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.

Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents.

PURPOSE: This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair. METHODS: This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist. RESULTS: Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p < 0.00056. CONCLUSIONS: Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. LEVEL OF EVIDENCE: IV.

Long-term outcome for arthroscopic repair of partial articular-sided supraspinatus tendon avulsion.

PURPOSE: To assess the long-term clinical outcome of arthroscopic transtendon repair of partial articular-sided supraspinatus tendon avulsion (PASTA) lesions using University of California, Los Angeles (UCLA) and Short Form 36 (SF-36) scores. METHODS: We prospectively collected and retrospectively reviewed data on 15 patients who underwent arthroscopic transtendon PASTA repair between 1997 to 2001. The mean patient age was 50.4 years (range, 31 to 68 years). Mean follow-up was 13.5 years (range, 12 to 15 years). To determine clinical outcome, UCLA and SF-36 scores were obtained preoperatively, at 1 to 3 years postoperatively, and again at final postoperative evaluation. RESULTS: Of the 15 patients enrolled in this study, 13 underwent concomitant procedures, including 10 subacromial decompressions, 2 open and one arthroscopic biceps tenodesis, 2 SLAP repairs, and one Bankart repair. There were no complications. A revision rotator cuff repair was performed 8 years after the index procedure in one patient (7%), indicating a 93% long-term success rate for arthroscopic PASTA repair. A significant difference (P < .0001) was noted between preoperative and postoperative UCLA scores. Pain and shoulder function improved in all patients. SF-36 scores showed improvement in physical health, physical functioning, and bodily pain (P = .003, P = .005, and P = .005, respectively). All 15 patients were satisfied with the surgery. CONCLUSIONS: Long-term follow-up shows that arthroscopic transtendon PASTA repair provides reliable and sustained pain relief and improvement in shoulder function. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic posterior stabilization and anterior capsular plication for recurrent posterior glenohumeral instability.

PURPOSE: The purpose of this study was to evaluate the outcomes and identify predictors of success for arthroscopic posterior Bankart reconstruction with modern suture anchor repair and anterior capsulolabral plication in a well-defined patient population-recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. METHODS: Patients with recurrent, traumatic, involuntary, unidirectional posterior shoulder instability who underwent arthroscopic repair with a minimum of 2 years' follow-up were identified and evaluated retrospectively with outcome measures in the form of objective and subjective scores. Statistical analysis was performed to identify predictors of success with significance set at .05. RESULTS: Twenty-nine consecutive patients with a mean age of 26.3 years underwent posterior reconstruction and anterior balancing capsulolabral plication as needed with a mean follow-up of 5.5 years. Outcome scores averaged as follows: American Shoulder and Elbow Surgeons, 90.7; University of California, Los Angeles, 32.6; Simple Shoulder Test, 11.7; and Western Ontario Shoulder Instability, 82.9% of normal. Recurrent instability occurred in 3.4% of patients, 84.6% returned to sports, and 96.6% of patients believed surgery was successful and worthwhile. Patients who were younger (<30 years) or patients with more extensive pathology who required additional surgical procedures or received supplemental anterior plication sutures had less reliable or worse outcomes (P < or = .041). CONCLUSIONS: In a traumatic patient population with involuntary, unidirectional posterior shoulder instability, modern suture anchor repair of posterior labral lesions is effective and provides reliable outcomes. Younger patients and patients with worse pathology who required additional procedures had less reliable outcomes. Patients with supplemental anterior plication had more postoperative pain, and this adjunctive procedure may not be necessary for traumatic posterior labral tear surgery. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopy classics. SLAP lesions of the shoulder.

A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid- glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.

Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment.

PURPOSE: The purpose of this study was to investigate the results of arthroscopic treatment in 14 patients with suprascapular nerve palsy secondary to spinoglenoid ganglion cysts. METHODS: Fourteen patients underwent arthroscopic decompression of ganglion cysts associated with suprascapular neuropathy. The most common presenting symptoms were pain and weakness, which lasted an average of 7.5 months. Ten of 14 patients were noted on examination to have atrophy, and all 14 patients had weakness of the infraspinatus. Magnetic resonance imaging (MRI) showed spinoglenoid ganglion cysts in all 14 patients; average cyst size was 3 cm. MRI revealed labral pathology in 12 of 14 cases; labral pathology was identified intraoperatively in all 14 patients. RESULTS: Postoperatively, the average Simple Shoulder Test (SST) score was 11.5 (12 maximum), which was improved from an estimated preoperative score of 4.3. Improvement in external rotation strength was seen in 100% of patients who were examined postoperatively. No patients were taking pain medicine at latest follow-up. No complications were reported, and there were no clinical or symptomatic recurrences at an average follow-up of 51 months. CONCLUSIONS: Arthroscopic treatment of patients with spinoglenoid ganglion cysts is safe and effective, resulting in good clinical outcomes. In our study of 14 patients, no recurrences were seen at an average of 51 months of follow-up. Level of Evidence: Level IV, therapeutic case series. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up.

