Superior capsular reconstruction for irreparable rotator cuff tears: Autografts versus allografts.

AIMS: Superior capsular reconstruction (SCR) is a treatment option for patients with massive irreparable rotator cuff tears. Different types of grafts from various donor sites have been described. There are no clinical studies comparing the different grafts available. The aim of this study is to compare the early clinical outcomes of patients who have undergone arthroscopic SCR with different types of grafts (allograft vs. autograft). MATERIAL AND METHODS: This study is a retrospective analysis of data collected prospectively, from patients who underwent arthroscopic SCR with either a long head of biceps autograft (LHB) (n=40) or an acellular dermal allograft (n=40), between March 2015 and April 2018. The pre- and postoperative clinical data were compared between the 2 groups, as well as the incidence and type of complications. RESULTS: All patients were monitored with a minimum follow-up of one year. Three patients (7.5%) in the autograft group, and 14 (35%) in the allograft group (p=0.005) had a complication, of which 2 (5%) and 5 (12.5%) respectively, required revision surgery (p=0.432). Linear regression ruled out any significant difference between the 2 groups, with respect to clinical scores. However, patients with a history of prior rotator cuff surgery had poorer results with regard to active elevation (ß, -29.3; p=0.020), internal rotation (ß, -3.4; p=0.003) and Subjective Shoulder Value (SSV) (ß, -17.2; p=0.023). Older patients, as well as men, are associated with poorer postoperative internal rotation (ß, -0.1; p=0.003 and ß, -1.9; p=0.039 respectively), and type D lesions are associated with poorer external rotation and postoperative SSV (ß, -11.3; p=0.012 and ß, -12.4; p=0.048 respectively), compared to type C lesions. Postoperative graft integrity was improved in the autograft group compared to the allograft group. (Grade 1: 65.8% vs. 2.9%; Grade 5: 5.3% vs. 28.6%; p<0.001). CONCLUSIONS: In both groups, clinical scores improved after SCR in patients with irreparable rotator cuff tears. Fewer complications and revisions were observed with the autograft compared to the allograft. If the LHB was still in place during surgery, its use appears valid, given the reasonable cost and low rate of complications associated with it. If absent, an allograft is also an option, considering the potential clinical improvement. LEVEL OF EVIDENCE: III; Case-control study.

Arthroscopic Double-Layer Lasso Loop Technique to Repair Delaminated Rotator Cuff Tears.

PURPOSE: To evaluate the arthroscopic double-layer lasso loop repair technique for delaminated posterosuperior rotator cuff tears. METHODS: Forty-one patients underwent arthroscopic rotator cuff repair of a delaminated posterosuperior rotator cuff tear by the double-layer lasso loop technique. Their preoperative and postoperative clinical and functional scores were compared to evaluate surgical outcomes. The prerequisite for inclusion was a minimum follow-up period of 2 years. We excluded patients with a history of shoulder surgery before the double-layer lasso loop repair. RESULTS: Statistically significant improvements (P < .001) were found in the Constant score (54 vs 83) and University of California, Los Angeles functional score (6.4 vs 9.5). Pain and strength improved according to the Jobe test, bear-hug test, belly-press test, Gerber lift-off test, and external rotation test (P < .001). No significant difference in strength was noted between the operated and nonoperated sides. There was only 1 complete rerupture (3.1%), whereas 5 patients (15.6%) had partial ruptures. CONCLUSIONS: The arthroscopic double-layer lasso loop repair technique for delaminated posterosuperior rotator cuff tears is an effective procedure. Our series showed a low rerupture rate. At a mean follow-up of 44 months, postoperative recovery with resultant functional, pain, and patient satisfaction scores was good to excellent and was comparable with the nonoperated side. LEVEL OF EVIDENCE: Level IV, case series.

Angiosarcoma around a knee arthroplasty. Report of a case and literature review.

The development of periprosthetic malignancy in proximity to an arthroplasty has been a matter of debate since it was first reported in 1978. We report a case of tibial angiosarcoma, an extremely rare malignancy, which developed in proximity to a primary knee arthroplasty performed ten years before. To our knowledge this is the second case ever described around a knee arthroplasty. While implantation of orthopaedic material can induce the development of malignant tumours in experimental animals, the overall incidence of malignancy recorded following arthroplasty in clinical studies does not appear to be increased compared to the control population. Each case of periprosthetic malignancy following arthroplasty must receive attention in order to better understand the underlying pathology and to measure the possibility for an increased risk of development of specific cancer types.

The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability.

Anterior instability is a difficult clinical problem that is treated by a variety of open and arthroscopic methods with good results. Bankart repair remains a popular option. However, in those situations involving irreparable ligamentous damage or bony deficiency, this technique may be insufficient to stabilize the shoulder. One of the principal methods of open treatment for this problem is the Latarjet procedure, as described in his article in 1954. It has proven to be a durable and reliable method of treatment for anteroinferior instability of the glenohumeral joint. Several authors have reported on the long-term outcomes of this procedure with satisfactory results. There has been no previous description of the Latarjet procedure being performed arthroscopically. We present the first report of a new surgical technique, the arthroscopic Latarjet procedure. This procedure is fully arthroscopic and combines the advantages of the open procedure with those of arthroscopic stabilization. This is a significant step forward in the development of arthroscopic shoulder reconstruction and enables shoulder surgeons to treat all cases of instability arthroscopically.