A Modified Weaver-Dunn Procedure with or without Chip Bone Graft for the Treatment of Acromioclavicular Joint Separation.

BACKGROUND: In spite of frequent injuries to the acromioclavicular (AC) joint, there is no consensus regarding optimal technique to be used. This cohort study evaluated the clinical results of a modified Weaver-Dunn procedure with or without chip bone graft for the treatment of AC joint separation retrospectively. MATERIALS AND METHODS: 60 consecutive patients with AC joint separation, between the age of 19-76 years (mean age 43 years), were enrolled between January 2005 and September 2011. Forty patients (35 men, 5 women) were treated with a modified Weaver-Dunn procedure, and did not receive bone graft during the procedure (Group 1), whereas twenty patients (19 men, 1 woman) received autogenous chip bone graft (Group 2). Stability of the AC joint was evaluated clinically and radiographically, and the clinical results were assessed by the Imatani evaluation system. RESULTS: The mean duration of followup was 2 years and 2 months. The results were excellent in all patients except one. At final followup, roentgenographic measurement revealed that the mean coracoclavicular interval was 8.2 mm on the affected side, and 8.9 mm on the unaffected side in Group 1, and 9.5 mm on the affected side and 10.1 mm on the unaffected side in Group 2. For Group 1, there were significant differences between augmentation of the grafted coracoacromial (CA) ligament antero-posteriorly and laterally (Option B) and repair of the torn AC ligament with augmentation of the grafted CA ligament antero-inferiorly (option A; P = 0.0351). CONCLUSIONS: The modified Weaver-Dunn procedure (Group 1 and 2) provides a stable and strong reconstruction for the treatment of AC joint separation. In addition, this modified Weaver-Dunn procedure with chip bone graft (Group 2) may lead to same or more secure healing of the grafted CA ligament-bone than the same procedure without chip bone graft (P = 0.9737).

Association between the location of tuberosity cysts and rotator cuff tears: A comparative study using radiograph and MRI.

BACKGROUND: The association between tuberosity cysts and rotator cuff tears (RCTs) and the nature of the major contributing factors to tuberosity cyst formation continue to be controversial. The purpose of our study was to evaluate the strength of associations of RCT and various factors involved in the chronicity of RCT with tuberosity cysts, using magnetic resonance imaging (MRI) and radiographs. METHODS: We reviewed consecutive patients with various disease entities between August 2004 and July 2013. After excluding unsuitable patients, this study involved 1007 shoulders of 906 consecutive patients. Each tuberosity cyst was categorized as an anterior greater tuberosity (GT), posterior GT, lesser tuberosity, and bare-area cyst. The odds ratios (ORs) and 95% confidence intervals (CIs) between the tuberosity cysts and various factors were evaluated by logistic regression analyses; p-value was set below 0.05. RESULTS: Anterior GT cysts and posterior GT cysts on MRI or anterior GT cysts on radiographs were significantly associated with supraspinatus tendon (SST) tears ( p ≤ 0.019) and infraspinatus tendon (IST) tears ( p ≤ 0.004). Among the shoulder pathologies, RCTs only significantly associated with cyst formation (OR 4.23, 95% CI 3.17-5.65; p < 0.001). The retraction grade of Patte was significantly associated with anterior GT cyst (OR 3.65, 95% CI 2.42-5.48; p < 0.001). CONCLUSION: Detecting an anterior GT cyst in a radiograph, even a low prevalence, in a patient with symptomatic shoulder indicates a need to consider RCT, especially of the SST, IST, and a high possibility of a retracted tear.

Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint.

BACKGROUND: Symptomatic acromioclavicular joint (ACJ) lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. MATERIALS AND METHODS: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years). The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months). The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score. RESULTS: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly (P < 0.001). There were no specific complications at the latest followup. CONCLUSION: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

The development and validation of an appraisal method for rotator cuff disorders: the Korean Shoulder Scoring System.

HYPOTHESIS: The purpose of this study was to develop and validate a disease-specific appraisal method for patients with rotator cuff disorders. The Korean Shoulder Scoring System (KSS) includes 5 domains totalling 100 points: function, 30 points; pain, 20; satisfaction, 10; range of motion, 20; and muscle power, consisting of strength, 10; and endurance, 10. METHOD: The KSS was used to evaluate clinical outcomes of 430 patients with rotator cuff disorder for a period of 6 months postoperatively. RESULT: The KSS had an acceptable level of internal consistency (alpha = 0.840). The KSS scores also correlated strongly with the Constant scores (r = 0.802), but less so with the American Shoulder and Elbow Surgeons scores (r = 0.602) and the University of California Los Angeles shoulder scores (r = 0.573). A large effect size (r = 1.234) and a standardized response mean (r = 1.317) for KSS were evident at 6 months postoperatively. CONCLUSION: The KSS is a useful measurement tool that combines subjective and objective evaluations for shoulder function related to rotator cuff disorders.

Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy.

This article presents uncommon cases of neuropraxia of the lesser occipital nerve and the greater auricular nerve after arthroscopic surgery of the shoulder in the beach-chair position under general anesthesia. The lesser occipital nerve and the greater auricular nerve are superficial ascending branches of the cervical plexus. These 2 superficial nerves may be easily vulnerable because of their superficial anatomic locations. We assumed that the severity of the neuropraxia of superficial branches of the cervical plexus was related to the degree of rotation and deviation of the head and neck, the duration of the procedure, and compression by head strap and elastic bandage used for fixing the head to the rectangular-shaped headrest of the beach-chair device. We recommend that during surgery in the beach-chair position, the auricle be protected and covered with cotton and gauze to avoid direct compression and the position of the head and neck be checked and corrected frequently. We hope for a new design of the headrest of the beach-chair device to prevent neuropraxia and to attach the head firmly and safely.

Sonography of the shoulder after arthrography (arthrosonography): preliminary results.

PURPOSE: The purpose of this study was to verify whether arthrosonography improves diagnostic accuracy in diseases of the shoulder and provides additional information for therapeutic planning, compared with conventional sonography. METHODS: We prospectively studied 113 consecutive patients with chronic shoulder pain. Sonography was performed before and after arthrography, with the radiologist blinded to the results of arthrography. When a rotator cuff tear was detected sonographically, its type, location, and size were recorded; we also evaluated any changes in the subacromial-subdeltoid bursa and any abnormalities in the biceps tendon sheath. The diagnostic accuracy of conventional sonography and arthrosonography was compared with that of arthrography for rotator cuff tear. Changes in the subacromial-subdeltoid bursa and biceps tendon sheath seen on conventional sonography were also compared with those seen on arthrosonography. RESULTS: The sensitivity and specificity of conventional sonography in the diagnosis of rotator cuff tear were 86% (25/29) and 95% (80/84), respectively; for arthrosonography, the values were 97% (28/29) and 95% (80/84), respectively. The differences in sensitivity and specificity for the 2 sonographic techniques were not statistically significant (p > 0.05). The accuracy in localizing the tear was also not significantly different between the 2 sonographic techniques. Synovial proliferation was more easily detected with arthrosonography than it was with conventional sonography in the subacromial-subdeltoid bursa (p < 0.01) and in the biceps tendon sheath (p < 0.0001). CONCLUSIONS: Our preliminary results suggest that although arthrosonography was not superior to conventional sonography in the diagnosis of rotator cuff tears, it may provide a better assessment of the size of tears and additional information about synovial proliferation in the subacromial-subdeltoid bursa and the biceps tendon sheath.