients with small tears and in 47 patients with medium-sized tears. PT and iPT were evaluated before and 1 year after surgery and were recorded at an angular velocity of 60°/sec and 180°/sec with an isokinetic test. Results: PT and iPT were significantly lower in the involved-side shoulders than in the uninvolved-side shoulders (PT: small tear, p < 0.001; medium tear, p < 0.001; iPT: small tear, p < 0.001; medium tear, p < 0.001) in both groups, preoperatively. However, postoperatively, in the involved-side shoulders, PTs were not different in both small- and medium-sized tears (all p > 0.05), but iPTs were significantly lower in the involved-side shoulders (small tear, p < 0.001; medium tear, p < 0.001). iPT was significantly lower in the involved side shoulders in the medium-sized tear group than in the small-sized tear group before and after surgery (p < 0.05). In the small- and medium-sized tear groups, tear size was significantly correlated with preoperative iPT in the involved-side shoulders (small tear: r = -0.304, p = 0.046; medium tear: r = -0.323, p = 0.027). However, pain visual analog scale was significantly correlated with preoperative (small tear: r = -0.455, p = 0.002; medium tear: r = -0.286, p = 0.044) and postoperative (small tear: r = -0.430, p = 0.005; medium tear: r = -0.354, p = 0.021) iPT in the involved-side shoulders. Furthermore, fatty infiltration grade of the supraspinatus muscle and global fatty degeneration index were not associated with preoperative and postoperative PT and iPT in each group (all p > 0.05). Conclusions: iPT is as important as conventional PT in isokinetic testing to assess supraspinatus muscle strength before and after RC repair.

Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation.

BACKGROUND: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. METHODS: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12-33 months). An additional posterolateral portal and a 70º arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. RESULTS: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0º for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. CONCLUSIONS: Complete debridement using an additional posterolateral portal and 70º arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

Alterations in articular cartilage T2 star relaxation time following mechanical disorders: in vivo canine supraspinatus tendon resection models.

BACKGROUND: The role of altered joint mechanics on cartilage degeneration in in vivo models has not been studied successfully due to a lack of pre-injury information. We aimed 1) to develop an accurate in vivo canine model to measure the changes in joint loading and T2 star (T2*) relaxation time before and after unilateral supraspinatus tendon resections, and 2) to find the relationship between regional variations in articular cartilage loading patterns and T2* relaxation time distributions. METHODS: Rigid markers were implanted in the scapula and humerus of tested dogs. The movement of the shoulder bones were measured by a motion tracking system during normal gaits. In vivo cartilage contact strain was measured by aligning 3D shoulder models with the motion tracking data. Articular cartilage T2* relaxation times were measured by quantitative MRI scans. Articular cartilage contact strain and T2* relaxation time were compared in the shoulders before and 3 months after the supraspinatus tendon resections. RESULTS: Excellent accuracy and reproducibility were found in our in vivo contact strain measurements with less than 1% errors. Changes in articular cartilage contact strain exhibited similar patterns with the changes in the T2* relaxation time after resection surgeries. Regional changes in the articular cartilage T2* relaxation time exhibited positive correlations with regional contact strain variations 3 months after the supraspinatus resection surgeries. CONCLUSION: This is the first study to measure in vivo articular cartilage contact strains with high accuracy and reproducibility. Positive correlations between contact strain and T2* relaxation time suggest that the articular cartilage extracellular matrix may responds to mechanical changes in local areas.

Maximum Bridging Suture Tension Provides Better Clinical Outcomes in Transosseous-Equivalent Rotator Cuff Repair: A Clinical, Prospective Randomized Comparative Study.

BACKGROUND: Some studies reporting clinical outcomes after transosseous-equivalent (TOE) repair have attributed type II rotator cuff failure to excessive bridging suture tension, as it can cause overloading on the medial row. In a previous biomechanical cadaveric study, increasing bridging suture tension over 90 N did not improve the contact area and ultimate failure load of the TOE construct, despite increasing the contact force and contact pressure. PURPOSE: To compare the clinical outcomes of different bridging suture tensions after TOE rotator cuff repair based on the results of a previous biomechanical study. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 78 patients who underwent arthroscopic rotator cuff repair for medium- to large-sized tears were prospectively enrolled and randomly divided into 2 groups according to the applied bridging suture tension: optimum tension group (96.3 ± 4.9 N) and maximum tension group (199.0 ± 20.3 N). Bridging suture tension was measured with a customized tensiometer, as used in the previous biomechanical study. The functional outcome was measured at the final follow-up (27.4 ± 5.9 months [range, 24-45 months]) using the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Constant score, and the anatomic outcome was evaluated using magnetic resonance imaging or ultrasonography at least 12 months after surgery. RESULTS: Overall, 64 patients (32 in each group) were analyzed. The functional outcomes improved significantly compared with preoperative values (all P < .05) but did not show significant differences between the 2 groups (all P > .05). Regarding the anatomic outcomes, the maximum tension group (n = 1; 3.1%) had a significantly lower healing failure rate than the optimum tension group (n = 9; 28.1%) (P = .013). One patient in the maximum tension group had a type II failure. CONCLUSION: Maximum bridging suture tension in TOE repair for medium- to large-sized rotator cuff tears provided better anatomic healing with less risk of medial rotator cuff failure, which differs from the results of a previous time-zero biomechanical study.

