Arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion.

PURPOSE: To evaluate the outcomes of arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion (PASTA) in a large study group. METHODS: A retrospective review of prospectively collected data was conducted. One hundred and eighteen patients with PASTA lesion (grade A2-A3) who underwent arthroscopic transtendon repair were identified, of which 110 were eligible for the study. Ten patients were lost at final follow-up leaving a study group of 100 patients (52 male, 48 female). The average follow-up was 37 months (minimum 24 months, range 24-50, median 40). Mean age at the time of surgery was 50.4 (range 17-71, median 45). Patients were assessed before surgery and at 24-month follow-up, using the Simple Shoulder Test (SST), UCLA shoulder rating scale and the visual analogue scale (VAS). ROM was measured bilaterally and was evaluated before surgery, at 3-, 6- and 24-month follow-up. The satisfaction rate was calculated. Data were analysed using a paired Student's t test with 95 % confidence interval (significance p < 0.05). RESULTS: Significant improvement in UCLA, SST and VAS score was observed. Fifty-four cases were rated excellent, 42 good, 2 fair, 2 poor according to the UCLA score. No significant differences in ROM were noted compared to the contra-lateral side (p < 0.001) at the 24-month follow-up. Eighteen patients presented with a stiff shoulder at the 3-month follow-up, but they recovered full ROM by the 6-month follow-up evaluation. CONCLUSIONS: The arthroscopic transtendon repair of partial articular-sided rotator cuff tears is an effective procedure that leads to significant improvement in pain and shoulder function, with high patients' satisfaction rate, while the complication rate is low. This study demonstrated the effectiveness and safety of this technique in a large homogeneous study group. LEVEL OF EVIDENCE: IV.

Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears.

PURPOSE: simple tenotomy in the treatment of long head biceps (LHB) lesion offers good results, as well as tenotomy/tenodesis. MATERIALS AND METHODS: we prospectively evaluated 252 patients, divided into 3 groups, treated with rotator cuff repair associated with LHB tenotomy or 2 different types of tenodesis in cases where there had been a partial lesion of the LHB or instability of the bicipital groove. We ascertained whether there was residual pain and the presence of the "Popeye sign" in the post-operative stage. RESULTS: patients who underwent tenotomy alone achieved an improvement on the Visual Analogue Scale (VAS), Simple Shoulder Test (SST) and modified UCLA shoulder rating compared to patients who underwent LHB tenodesis. A positive Popeye sign is poorly perceived by patients. CONCLUSION: we considered the LHB tenotomy as treatment of choice for the rotator cuff surgical repair when there was an evident LHB lesion.

Clinical review of patients subjected to mini-Mumford arthroscopy.

PURPOSE: assessment of the clinical efficacy of isolated arthroscopic mini-Mumford surgery, associated with shoulder surgery in patients with degenerative disease of the acromioclavicular joint. MATERIALS AND METHODS: 52 patients (group A) underwent isolated arthroscopic mini-Mumford and 84 (group B) additional arthroscopic surgery of rotator cuff and/or long head of biceps. They were evaluated clinically using Visual Analogue Scale (VAS), Simple Shoulder Test (SST) and Modified UCLA shoulder rating, pre- and post-operatively after a mean period of 18.1 months. RESULTS: the results obtained in groups A and B overlap. DISCUSSION: arthroscopic mini-Mumford is a simple, low-risk procedure, which has proved effective in treating degenerative disease of the acromioclavicular joint, both in isolation and in association with reconstruction of the rotator cuff and/or biceps long head tenotomy.

Flow-mediated arterial dilation in primary antiphospholipid syndrome.

OBJECTIVE: To investigate precocious alterations in the artery wall of patients with primary antiphospholipid syndrome (APS). METHODS: We evaluated flow-mediated dilation (FMD) of the brachial artery and intima-media thickness (IMT) of carotid arteries in 16 patients and 16 healthy controls matched for age, gender, and other cardiovascular risk factors. RESULTS: FMD of the brachial artery was significantly lower in patients than in controls (6.3 +/- 5.2% vs 18.2 +/- 2.7; P < .005). IMT was similar in the 2 groups. FMD was significantly reduced in patients with anticardiolipin antibodies IgM. CONCLUSIONS: APS correlates closely with precocious atherosclerosis, and the correlation with a type of anticardiolipin antibody may be predictive of more accelerated atherosclerosis.

Carotid and femoral atherosclerosis in chronic hepatitis C: a 5-year follow-up.

The objective of this study was to assess the progression of atherosclerosis in carotid and femoral arteries after a 5-year period using ultrasound in subjects with chronic hepatitis C and in controls matched for classic atherosclerotic risk factors. A total of 40 patients and 40 controls were assessed by echocolor Doppler in 2001 and in 2006 to evaluate plaque and intima-media thickness. The patients showed no changes in plaque and intima-media thickness during the 5-year period in all districts examined, whereas a significant increase in intima-media thickness in the carotid sections was recorded in the controls. Chronic hepatitis C seems to cause delay in the atherosclerotic process.