Arthroscopic Repair of Medium to Large Rotator Cuff Tears With a Triple-Loaded Medially Based Single-Row Technique Augmented With Marrow Vents.

PURPOSE: The primary purpose of this study was to evaluate the repair integrity on magnetic resonance imaging (MRI), and secondarily, clinical outcomes, of medium to large (2-4 cm) rotator cuff tears treated using an arthroscopic triple-loaded medially based single-row repair technique augmented laterally with bone marrow vents. METHODS: This is a retrospective outcomes study of patients with full-thickness medium to large (2-4 cm) rotator cuff tears repaired by 4 surgeons at a single institution over a 2-year period with a minimum of 24 months' follow-up. A single-row repair with tension-minimizing medially based triple-loaded anchors and laterally placed bone marrow vents was used. Patients completed a satisfaction and pain survey, the Western Ontario Rotator Cuff index questionnaire, and a Short Form-36 version 2 survey to evaluate clinical outcomes. MRI was obtained at a minimum of 24 months follow-up to assess repair integrity. RESULTS: A total of 64 males and 27 females with a mean age of 59.7 (range, 34-82) were included. The mean tear size was 2.6 cm in anteroposterior dimension, treated with a mean of 2.2 anchors. Eighty-three of 91 shoulders (91%) reported being completely satisfied with their result. The median Western Ontario Rotator Cuff score was 95.2% of normal, with a significant difference found between those with an intact repair and those with a full-thickness recurrent defect (median, 95.9% vs. 73.8%; P = .003). Postoperative MRI obtained at a median of 32 months (range, 24-48) demonstrated an intact repair in 84 of 91 shoulders (92%), with failure defined as a full-thickness defect of the tendon. CONCLUSIONS: Arthroscopic repair of medium to large rotator cuff tears using triple-loaded medially based single-row repair augmented with marrow vents resulted in a 92% healing rate by MRI and excellent patient-reported outcomes LEVEL OF EVIDENCE: Level IV, retrospective case series.

Case-control comparison of "in-the-groove" and lateral-row arthroscopic biceps tenodesis with concomitant rotator cuff repair.

BACKGROUND: Lateral-row (LR) arthroscopic biceps tenodesis (BT) has been described as a technique using an LR rotator cuff repair (RCR) anchor for biceps fixation. This technique has not been compared with other BT techniques. The purpose of this study was to compare the clinical outcomes of patients undergoing a suprapectoral "in-the-groove" arthroscopic BT and patients treated with an LR tenodesis performed in conjunction with arthroscopic RCR. METHODS: Patients undergoing arthroscopic BT in the setting of an arthroscopic RCR were evaluated preoperatively and at a minimum of 12 months' follow-up. Patients who underwent an in-the-groove BT were matched 1:1 to patients who underwent an LR BT based on age at surgery and size of the rotator cuff tear using the Patte classification. Comparisons made included age, sex, body mass index, patient-reported outcome measures, range of motion, and patient satisfaction. RESULTS: There were 82 patients (41 in each group) who met the inclusion criteria, with an average follow-up period of 33 months and average age of 61 years. By use of the Patte classification, there were 20 matched pairs with stage 1 tears, 11 matched pairs with stage 2 tears, and 10 matched pairs with stage 3 tears. Comparisons of the 2 cohorts revealed no differences in preoperative or postoperative motion, patient-reported outcome measures, or patient satisfaction. Furthermore, no differences were found in overall improvements in motion or outcome measures, as well as overall satisfaction. CONCLUSIONS: Patients undergoing simultaneous RCR and BT demonstrate similar patient-reported and objective outcomes for both LR tenodesis and in-the-groove tenodesis techniques.

Anterolateral ligament injuries on magnetic resonance imaging and pivot-shift testing for rotational laxity.