Which muscle performance can be improved after arthroscopic Bankart repair?

BACKGROUND: There are no published reports available regarding neuromuscular control recovery in nonathletic patients after arthroscopic (A/S) Bankart repair. This study aimed to compare neuromuscular control and performance of the rotator cuff muscles between patients who underwent A/S Bankart repair and normal controls. METHODS: In total, 32 nonathletic patients who underwent A/S Bankart repair were compared with 32 asymptomatic nonathletic volunteers. Neuromuscular control index (time to peak torque and acceleration time), muscle strength ratio, muscle strength, and muscle endurance of the internal rotators (IRs) and external rotators (ERs) were measured using an isokinetic device at an angular velocity of 180°/s, with 90° shoulder abduction. RESULTS: The neuromuscular control indices of both IRs and ERs were significantly lower in patients who underwent A/S Bankart repair than in normal controls (time to peak torque, IRs: 1059 ± 143 ms vs. 679 ± 226 ms, P = .011; ERs: 595 ± 286 ms vs. 379 ± 123 ms, P = .044; acceleration time, IRs: 75 ± 16 ms vs. 62 ± 15 ms, P = .039, ERs: 70 ± 19 ms vs. 54 ± 18 ms, P = .047). Muscle endurance was significantly lower in patients who underwent A/S Bankart repair than in normal controls (IRs: 670 ± 1 J vs. 718 ± 2 J, P = .002, ERs: 422 ± 6 J vs. 501 ± 2 J, P = .044). The neuromuscular control index showed a significant negative correlation with muscle endurance for both IRs and ERs after the operation (IRs: r = -0.737, P = .003, ERs: r = -0.617, P = .019). CONCLUSION: Compared with normal controls, patients who underwent A/S Bankart repair did not show complete recovery of neuromuscular control of IRs and ERs, although their muscle strength ratio and muscle strength had fully recovered.

Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study.

BACKGROUND: Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). METHODS: This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. RESULTS: The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). CONCLUSIONS: Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.

Time to peak torque and acceleration time are altered in male patients following traumatic shoulder instability.

BACKGROUND: Numerous authors have evaluated the strength of the rotator cuff muscles in patients with shoulder instability. However, only limited data are available with regard to neuromuscular control in patients with traumatic anterior shoulder instability, in particular at 90° of abduction. This study was designed to assess muscle strength and neuromuscular control ability using time to peak torque and acceleration time in nonathletic patients with traumatic anterior shoulder instability. METHODS: Isokinetic muscle performance testing was performed in 20 male nonathletic anterior shoulder instability patients compared with 20 side-matched asymptomatic volunteers. Isokinetic muscle performance testing was performed at an angular velocity of 180°/s with 90° of shoulder abduction. Muscle strength and neuromuscular control (time to peak torque and acceleration time) of the internal rotators (IRs) and external rotators (ERs) were measured. RESULTS: There were no significant differences in muscle strength of the IRs and ERs between the 2 groups. The injured shoulder showed delayed neuromuscular control in both the IRs and ERs in the instability patients compared with the normal control subjects (time to peak torque, P = .023 for IRs and P = .020 for ERs; acceleration time, P = .035 for IRs and P = .021 for ERs). CONCLUSION: The neuromuscular control of both the IRs and ERs was decreased in male nonathletic patients with traumatic anterior shoulder instability even though muscle strength was not altered. Therefore, clinicians and therapists should implement exercises that aim to restore neuromuscular control in the rehabilitation of nonathletic patients with anterior shoulder instability.

A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis.

