Diagnostic Ultrasound Shows Reversal of Supraspinatus Muscle Atrophy Following Arthroscopic Rotator Cuff Repair.

PURPOSE: Prospective study to assess ultrasonography (US) utility as an imaging tool for supraspinatus muscle atrophy diagnosis, establishing if there is any relationship between repairing supraspinatus tears and its eventual muscular recovery. METHODS: Observational study. SELECTION CRITERIA: adults with a full-thickness reparable supraspinatus tear confirmed arthroscopically. Clinical and imaging data pre- and postoperatively with 12 months of follow-up were recorded, including demographic data, Constant scale, Patte classification, repair type, and supraspinatus muscle belly US images in both shoulders, recording height, diameter, echogenicity (mean number of pixels between 0-black and 255-white), and central tendon pennate angle (PA). RESULTS: In total, 110 supraspinatus tears underwent arthroscopic repair (2015-2018). Mean age was 61 ± 8 years (46-77). We detected a correlation between atrophy and age in terms of echogenicity and PA (P = .01). Echogenicity improved from 54.5 to 51.0 (P = .365) and slightly deteriorated on the contralateral side from 51.6 to 52.9 (P = .351). Supraspinatus echogenicity compared to trapezius muscle reduced from 0.43 to 0.36 (P < .001). PA augmented from 5.8 to 8.6 (P < .001). Mean PA on the contralateral side was 8.6 preoperatively. Patte II cases showed the most significant improvement in terms of imaging evaluation of atrophy. Although Patte III cases almost did not improve in terms of atrophy, they improved clinically. We observed improvement after surgery in Constant score from 35 to 85 (P < .001). Minimal clinically important differences for Constant and visual analog scale were 44.45 ± 12.87 and 6.54 ± 1.41, respectively. Recurrence of symptoms was 13%, related to worse results of PA and echogenicity compared to nonrecurrences. CONCLUSIONS: Supraspinatus atrophic muscle changes after repair can be reversed. It can be quantified using US imaging (histogram, histogram ratio and echogenicity reduction, pennate pattern, and PA augmentation). Patte II cases showed the best results after repair, demonstrated by US. The faster the repair, the better the results without being influenced by repair type. The bigger the tear and retraction, the more echogenicity and less PA, with worse clinical and US results. LEVEL OF EVIDENCE: Level III, prospective therapeutic study.

Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space.

Subacromial impingement syndrome is a common cause of shoulder pain in young adults and seniors at present. The etiology of this syndrome is associated with several shoulder disorders, most related to aging, overhead activities, and overuse. The subacromial space is well circumscribed and limited in size, and soft-tissue growing lesions, such as tumors, can endanger the normal function of the shoulder girdle. We present a case of shoulder impingement syndrome caused by an intramuscular lipoma of the supraspinatus muscle in the subacromial space in a 50-year-old male bank manager. Radiographs, magnetic resonance imaging, and a computed tomography scan showed a well-circumscribed soft-tissue tumor at the supraspinatus-musculotendinous junction. It was arthroscopically inspected and dissected and complete marginal excision was performed through a conventional augmented anterolateral portal, avoiding the need to open the trapezius fascia or perform an acromial osteotomy. Microscopic study showed a benign lipoma, and the shoulder function of the patient was fully recovered after a rehabilitation period of 4 months. This less invasive technique shows similar results to conventional open surgery.

[Arthroscopic repair of partial subcapularis tendon lesions. Simplified approach]. / Reparación artroscópica del tendón subescapular del hombro. Abordaje simplificado.

We present a technical variation for arthroscopic subscapularis tendon repair. Sutures of isolated partial subscapularis tendon avulsions can be passed and fixed securely through an isolated anterolateral portal just over the rotator interval (mono-tunnel technique). Primarily a shoulder free of fixation devices is needed. Patient on a beach chair position or lateral decubitus without traction is advised. The best view can be obtained from a posterior portal with the shoulder on 75 degrees forward elevation and 90 degrees medial rotation. In a shoulder 30 degrees adducted at a good view can be also obtained from the antero-lateral portal. This working portal alone allows joint and tendon inspection, introduction of round burrs and devices needed for working on bone bed receptor. A titanium anchor of 5 mm with doubled non-absorbable suture is used, it can be passed through tendon with the Artropierce and an all-inside arthroscopic knot tying is done by just one tunnel thus minimizing the potential of injury of the coracohumeral ligament complex. This technique allows the surgeon to perform subscapularis tendon repair easily with reproducible good results in 7 cases of isolated partial tendon avulsions in this serie. We also recommend it in combination with other rotator cuff repairing techniques.

Fractura de estrés bilateral de tibia en un jugador de baloncesto / Bilateral tibial stress fractures in a basketball player

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