Effect of cocktail therapy after arthroscopic rotator cuff repair: a randomized, double-blind trial.

BACKGROUND: We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR). METHODS: We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion. RESULTS: The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group. CONCLUSION: We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.

Correlation between retear after arthroscopic rotator cuff repair and stiffness of the shoulder.

BACKGROUND: The purpose of this study was to investigate the relationship between retear after arthroscopic rotator cuff repair and passive range of motion of the shoulder. METHODS: Passive range of motion before and after surgery was compared between the two groups. RESULTS: The healed and retear groups comprised 86.4% and 13.6% shoulders, respectively. Passive external rotation with the arm at the side at 3 months postoperatively was significantly smaller in the healed group than retear group. CONCLUSIONS: This difference seemed to be associated with stiffness in external rotation of the shoulder and the process of cuff healing after surgery. LEVEL OF EVIDENCE: Level III, Case-Control Study, Treatment Study.

Effects of Platelet-Rich Plasma and Indomethacin on Biomechanics of Rotator Cuff Repair.

We conducted a study to determine if platelet-rich plasma (PRP) enhances the strength of rotator cuff repair (RCR) and if concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) affects PRP efficacy. We also wanted to determine the optimal centrifugation protocol for making PRP from rats. This study used 48 rats, 14 in a centrifugation protocol and 34 in an operative protocol. Six syngeneic rats from the operative group were used as PRP blood donors; the other 28 operative rats underwent bilateral RCRs. The Autologous Conditioned Plasma system (Arthrex) was used to prepare leukocyte-poor PRP. One shoulder was randomized to an intratendinous PRP injection, and the other received normal saline. Each rat was also randomly placed on a postoperative diet, either a regular diet or an indomethacin-enhanced diet. After rats were euthanized at 3 weeks, specimens were dissected to isolate the supraspinatus tendon at its humeral attachment, which was subjected to biomechanical testing. PRP prepared with a protocol of 5 minutes × 1300 revolutions per minute had the highest platelet index. Mean (SD) energy to failure was significantly higher (P = .03) in tendons treated with PRP, 11.7 (7.3) N-mm, than in tendons treated with saline, 8.7 (4.6) N-mm. Both groups (PRP, saline) showed no significant differences between tendons treated with NSAIDs and those not treated with NSAIDs. Intraoperative application of PRP enhances energy to failure after RCR in rats. There were no differences in biomechanical strength with NSAID use and no interactions between PRP and NSAID use.

Comparison of epidemiology and outcomes of arthroscopic rotator cuff repair for anterosuperior and posterosuperior rotator cuff tears.

BACKGROUND: The purpose of this study was to investigate the prevalence, epidemiology, and outcomes of anterosuperior (A group) rotator cuff tears (RCTs) and posterosuperior (P group) RCTs treated by arthroscopic rotator cuff repair (ARCR). METHODS: A total of 67 A group patients and 14 P group patients were included in the study. RESULTS: The prevalence of the A group (82.3%) was significantly higher than that of the P group (17.7%). CONCLUSION: The outcomes in both groups were good, even though the A group had a higher rate of injury to the LHB than the P group. LEVEL OF EVIDENCE: Level III, case-control Study, treatment study.

Comparison of the epidemiology and outcomes of traumatic and nontraumatic rotator cuff tears.

OBJECTIVE: The purpose of this study was to investigate the differences in the epidemiology and outcomes of traumatic and nontraumatic rotator cuff tears. METHODS: Thirty-three patients with traumatic and 46 with nontraumatic rotator cuff tears were included. RESULTS: The rate of injury to the long head of the biceps was significantly higher in the traumatic group. Preoperative active forward elevation was significantly lower in the traumatic group. CONCLUSION: The outcomes of both groups were good. This may have been because milder preoperative muscle atrophy and a shorter duration of symptoms were observed in the traumatic group.

Periacetabular osteotomy in patients fifty years of age or older: surgical technique.

BACKGROUND: Periacetabular osteotomy has been established as an effective treatment for early or mild osteoarthritis caused by developmental dysplasia of the hip. However, the optimal method of surgical reconstruction for older patients remains controversial. The purpose of this retrospective study was to evaluate the clinical and radiographic results of a curved periacetabular osteotomy for the treatment of developmental dysplasia of the hip in patients fifty years of age or older. METHODS: We evaluated forty-six consecutive hips in forty-two patients fifty years of age or older (the older group) who had developmental dysplasia of the hip and had undergone a curved periacetabular osteotomy between 1995 and 2006 with a minimum two-year follow-up period. The mean age was 54.6 years. We compared the clinical and radiographic results of this cohort with those of fifty hips in forty-four patients who were less than fifty years old (the younger group) and were managed with the same osteotomy. The mean age was 32.3 years. The patients were matched according to sex and Tönnis grade. Radiographic measurements included the center-edge angle, acetabular roof obliquity, acetabular head index, anterior center-edge angle, and head lateralization index. RESULTS: The mean Harris hip score improved from 69.6 points preoperatively to 90.9 points postoperatively in the older group and from 71.1 points preoperatively to 91.8 points postoperatively in the younger group. There were no significant differences in any of the radiographic measurements between the two groups preoperatively or postoperatively. The Tönnis grades improved in two hips and progressed in three hips in the older group and improved in three hips and progressed in three hips in the younger group. CONCLUSIONS: Satisfactory results can be obtained clinically and radiographically after curved periacetabular osteotomy in patients fifty years of age or older with Tönnis grade-1 or 2 osteoarthritis of the hip secondary to developmental dysplasia.