BACKGROUND: Several methods are used to perform biceps tenodesis in patients with superior labrum-biceps complex (SLBC) lesions accompanied by a rotator cuff tear. However, limited clinical data are available regarding the best technique in terms of clinical and anatomic outcomes. PURPOSE: To compare the clinical and anatomic outcomes of the interference screw (IS) and suture anchor (SA) fixation techniques for biceps tenodesis performed along with arthroscopic rotator cuff repair. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 80 patients who underwent arthroscopic rotator cuff repair with SLBC lesions were prospectively enrolled and randomly divided according to the tenodesis method: the IS and SA groups. Functional outcomes were evaluated with the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Constant score, Korean Shoulder Score (KSS), and long head of the biceps (LHB) score at least 2 years after surgery. The anatomic status of tenodesis was estimated using magnetic resonance imaging or ultrasonography, and the anatomic failure of tenodesis was determined when the biceps tendon was not traced in the intertubercular groove directly from the insertion site of the IS or SA. RESULTS: Thirty-three patients in the IS group and 34 in the SA group were monitored for more than 2 years. All postoperative functional scores improved significantly compared with the preoperative scores (all P < .001) and were not significantly different between the groups, including the LHB score (all P > .05). Nine anatomic failures of tenodesis were observed: 7 in the IS group and 2 in the SA group ( P = .083). In a multivariate analysis using logistic regression, IS fixation ( P = .003) and a higher (ie, more physically demanding) work level ( P = .022) were factors associated with the anatomic failure of tenodesis significantly. In patients with tenodesis failure, the LHB score ( P = .049) and the degree of Popeye deformity by the patient and examiner ( P = .004 and .018, respectively) were statistically different compared with patients with intact tenodeses. CONCLUSION: Care must be taken while performing biceps tenodesis in patients with a higher work level; IS fixation appears to pose a higher risk in terms of the anatomic failure of tenodesis than SA fixation, although functional outcomes were not different.

Comparison of Treatments for Superior Labrum-Biceps Complex Lesions With Concomitant Rotator Cuff Repair: A Prospective, Randomized, Comparative Analysis of Debridement, Biceps Tenotomy, and Biceps Tenodesis.

PURPOSE: To compare the clinical outcomes in patients with concomitant superior labrum-biceps complex (SLBC) lesions and rotator cuff tears who underwent arthroscopic rotator cuff repair, according to 3 different treatment methods (simple debridement, biceps tenotomy, or biceps tenodesis) for the SLBC lesions. METHODS: One hundred twenty patients who underwent arthroscopic rotator cuff repair with SLBC lesions (biceps partial tears <50%, partial pulley lesions, and type II SLAP lesions) were enrolled in this prospective comparative study and randomly assigned to 1 of 3 treatment groups (simple debridement [Deb], biceps tenotomy only [BTo], or biceps tenodesis with one suture anchor [BTd]). Patients with isolated subscapularis tears or osteoarthritis were excluded. Finally, 86 patients (Deb in 28, BTo in 27, and BTd in 31) were analyzed (mean follow-up, 22.1 ± 7.72 months; mean age, 58.98 ± 7.8 years). Pain; functional, clinical, and radiologic outcomes; and the strength index of elbow flexion and forearm supination were analyzed. RESULTS: Pain, range of motion, and functional scores significantly improved postoperatively in all 3 groups, with no significant differences across groups. At the 6-month follow-up, 8 patients reported cramping pain (5 Deb patients, 2 BTo patients, and 1 BTd patient), but the pain improved in most patients over time (with cramping pain reported by zero Deb patients, 1 BTo patient, and 1 BTd patient at final follow-up). Bicipital groove tenderness significantly improved in the BTo group postoperatively (P = .006). The Popeye deformity was noted in 10 patients (37.0%) in the BTo group, 8 (25.8%) in the BTd group, and only 2 (7.1%) in the Deb group (P = .029). On radiologic examination, the presence of tenodesis of the biceps tendons on the bicipital groove showed low agreement with the presence of the Popeye deformity (observed in 13 of 20 patients with the deformity, 65%). On strength index analysis, the BTo group showed lower forearm supination strength (0.877 ± 0.44) compared with that in the other groups (1.29 ± 0.525 in the Deb group and 1.12 ± 0.451 in the BTd group, P = .049). CONCLUSIONS: All 3 treatments improved pain and function. Simple debridement showed the lowest risk of the Popeye deformity and preserved forearm supination strength. Biceps tenotomy and tenodesis may be preferable for selected patients: biceps tenotomy for patients with definite bicipital groove tenderness and biceps tenodesis for patients, especially male patients, with bicipital groove tenderness who want to preserve supination strength. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Perianchor Cyst Formation Around Biocomposite Biodegradable Suture Anchors After Rotator Cuff Repair.

