Radiographic Progression of Osteoarthritis after Rotational Acetabular Osteotomy: Minimum 10-Year Follow-up Outcome According to the Tönnis Grade.

BACKGROUND: Although satisfactory mid- to long-term results of rotational acetabular osteotomy for early osteoarthritis secondary to acetabular dysplasia have been reported, there is still controversy about the long-term effects of this surgery in more advanced osteoarthritis. The purpose of this study was to investigate the radiographic progression of osteoarthritic changes after rotational acetabular osteotomy in acetabular dysplasia according to the preoperative Tönnis grade and evaluate its effects after minimum 10-year follow-up. METHODS: We performed 71 consecutive rotational acetabular osteotomies in 64 patients with symptomatic acetabular dysplasia between November 1984 and April 2005. Of these, 46 hips (four hips with Tönnis grade 0, 30 with grade 1, and 12 with grade 2) whose clinical and radiographic findings were available after minimum 10-year follow-up were evaluated in this study. The mean age at the time of surgery was 39.0 years (range, 18 to 62 years) and the average follow-up duration was 17.3 years (range, 10.0 to 27.7 years). Clinical and radiographic evaluations were performed according to the preoperative Tönnis grade. RESULTS: The average Harris hip score improved from 71.8 (range, 58 to 89) to 85.1 (range, 62 to 98). The radiographic parameters also improved in all Tönnis grades after the index surgery. Although the improvement of radiographic parameters was not different between preoperative Tönnis grades, the incidence of osteoarthritic progression was significantly different between grades (zero in Tönnis grade 0, four in Tönnis grade 1, and 10 in Tönnis grade 2; p < 0.001). The mean age at the time of surgery was also significantly older in osteoarthritic progression patients (p < 0.002). Kaplan-Meier survivorship analysis, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 100% in Tönnis grade 0, 85.7% in Tönnis grade 1, and 14.3% in Tönnis grade 2 (p < 0.001). CONCLUSIONS: The outcome of rotational acetabular osteotomy in most hips with Tönnis grade 0 and 1 was satisfactory after an average of 17 years of follow-up. The incidence of osteoarthritic progression was higher in Tönnis grade 2 and older age. Our results support that early joint preserving procedure is essential in the case of symptomatic dysplastic hips.

Arthroscopic direct repair for radial tear of the triangular fibrocartilage complex.

Although various repair techniques for Palmer type 1B lesions of the triangular fibrocartilage complex (TFCC) have been introduced, arthroscopic repair techniques for Palmer type 1D lesions are still being honed. Until recently, inside-out techniques have commonly been used to repair radial tears of the TFCC. However, that technique has the disadvantages of a requirement for an extra skin incision, pain resulting from prominent subcutaneous suture knot stacks, and peripheral nerve injury. We describe an all-arthroscopic direct-repair technique using a suture hook with 2-0 polydioxanone that is relatively simple and safe and is thus a useful alternative for radial tears of the TFCC.

Anterolateral approach for mini-open rotator cuff repair.

PURPOSE: This study was undertaken to introduce an anterolateral approach for mini-open rotator cuff repair and evaluate its clinical outcome and effectiveness. METHODS: We evaluated 128 consecutive cases that were repaired by mini-open repair using an anterolateral approach. There were 80 men and 48 women, with an average age of 56.2 years. Average follow-up was 25.7 months. There were eight partial-thickness, 26 small, 40 medium, 39 large and 15 massive tears. After arthroscopic glenohumeral examination and subacromial decompression, we made a 3- to 4-cm skin incision from anterolateral edge of the acromion and dissected to the raphe between the anterior and middle deltoid. The torn tendon was repaired with single- or double-row technique using suture anchors. To prevent avulsion of the deltoid from the acromion, additional suturing within the bone tunnel was performed. We retrospectively evaluated clinical outcomes using the American Shoulder and Elbow Surgeon (ASES) scoring system. RESULTS: The average visual analogue scale (VAS), activity of daily living (ADL) and ASES scores improved, respectively, from 6.6, 12.0 and 36.7 preoperatively to 1.2, 26.6 and 88.2 postoperatively. There were 71 excellent, 39 good, ten fair and eight poor results. There were no statistically significant difference between final ASES scores and age, symptom duration, tear size or preoperative stiffness, but men had significantly higher final ASES scores than women (P = 0.014). CONCLUSION: Anterolateral approach for mini-open rotator cuff repair produces satisfactory results. It may also provide better visualisation for rotator cuff tears of all sizes.