Periacetabular osteotomy in patients fifty years of age or older.

BACKGROUND: Periacetabular osteotomy has been established as an effective treatment for early or mild osteoarthritis caused by developmental dysplasia of the hip. However, the optimal method of surgical reconstruction for older patients remains controversial. The purpose of this retrospective study was to evaluate the clinical and radiographic results of a curved periacetabular osteotomy for the treatment of developmental dysplasia of the hip in patients fifty years of age or older. METHODS: We evaluated forty-six consecutive hips in forty-two patients fifty years of age or older (the older group) who had developmental dysplasia of the hip and had undergone a curved periacetabular osteotomy between 1995 and 2006 with a minimum two-year follow-up period. The mean age was 54.6 years. We compared the clinical and radiographic results of this cohort with those of fifty hips in forty-four patients who were less than fifty years old (the younger group) and were managed with the same osteotomy. The mean age was 32.3 years. The patients were matched according to sex and Tönnis grade. Radiographic measurements included the center-edge angle, acetabular roof obliquity, acetabular head index, anterior center-edge angle, and head lateralization index. RESULTS: The mean Harris hip score improved from 69.6 points preoperatively to 90.9 points postoperatively in the older group and from 71.1 points preoperatively to 91.8 points postoperatively in the younger group. There were no significant differences in any of the radiographic measurements between the two groups preoperatively or postoperatively. The Tönnis grades improved in two hips and progressed in three hips in the older group and improved in three hips and progressed in three hips in the younger group. CONCLUSIONS: Satisfactory results can be obtained clinically and radiographically after curved periacetabular osteotomy in patients fifty years of age or older with Tönnis grade-1 or 2 osteoarthritis of the hip secondary to developmental dysplasia.

Intraoperative muscle damage in total hip arthroplasty.

Tenderness in the medial and posterior thigh is sometimes observed during the early postoperative period after total hip arthroplasty (THA). In this study, the possible correlations of preoperative hip range of motion, surgical approach, and limb lengthening with postoperative muscle strain injury in THA were investigated. Sixty primary THA patients given the posterolateral approach or direct-lateral approach were examined. For comparison of the muscle strain injury in the 2 groups, we used magnetic resonance imaging. There were significant differences in postoperative thigh pain between cases in the posterolateral group with reduction of internal rotation and those with no reduction, and between cases in the direct-lateral group with reduction of external rotation and those with no reduction.

Modified pubic osteotomy for medialization of the femoral head in periacetabular osteotomy: a retrospective study of 144 hips.

BACKGROUND AND PURPOSE: Medial displacement of the femoral head reduces the force transmitted across the hip joint. Since 2005, we have performed a modified Ganz's osteotomy with curved periacetabular osteotomy (CPO) to obtain medialization of the femoral head. The modification involves cutting of the pubis at 30 degrees to the horizontal line. Here, we examined whether this modified CPO procedure medialized the femoral head more than the conventional CPO procedure. PATIENTS AND METHODS: 69 patients (mean age 37 years, 72 hips) treated with the modified CPO procedure (the M group) were compared with 68 patients (mean age 38 years, 72 hips) previously treated with conventional CPO (the C group). All patients were operated because of dysplastic hips. We used radiographic measurements from anteroposterior radiographs. The magnitude of the resultant hip force normalized with respect to the body weight (R/WB) and hip contact joint stress (Pmax/ WB) was calculated in all cases. RESULTS: The average lateral center-edge (CE) angle, acetabular roof obliquity (ARO), and acetabulum-head index (AHI) improved in both groups. The CE angle, ARO, and AHI were similar in the 2 groups before and after surgery. Medialization of the femoral head was larger in the M group than in the C group (p < 0.001). The average value of the resultant hip force decreased from 3.2 to 2.9 in the M group and remained unchanged, at 3.1, in the C group. In addition, the average value of the peak contact stress decreased more in the M group (from 9.4 kPa/N to 3.4 kPa/N) than in the C group (from 9.1 kPa/N to 4.3 kPa/N). INTERPRETATION: In dysplastic hips, the modified CPO reduces the contact hip stress more than the conventional CPO because of better medialization of the femoral head.