Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors.

PURPOSE: The aim of the study was to evaluate the histopathological changes that occur in the tendon and subacromial bursal tissue in patients with rotator cuff tear trying to correlate these changes to their healing capability. METHODS: Eighty-four patients were clinically evaluated with the Constant Scale. Radiographs and MRI were performed preoperatively and ultrasound were performed postoperatively. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed, and the specimens were histopathologically analyzed. RESULTS: Tendons histopathological features consisted of loss of structural organization, poor or absent neoangiogenesis, chondral metaplasia, and fibrosis. Bursal features consisted of neoangiogenesis, absence of chondral metaplasia, hyperplasia/hypertrophy, and absence of necrosis. Direct correlation was seen between tendon and bursal hyperplasia and time of the onset of symptoms; between tendon chondral metaplasia, fibrosis, bursal neoangiogenesis, inflammation, and patient age; between tendon neoangiogenesis, hyperplasia, necrosis, fibrosis, bursal necrosis, inflammation, and lesion size; on the contrary, tendon fibrosis, necrosis, and bursal tissue inflammation decrease as time passes from the onset of symptoms. Tendon fibers disarray, neoangiogenesis, and inflammation decreases as the patient's age increases. Bursal tissue fibrosis decreases as lesion size increases. CONCLUSIONS: Simple histopathological techniques should be employed routinely to assess the tissue quality, with the aim to predict future clinical evolution (repair or non-repair). Comparing the histopathological data with the demographical information and the descriptive statistics, it is possible to define the RCT repair at risk and identify which RCT will be able to heal.

[CT-guided percutaneous treatment of osteoid osteoma]. / Trattamento percutaneo dell'osteoma osteoide sotto guida con Tomografia Computerizzata.

CT was used to localize and guide the percutaneous ablation of osteoid osteomas in 11 patients whose age ranged 5 to 63 years. The treatment was performed directly in the CT room ensuring maximum asepsis. General anesthesia was used in children and in vertebral and sacroiliac localizations, while the peripheral block was used in peripheral localizations. In the latter cases, an ischemic band was used to reduce bleeding. A dedicated drill resection system guided by a Kirschner guide wire was used for removal. The treatment was curative in the short period in all the patients, with complete symptom remission. Only one patient required retreatment after 6 months. In our series of patients no major complications, e.g., bleeding or infections, were observed. In 8 cases the resection yielded enough material for histology. To conclude, this technique can be considered a valuable alternative to surgery in the treatment of osteoid osteomas.