Open repair of isolated traumatic subscapularis tendon tears with a synthetic soft tissue reinforcement.

BACKGROUND: Missed or chronic subscapularis tendon ruptures may have muscle atrophy and tendon retraction resulting in a large defect with high risk of re-tear after a surgical repair. To improve the clinical results of this challenging surgery, the repaired tendon could be augmented with endogenous or exogenous materials. The purpose of this study was to evaluate the structural tendon integrity and clinical outcomes after an open subscapularis tendon repair with a synthetic soft tissue reinforcement. MATERIALS AND METHODS: Ten patients were managed with an open repair of the subscapularis tendon with augmentation by means of SportMesh, a readily available synthetic degradable poly(urethaneurea) scaffold. Clinical findings were assessed for all patients preoperatively and postoperatively with use of the visual analog scale for pain and the DASH scoring system. All patients had an ultrasonographic study at the latest follow-up. RESULTS: The visual analog scale for pain (mean ± standard deviation) improved significantly (P < 0.01) from 7.9 ± 1.1 preoperatively to 1.95 ± 1.85 at the latest clinical follow-up evaluation. The mean DASH score at the latest clinical follow-up was 12.63 %. Ultrasound imaging revealed a structural intact repair at follow-up in 9 shoulders (90 %) with average 5.4 mm in thickness (4.3 mm in the contralateral healthy side). CONCLUSIONS: At a median follow-up of 23 months, 80 % (8 of 10) of patients had a good or excellent result after an open subscapularis tendon repair with a soft tissue reinforcement. As a synthetic material, SportMesh Soft Tissue Reinforcement eliminates the risk of collagen reactions, which may result from collagen or dermis patches. Although the follow-up is relatively short, our series shows a promising durable repair with a 10 % re-tear rate at an average of 23 postoperative months. Level of evidence Case Series, Treatment Study, Level IV.

[Shoulder diseases in throwing athletes: radiologic assessment and surgical correlation]. / Patologie della spalla del lanciatore: valutazione radiologica e correlazioni chirurgiche.

Lesions of the shoulder, especially rotator cuff tears and glenoid labrum (SLAP) lesions, are commonly caused by traumatic episodes in athletes such as repeated trauma from throwing. The available radiological methods are MRI, CT and MR arthrography. Twelve athletes suffering from shoulder pain or instability have been studied and then underwent successful treatment in arthroscopy. On the basis of our results and experience, we think that MR, especially with intra-articular injection of contrast medium, is the best examination because it offers an accurate evaluation of both rotator cuff and glenoid labrum. Nevertheless difficulties are often encountered and definitive diagnosis sometime rests on arthroscopic exploration.

Seidel locked nailing for the treatment of unstable fractures and nonunion of the humerus.

The results of treatment by Seidel locked nailing in 13 recent fractures and 4 nonunions of the humerus are reported. The feature common to all of the fractures was instability consequent to comminution or in the site of the fracture center. The 4 nonunions were originally fractures synthesized by Rush intramedullary nailing. The surgical method used an entry approximately 1 cm from the greater tuberosity through a well-vascularized area of the rotator cuff. All of the cases achieved consolidation and in 70% of the patients results were excellent with complete recovery of range of movement of the shoulder. Thus, the Seidel nail appears to be an intramedullary means of synthesis particularly suited to the treatment of unstable fractures and nonunion of the humerus because it guarantees stability, especially in rotation, superior to any other intramedullary means of synthesis.