A radiographic study of proximal radius anatomy with implications in radial head replacement.

Anteroposterior (AP) and lateral radiographs of 20 healthy volunteers' forearms were taken in three views (full supination, neutral rotation, and full pronation). Radial head maximum diameter and angular measurements between the axis of forearm rotation (AFR) and the radial neck axis (RNA) were made with digital calipers. Repeated-measures analysis of variance revealed a statistically significant difference between the three AP groups, with supination having the smallest values (P <.0001), but not for the lateral groups (P =.128). Comparison of the AFR-RNA angle between the AP supinated position and the three lateral views revealed a statistically significant difference among all of the pairs, with the AP supinated position having the smallest values. The RNA most closely approximated the AFR with the forearm in the supinated position. For best approximating the native AFR during radial head replacement, the cut should be made perpendicular to the neck axis with the elbow extended and the forearm in the supinated position.

All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison.

PURPOSE: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. TYPE OF STUDY: Retrospective outcome study. METHODS: Sixty-four shoulders (58 patients) were identified; 35 in the all-arthroscopic group and 29 in the mini-open group. Average follow-up for all patients was 44.6 months, with a minimum of 24 months. The all-arthroscopic group included 3 small tears (< 1 cm), 24 medium-size tears (1 to 3 cm), and 9 large tears (3 to 5 cm). The mini-open group included 2 small tears, 9 medium tears, and 18 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. None underwent formal acromioclavicular joint resection. Four of the all-arthroscopic and 11 of the mini-open patients underwent coplaning of the acromioclavicular joint. Anchors were the primary method of arthroscopic fixation, with an average of 1.5 anchors per case. RESULTS: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 91.7 and for the mini-open group was 90.0. No patients in the arthroscopic group developed fibrous ankylosis, whereas 4 patients in the mini-open group developed the condition (14%). No anchor-related complications were noted. Shoulders in the all-arthroscopic group showed greater motion at 6 and 12 weeks postoperatively and slightly better motion at final review. However, final motion difference was not statistically significant. Overall, 4 patients (6.3%) demonstrated some tenderness in the acromioclavicular joint on palpation, but none had clinical symptoms requiring treatment. CONCLUSIONS: All-arthroscopic cuff repair provides comparable outcomes and complication rates to arthroscopic decompression with mini-open repair. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. A trend for better early motion was also noted in the all-arthroscopic group. Analysis of variance shows no measurable outcome difference between tear sizes.