Classification and clinical significance of acromial spur in rotator cuff tear: heel-type spur and rotator cuff tear.

UNLABELLED: Acromial spurs reportedly relate to the impingement syndrome and rotator cuff tears. We classified the morphologic characteristics of the acromion (shape and thickness) and acromial spurs and determined whether they correlated with rotator cuff tears. We measured acromial shape and thickness using simple radiography and MR arthrography or CT arthrography in 106 patients with full-thickness rotator cuff tears and in 102 patients without tears. Acromial spurs could be classified morphologically into six types: heel, lateral/anterior traction, lateral/anterior bird beak, and medial. We found acromial spurs in 142 of the 208 patients (68%), and their incidence increased with age. The acromial spur was more common in the cuff tear group. The heel type was most common and detected in 59 patients (56%) in the cuff tear group and in 36 patients (35%) in the control group. The flat acromion was more common (60%) than curved and hooked acromion; however, there was no major difference between acromial shape and cuff tear. The mean acromial thickness was 8.0 mm, and the cuff tear group had thicker acromion. These data suggest acromial spurs can be classified according to the distinct morphology, and the most common heel-type spur might be a risk factor for full-thickness rotator cuff tears. LEVEL OF EVIDENCE: Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Clinical and radiologic outcomes of arthroscopic glenoid labrum repair with the BioKnotless suture anchor.

BACKGROUND: Although arthroscopic glenoid labrum repair using the BioKnotless anchor is common, the benefits and efficacy have not been fully evaluated. HYPOTHESIS: BioKnotless suture anchor is a clinically and radiologically suitable material for arthroscopic labral repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Ninety-seven patients underwent arthroscopic glenoid labrum repair with BioKnotless anchor between July 2004 and December 2005. Thirty-seven patients had traumatic anterior instability and 60 patients had an isolated superior labrum, anterior-posterior (SLAP) lesion. The mean age at surgery was 36.0 years (range, 15-66); the average follow-up was 34.1 months (range, 24-54). Clinical outcomes were evaluated using range of motion and various functional evaluation scores including sports activity. Pain and patient satisfaction were measured using a visual analog scale (VAS). Computed tomography arthrography was conducted in 73 patients at least 1 year after surgery for radiologic evaluation. RESULTS: In patients with instability, the Western Ontario Shoulder Instability index and Rowe score improved from 53.2 to 85.9 and from 68.7 to 92.7, respectively. Return to normal recreation and sports were possible in 30 patients (81.1%); the mean satisfaction VAS was 9.2. There was 1 postoperative dislocation, and the apprehension test was positive in 1 case. Postoperative range of motion including external rotation was not different. In patients with a SLAP lesion, the American Shoulder and Elbow Surgeons score and Constant score improved from 67.3 to 96.0 and 79.1 to 96.8, respectively. Pain VAS decreased from 6.0 to 0.4, and the mean satisfaction VAS was 9.4. Return to normal recreation and sports were possible in 50 patients (83.3%). All labra were found to have firmly healed to bony glenoid rim without anchor-related osteolysis in postoperative CT arthrography. CONCLUSION: Clinically and radiologically, the BioKnotless anchor appears to be an acceptable alternative for arthroscopic labrum repair, and a suitable material allowing the avoidance of certain troublesome drawbacks of the conventional knot-tying suture anchor.

Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation.

PURPOSE: The purpose of this study was to determine whether moderate preoperative shoulder stiffness affects the clinical outcome of rotator cuff repair, and to evaluate the serial change in range of motion (ROM), functional scores, pain, and satisfaction after rotator cuff repair. METHODS: Rotator cuff repair was performed in 125 consecutive patients (127 shoulders). Thirty patients had concomitant moderate shoulder stiffness at the time of the repair. There were no statistical differences in sex ratio, age, the size and retraction of the tear, or the associated pathologies and repair procedure between the stiffness and nonstiffness groups. Arthroscopic capsular release and manipulation were added to the stiffness group, and the same rehabilitation protocol was applied according to the size of the tear. Clinical outcomes were evaluated using ROM, American Shoulder and Elbow Surgeon (ASES) score, Constant score, Simple Shoulder Test (SST), and short form 36. Pain and postoperative patient satisfaction were measured by a visual analog scale. All clinical parameters were prospectively recorded on the day before surgery, and at 3, 6, and 9 months postoperatively, and at their last follow-up visit. RESULTS: Differences of ROM did not reach statistical significance after 6 months of operation. Other functional outcome instruments showed no statistical difference at any follow-up period. Postoperative cuff integrity after 1 year showed no statistical difference between 2 groups. CONCLUSIONS: This study suggests that moderate preoperative shoulder stiffness does not affect clinical outcomes of rotator cuff repair if arthroscopic capsular release with manipulation is added to the index procedure. Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions.

BACKGROUND: There are numerous accessory portals for the arthroscopic repair of superior labral anterior and posterior lesions. Many surgeons are reluctant to make a portal through the cuff because of concern about iatrogenic injury to the cuff. HYPOTHESIS: An arthroscopic superior labral anterior and posterior lesion repair procedure using the trans-rotator cuff portal may yield favorable clinical and radiological outcomes, and cuffs may heal properly. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-eight consecutive patients undergoing superior labral anterior and posterior lesion repair using the trans-rotator cuff portal, who had available both functional and radiological outcomes after 1 year of the operation, were enrolled. We evaluated the structural outcomes for the labrum and cuff using computed tomographic arthrography and measured various clinical outcomes (the supraspinatus power, visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons shoulder evaluation form, University of California-Los Angeles shoulder score, Constant score, and Simple Shoulder Test) at the final visit. RESULTS: All functional outcomes were improved significantly (P < .001). On computed tomographic arthrography, labral healing to the bony glenoid was achieved in all patients. Subacromial leakage of contrast media was observed in 3 patients (5.2%) through the muscular portion without any retraction or gap of the tendon. Two of 3 had preoperative cuff pathologic changes, and they were older than 45 years of age. Partial articular cuff tears were observed in 6 patients (10.3%), and 4 had the lesion preoperatively. There were no statistical differences in functional scores according to the presence of preoperative lesion, postoperative leakage, or partial cuff tear. CONCLUSION: The data demonstrate favorable outcomes for arthroscopic superior labral anterior and posterior lesion repair using the trans-rotator cuff portal. We suggest that the trans-rotator cuff portal is an efficient and safe portal for superior labral anterior and posterior lesion repair, although there are some valid concerns of damaging the cuff in patients with a superior labral anterior and posterior lesion with concurrent cuff disorders, as well as in older patients.