Relationship between the lateral acromion angle and rotator cuff disease.

One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78 degrees, with a range from 64 degrees to 99 degrees. Eight shoulders had angles less than or equal to 70 degrees, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p < 0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p < 0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I--flat, II--curved, and III--hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p = 0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease.

An analysis of 140 injuries to the superior glenoid labrum.

Between 1985 and 1993 140 injuries of the superior glenoid labrum were identified on arthroscopic evaluation and were recalled from a data bank of 2375 shoulder procedures performed during that time. The average patient age was 38 years, and 91% of the patients were men. The most common problem was pain, with 49% of all patients noting mechanical catching or grinding in their shoulders. No preoperative imaging modality consistently defined disease in the superior labral area. Fifty-five percent of all lesions were type II, 21% were type I, 10% were type IV, 9% were type III, and 5% were complex. Twenty-nine percent of lesions were associated with a partial-thickness tear of the rotator cuff, 11% with a full-thickness tear, and 22% with an anterior Bankart lesion. Twenty-eight percent of the superior labral lesions seen were isolated and did not have any associated rotator cuff or anterior labral disease. Type I lesions were debrided. Fifty-six percent of type II lesions were debrided in conjunction with an abrasion of the underlying glenoid rim. More recently suture anchors have been used to stabilize type II lesions. Treatment of type III and IV lesions depended on the extent of labral tissue disruption and involved either debridement or suture repair. Repeat arthroscopies were performed on 18 shoulders. Three of five type lesions treated with debridement and glenoid abrasion were healed. Four of five type II lesions treated with an absorbable anchor were healed. Three type III and one type IV lesion treated with debridement had normal superior labrums. Two type IV injuries treated with suture repair had completely healed. Two complex type II and III injuries treated with debridement and anchor fixation were healed.

Rate of degeneration of human acetabular cartilage after hemiarthroplasty.

Biopsy specimens of cartilage and subchondral bone were obtained from the weight-bearing dome of the acetabulum in twelve elderly patients who were having a revision of a hemiarthroplasty of the hip because of pain. Biopsy specimens of acetabular cartilage and subchondral bone were also obtained from eight patients of comparable age who were having a primary hemiarthroplasty for a displaced fracture of the femoral neck; these served as the control specimens. The specimens were stained with hematoxylin and eosin for the initial histological assessment of cartilage structure and cellularity as well as the integrity of the tidemark. Safranin-O and toluidine-blue stains were used to assess proteoglycan content. A histological grading scale was employed for comparative analysis of samples. The joint space of the hip was measured on the radiographs that were made before the revision and was correlated with the histological grade. Review of the histological specimens demonstrated considerable degeneration of acetabular cartilage in the patients who were having a revision of a hemiarthroplasty as compared with that in the age-matched control patients who were having a primary hemiarthroplasty. The progression in the severity of the degeneration correlated directly with the duration of articulation of the implant with the acetabulum. All six of the patients in whom the implant had been in situ for more than five years, and in whom the femoral stem was determined to be stable at the operation, had nearly complete loss of cartilage as seen on histological examination.(ABSTRACT TRUNCATED AT 250 WORDS)

The arthroscopic Mumford procedure: an analysis of results.

A total of 50 arthroscopic distal clavicle resections were performed for acromioclavicular joint pathology at our institution between 1990 and 1993. Follow-up on 50 shoulders (100%) was obtained at an average postoperative time of 2 years. Data were collected via physical examination, radiograph review, University of California at Los Angeles (UCLA) shoulder score, and questionnaire. Average patient age was 42 years. Preoperatively all patients showed acromioclavicular joint tenderness, whereas 80% had a positive adduction test. The diagnosis of acromioclavicular degeneration was made by a combination of physical examination and radiographs (100%), acromioclavicular joint injection (4%), bone scan (44%), and magnetic resonance imaging (30%). Intraoperatively, a Claviculizer (Smith-Nephew Dyonics, Andover, MA) burr was used through standard portals in a subacromial approach to the acromioclavicular joint. There were no intraoperative complications. Forty-one patients (82%) had their general anesthetic augmented with an intrascalene block, and all procedures were done on an outpatient basis. The average distal clavicle resection was 14.8 mm. Calcifications within the resected clavicle zone were noted in the shoulders of four of the patients (16%) who returned for radiographic follow-up. The UCLA shoulder score ranked 47 shoulders (94%) good to excellent and 3 fair (6%). Subjective patient satisfaction recorded 47 (94%) good to excellent results, with an average pain relief grade of 87%. Forty-five patients (98%) would recommend the procedure. The arthroscopic Mumford procedure effectively treats acromioclavicular joint pathology. The amount of bone removed can be precisely determined with the Claviculizer burr and reliably reproduced. The procedure has low associated morbidity and high patient satisfaction regarding functional outcome.