Maintaining anterolateral rotational stability of the knee requires a complex set of structures, most notably the anterior cruciate ligament. However, lateral knee structures such as the anterolateral ligament (ALL) also play an important role. There has been controversy over the role the ALL plays in an ACL deficient knee to maintain rotational stability. In this study, we examined ACL deficient knees with and without intact ALLs, for rotatory laxity using a pivot shift examination. This was graded using International Knee Document Committee (IKDC) criteria. MRI was used to view the ALL and its status. We found no statistically significant difference in rotational stability of ACL deficient knees, with or without intact ALLs. We did however find a statistically significant association between injury to the ALL and other concomitant lateral structures such as the lateral collateral ligament, biceps femoris tendon, and iliotibial band. This supports that the ALL works in concert with the other lateral structures in the knee and the ACL, to provide rotational stability. This suggests that as an isolated structure, the ALL's contribution to clinical rotational stability is not significant, even in the presence of an ACL tear.

Influence of screw type and length on fixation of anterior glenoid bone grafts.

BACKGROUND: Bone-grafting procedures for recurrent shoulder instability produce low recurrence rates, although they are associated with complications such as graft non-union. Inadequate screw purchase is considered to play a causative role. However, excessive screw length can endanger neurovascular structures. The present study aimed to investigate how type and length of screws influences construct rigidity in a simplified glenoid model. METHODS: Testing was performed on composite polyurethane foam models with material properties and abstract dimensions of a deficient glenoid and an bone graft. Three screw types (cannulated 3.75 mm and 3.5 mm and solid 4.5 mm) secured the graft in a bicortical-bicortical, bicortical-unicortical and unicortical-unicortical configuration. Biomechanical testing consisted of applying axial loads when measuring graft displacement. RESULTS: At 200 N, graft displacement reached 0.74 mm, 0.27 mm and 0.24 mm for the unicortical-unicortical and 0.40 mm, 0.25 mm and 0.24 mm for the unicortical-bicortical configuration of the 3.75 mm, 3.5 mm and 4.5 mm screw types. The 3.75 mm screw incurred significant displacements in the unicortical configurations compared to the bicortical-bicortical method (p < 0.001). CONCLUSIONS: The present study demonstrates that common screw types resist physiological shear loads in a bicortical configuration. However, the 3.75 mm screws incurred significant displacements at 200 N in the unicortical configurations. These findings have implications regarding hardware selection for bone-grafting procedures.

Rare Dual Lesion: Extraskeletal Osteosarcoma Developing Within a Simple Lipoma.

Extraosseous osteosarcoma is a rare malignancy, but simple lipomas are common. This article is the first report of a case of radiation-induced extraosseous osteosarcoma that developed within a simple lipoma in a 72-year-old woman. We correlate the magnetic resonance imaging, computed tomography, positron emission tomography, and plain radiographic findings. The patient, treated with systemic therapy and wide surgical resection of the neoplasm, remained clinically free of disease during the first 22 months of follow-up.

The use of anabolic steroids as a strategy in reversing denervation atrophy after delayed nerve repair.

BACKGROUND: Denervation atrophy is one factor contributing to suboptimal motor recovery following major nerve repair. The hypertrophic effects of anabolic steroids may have a potential role in improving reinnervated muscle strength after delayed repair. METHODS: Forty-five immature female Sprague-Dawley rats underwent three surgeries and final testing. The tibial nerve was transected in the hind limb of the experimental (n = 13) and control (n = 14) animals and exposed, but not transected in the sham (n = 15) group animals. Three months later, once denervation atrophy was established, all transected nerves underwent repair using an autograft from the contralateral limb. After waiting an additional month to allow axonal regeneration to the gastrocnemius muscles, the rodents were implanted with a subcutaneous infusion pump. For the experimental group, nandrolone was administered over the next 30 days via this pump, while the control and sham group pumps were filled with carrier only. RESULTS: Final testing, 6 weeks later, showed improved muscle contraction strength in the steroid-treated animals (72% of sham group strength) compared to control animals (57% of sham group strength, p < 0.5). A trend towards increased weight and muscle belly diameter in the steroid-treated group was not statistically significant. CONCLUSIONS: These findings support the potential role of anabolic steroids in improving recovery of atrophic muscle after delayed reinnervation.