BACKGROUND: Biodegradable anchors may lead to perianchor cyst formation or osteolysis. A new generation of anchors containing osteoconductive material was recently presented, but there is currently no solid evidence that this concept decreases cyst formation around anchors. HYPOTHESIS: The null hypothesis was that the prevalence and severity of cyst formation around anchors would be similar for all 3 anchor types. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: To evaluate differences between anchor behaviors postoperatively, this study included 2 groups of patients who underwent rotator cuff repair. In group 1 (n = 38), transosseous-equivalent rotator cuff repair was performed in all patients. At the time of repair, 2 different anchors (anchor A: 23% microstructured ß-tricalcium phosphate plus 77% polylactic acid enantiomers [PLLA]; and anchor B: 30% hydroxyapatite plus 70% PLLA) were used for medial-row repair. Insertion locations (anterior or posterior) were randomly assigned. In group 2 (n = 38), the same procedure was performed; however, 1 of the anchors used in group 1 was changed (anchor A: as above; and anchor C: 30% ß-tricalcium phosphate plus 70% faster absorbing polylactic-co-glycolic acid copolymer [85% PLLA plus 15% polyglycolic acid]). The presence and severity of fluid collection around the anchors was evaluated by magnetic resonance imaging at approximately 1 year after rotator cuff repair (12.7 ± 0.9 months for group 1 and 12.6 ± 1.8 months for group 2). RESULTS: In group 1, a fluid signal was observed in 14 patients (36.8%) for anchor A and in 12 patients (31.6%) for anchor B (P > .05). The severity of perianchor cyst formation was no different for the 2 anchors (respective fluid signal grades [0-4]: 24, 3, 9, 1, and 1 for anchor A; and 26, 4, 7, 1, and 0 for anchor B; P > .05). However, in group 2, cysts were observed in 19 patients (50%) for anchor A and in 3 patients (7.9%) for anchor C (P < .001). For anchor C, only 2 cases of grade 1 and 1 case of grade 2 fluid collection were observed. Intergroup analysis of anchor A revealed no significant differences in the prevalence or severity of perianchor cyst formation (P > .05). Healing failure was observed in 12 patients (31.6%) in group 1 and 10 patients (26.3%) in group 2 (P > .05). CONCLUSION: New-generation biodegradable suture anchors seem to decrease the severity of perianchor cyst formation. Future research is required to optimize the compositions and proportions of osteoconductive materials and polymers to improve adverse reactions. Nevertheless, controlling the properties of polymers and adding osteoconductive material both appear to enhance biocompatibility.

Prognostic Factors Affecting Rotator Cuff Healing After Arthroscopic Repair in Small to Medium-sized Tears.

BACKGROUND: Small and medium-sized rotator cuff tears usually have good clinical and anatomic outcomes. However, healing failure still occurs in some cases. PURPOSE: To evaluate prognostic factors for rotator cuff healing in patients with only small to medium-sized rotator cuff tears. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were prospectively collected from 339 patients with small to medium-sized rotator cuff tears who underwent arthroscopic repair by a single surgeon between March 2004 and August 2012 and who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery. The mean age of the patients was 59.8 years (range, 39-80 years), and the mean follow-up time was 20.8 months (range, 12-66 months). The functional evaluation included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons score, Constant-Murley score, and Simple Shoulder Test. RESULTS: Postoperative VAS for pain and functional scores improved significantly compared with preoperative values (P < .001). Forty-five healing failures occurred (13.3%), and fatty degeneration of the infraspinatus muscle, tear size (anteroposterior dimension), and age were significant factors affecting rotator cuff healing (P < .001, = .018, and = .011, respectively) in multivariate logistic regression analysis. Grade II and higher infraspinatus fatty degeneration correlated with a higher failure rate. The failure rate was also significantly higher in patients with a tear >2 cm in size (34.2%) compared with patients with a tear ≤2 cm (10.6%) (P < .001). A receiver operating characteristic curve was used to determine the predictive cut-off value for the oldest age and the largest tear size for successful healing, which were calculated as 69 years and 2 cm, respectively, with a specificity of 90%. CONCLUSION: In small to medium-sized rotator cuff tears, grade II fatty degeneration of the infraspinatus muscle according to the Goutallier classification could be a reference point for successful healing, and anatomic outcomes might be better if repair is performed before the patient is 69 years old and the tear size exceeds 2 cm.

The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study.

BACKGROUND: Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. PURPOSE: To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. RESULTS: As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P < .05 for all). Regarding contact area, no significant differences were found between 90 and 120 N at all positions, although there were significant differences between 60 and 90 N. The construct failure test demonstrated no significant differences in any parameters according to various tensions (P > .05 for all). CONCLUSION: Increasing bridging suture tension to over 90 N did not improve contact area but did increase contact force and pressure. Bridging suture tension did not significantly affect ultimate failure loads. CLINICAL RELEVANCE: Considering the risks of overtensioning bridging sutures, it may be clinically more beneficial to keep bridging suture tension below 90 N.

Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery.

PURPOSE: To compare the clinical efficacy of warmed irrigation fluid and room-temperature fluid in decreasing perioperative hypothermia during arthroscopic rotator cuff surgery. METHODS: In this prospective, randomized, comparative study, warmed (36°C) arthroscopic irrigation fluid (group W, n = 36) or room-temperature irrigation fluid (group RT, n = 36) was used without intraoperative warming devices during arthroscopic shoulder surgery in 72 patients. The serial core body temperature and the last and lowest core body temperatures were measured by use of an esophageal stethoscope with a thermometer and a digital tympanic thermometer at 15-minute intervals during the operation and recovery period, respectively. When patients arrived in the postanesthesia care unit (PACU) after surgery, they were warmed immediately and monitored thereafter for body temperature and development of hypothermia-related adverse effects such as postoperative shivering and cardiac events. We evaluated the changes in the patients' weight and prothrombin time on postoperative day 1 and the hemoglobin level and visual analog scale pain score immediately after the operation and on postoperative day 1. RESULTS: The 2 groups did not differ in demographic and surgical data and incidence of intraoperative hypothermia (33 of 36 [91.6%] in group RT and 34 of 36 [94.4%] in group W, P = .276). The core body temperatures decreased throughout the surgery and increased linearly in the PACU, without any intergroup differences (P > .05). All patients were normothermic within 1 hour of arrival in the PACU. The 2 groups did not differ in postoperative weight change, prothrombin time, hemoglobin level, or postoperative visual analog scale pain score (all P > .05). Postoperative shivering occurred in 3 patients and 1 patient in group RT and group W, respectively. No cardiac events occurred in either group. CONCLUSIONS: Warmed irrigation fluid was not superior to room-temperature irrigation fluid in reducing the occurrence of perioperative hypothermia during arthroscopic shoulder surgery. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

Modified extensor carpi radialis brevis adductorplasty for ulnar nerve palsy.

Residual paralysis or irreparable injury to the ulnar nerve results in considerable impairment of hand function and posture that directly affect daily living. Usually, claw hand deformity and loss of key pinch become problematic, but tendon transfer can be used to restore the lost functions. Adductorplasty using a wrist extensor tendon can restore thumb adduction strength without a significant loss of wrist extension strength, but the short length of the wrist extensor necessitates a free tendon graft to reach the thumb. Here, the authors present a modified extensor carpi radialis brevis adductorplasty technique that does not need a tendon graft by elongating the tendinous portion.

Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors.

BACKGROUND: Despite its importance, few studies regarding health-related quality of life (HRQOL) after rotator cuff repair have been reported. PURPOSE: To evaluate the outcomes of rotator cuff repair in terms of HRQOL using SF-36 and to analyze factors affecting postoperative HRQOL. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We included 309 patients who were followed-up for a mean 26.3 months (range, 12-48 months) after arthroscopic rotator cuff repair, between November 2004 and August 2008, and who underwent periodic measurement of HRQOL using SF-36 preoperatively, 1 year postoperatively, and at the final follow-up. The correlation between SF-36 and shoulder-specific functional outcome measures (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Constant score) was evaluated using correlation analysis, and the relationship between various clinical factors, including rotator cuff healing and HRQOL, was assessed using univariate and multivariate analyses. RESULTS: The SF-36 scores for physical HRQOL and mental HRQOL showed significant improvement, from 40.40 to 47.53 and from 44.45 to 50.55 at 12 months after surgery, respectively (all P < .001), and improvement was maintained with 48.24 and 50.45, respectively, at the final follow-up (all P < .001). Scores also showed improvement according to all clinical variables, even after stratification of each variable. The correlation between SF-36 and shoulder-specific functional outcome measures was fair to moderate (Pearson correlation coefficients, 0.199-0.528). Various factors had significant effects on preoperative physical and mental HRQOL; however, postoperatively (at 12 months and final follow-up, respectively), only older age (P = .008 and .013), female sex (P = .036 and .043), presence of diabetes (P = .026 and .027), and low level of sports activity (P = .049 at final follow-up) had a negative effect on postoperative physical HRQOL in multivariate analysis, and female sex (P = .010 and .001) was the only factor leading to worse postoperative mental HRQOL. CONCLUSION: Arthroscopic rotator cuff repair significantly improved the patients' HRQOL both physically and mentally. Older age, female sex, diabetes, and low level of sports activity were related to low postoperative physical HRQOL, and female sex was also related to low postoperative mental HRQOL.