Tuberculosis of the foot: a case report.

A case of tuberculosis of the foot that was delayed in diagnosis is presented. Common pitfalls of diagnostic evaluation as well as pathogenesis and recent epidemiologic trends are discussed. It is hoped that such reports will serve to heighten awareness of the return of this mighty pathogen.

Long-term followup of the modified Bristow procedure.

A total of 86 modified Bristow procedures were performed for anterior shoulder instability between 1975 and 1987. Followup on 79 shoulders (92%) was obtained at an average postoperative time of 8.6 years. The redislocation rate was 4%. Average motion loss was 5 degrees of internal rotation and 9 degrees of external rotation. Fifteen percent of the patients examined expressed mild apprehension with the shoulder abducted and externally rotated. Radiographic bone union of the coracoid transplant was noted in 82% of patients. Additional surgical procedures were required in 14% of patients. Seventy-three percent of the reoperations were for screw removal because of persistent shoulder pain. The average subjective shoulder function was rated at 86% of preinjury level. All throwing athletes were able to return to throwing, although 54% of the patients with dominant shoulder involvement noted a decrease in throwing velocity. Ninety-seven percent of the patients rated their results as good or excellent.

The allman modification of the bristow procedure for recurrent anterior glenohumeral instability.

The Bristow procedure has undergone several modifications since Latarjet's original description in 1954. Throughout all the variations, the main principle remains in that the transferred bone block and muscle unit act as a mechanical buttress and sling to reinforce the weak anterior glenohumeral capsule. Several authors have reported satisfactory follow-up results with low rates of dislocation. However, multiple reports exist of complications involving hardware migration and damage to neurovascular structures. We review our previously reported follow-up on 79 shoulders after an Allman modification of the Bristow procedure at an average postoperative time of 8.6 years. The redislocation rate was 4% with average loss of external rotation of 9 degrees and internal rotation 5 degrees . Fourteen percent of shoulders required reoperation, the majority for screw removal. The likelihood of a quick return to full participation in athletics is good, except for the throwing athlete. The modified Bristow procedure provides excellent long-term stability with minimal loss of external rotation. Intraoperative radiographs are recommended to assure proper bone block placement. Patient satisfaction remains high regarding functional outcome.

Skateboard and in-line skate fractures: a report of one summer's experience.

During a 5 month period, 26 skateboarding and 10 in-line skating fractures were seen at our institution. The radius was the most commonly injured bone in both groups. Forty-two percent of skateboard fractures required reduction and another 16% required operative intervention. Epiphyseal fractures occurred in 42% of the skateboard riders who were skeletally immature. A greater proportion of high-energy fracture patterns was recorded in contrast to earlier reports. Also, a trend towards injuries occurring on the street, as opposed to home, has been noted. Skateboard riders continue to shun protective gear and hitting a surface irregularity is the most common cause of fall. In-line skaters, on average, wear more protective gear and are more likely to continue riding after their injury. Routine protective gear and avoidance of street riding should be encouraged. Instructions stressing balance and control as opposed to showmanship are recommended. Caution is given to first time in-line skaters, as this appears to be an injury-prone period.

Regional migratory osteoporosis. A case report and review of the literature.

Regional migratory osteoporosis (RMO) is an idiopathic disorder characterized by bouts of severe periarticular lower limb pain associated with rapidly developing localized osteoporosis. Symptoms often reverse spontaneously after six to nine months. Recurrence of symptoms in an adjacent joint is a distinguishing feature. Routine laboratory tests are uninformative. Diagnosis is made after exclusion of more common entities. Knowledge of RMO can prevent unnecessary invasive procedures. Vertebral osteoporosis has recently been associated with RMO. A 50-year-old physician developed the symptoms and signs of RMO superimposed upon well-documented idiopathic vertebral osteoporosis. This association should be recognized when evaluating lower limb pain.