BACKGROUND: Although recurrent patellar dislocations are not uncommon, their pathophysiology and treatment are controversial. HYPOTHESIS: Stabilization of recurrent patellar dislocations can be successfully managed with a mini-open approach. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-two patients (23 knees) underwent a mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocations with an average follow-up of 4.4 years (range, 1.4-14 years). The average age at the first dislocation was 15 years (range, 5-26 years), and the average age at surgery was 23 years (range, 12-65 years). RESULTS: There was 1 postoperative dislocation (4%) and 1 recurrent subluxation (4%). The average Kujala knee score was 88.2 +/- 13.5, with overall good scores in each category. The lowest scores involved squatting (5.7), abnormal painful kneecap movements (subluxations) (7.1), and jumping (7.9). Overall, there was a statistically significant improvement in the Tegner score from 3.7 +/- 1.8 before surgery to 6.9 +/- 2.0 after surgery (P < .001). Six knees (26%) were rated subjectively as excellent, 15 (65%) as good, 2 (9%) as fair, and 0 (0%) as poor. All 22 patients (100%) stated that the procedure was worthwhile. Radiographically, there was a statistically significant improvement in the congruence angle (normal, -8.0 degrees +/- 6.0 degrees) from 15.7 degrees +/- 12.6 degrees (range, 0.0 degrees to +44.0 degrees) before surgery to -11.5 degrees +/- 8.7 degrees (range, -20.0 degrees to +10.0 degrees) after surgery (P < .001) and in the lateral patellofemoral angle (normal, >0 degrees) from -0.2 degrees +/- 6.4 degrees (range, -10 degrees to +8 degrees) before surgery to 7.9 degrees +/- 2.6 degrees (range, 0.0 degrees to +11.0 degrees) after surgery (P < .001). CONCLUSION: Our mini-open technique provides anatomical restoration with limited morbidity and cosmetically appealing results. Furthermore, our redislocation rates compare favorably with traditional, more extensile open approaches.

Ganglion cysts of the shoulder: technique of arthroscopic decompression and fixation of associated type II superior labral anterior to posterior lesions.

Ganglion cysts of the shoulder and concomitant suprascapular nerve compression should be considered in the differential diagnosis of shoulder pain. They are associated commonly with labral tears, most commonly SLAP lesions. MRI has become commonplace in evaluating shoulder pain and has led to the increased awareness of shoulder cysts. MRI accurately demonstrates the size and location of ganglions, which is critical when planning surgical intervention. It also has shown the frequent association of intra-articular pathology with these cysts. Despite that MRI can detect atrophy, the diagnosis of suprascapular nerve compression can be confirmed only by EMG/NCS, because the presence of a cyst does not necessarily mean the nerve is compressed. Likewise, a positive EMG does not confirm that the compression is caused by a ganglion cyst. EMG/NCVs are necessary for confirming the diagnosis and evaluating nerve and muscle function. A trial of nonoperative management is warranted; however, this is associated with a high failure rate. Aspiration techniques are successful for decompression of the cysts and initial pain relief; however, the intra-articular pathology is not addressed and there is a higher rate of recurrence. Open resection of the ganglion cyst is successful; however, the intra-articular labral tears are not addressed, which can lead to recurrence and the morbidity of the cyst excision is not warranted. Shoulder arthroscopy has led to the identification of associated intra-articular pathology such as SLAP lesions. These were not appreciated previously with open surgery and therefore were not addressed. Arthroscopic techniques have evolved to allow decompression of the ganglion cysts and repair of the labral lesions. This should decrease the possibility of recurrence of the cyst by eliminating the cyst and the pathologic lesion that created it. Arthroscopic excision also avoids much of the morbidity of the open approach and allows intra-articular pathology to be addressed concomitantly. This point has been emphasized by other investigators also. Furthermore, because of the limited surgical dissection, rehabilitation is able to begin earlier, with less patient discomfort and more prompt return to normal activities.