Evaluating the role of graft integrity on outcomes: clinical and imaging results following superior capsular reconstruction.

BACKGROUND: Superior capsular reconstruction (SCR) addresses massive, irreparable rotator cuff tears in young patients. The purpose of this study was to retrospectively evaluate clinical outcomes and graft integrity in patients following SCR. METHODS: Thirty-four consecutive patients undergoing SCR by 2 surgeons with minimum 2-year follow-up were identified. Functional outcomes were obtained, including Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and Single Assessment Numeric Evaluation (SANE) scores. Graft integrity was evaluated on magnetic resonance images (MRIs). RESULTS: Thirty-five shoulders in 34 patients were identified. Four patients underwent subsequent surgery. The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7. The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2. There was statistically significant improvement in SST, ASES, and VAS following SCR. MRI revealed graft failure in 62% (n = 13 of 21) of shoulders. Radiographic evidence of graft healing did not have any effect on SST, ASES, SANE, or VAS scores. CONCLUSION: Given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, débridement, and biceps management.

A new technique for establishing and maintaining an anteromedial knee portal.

Precise placement of the anteromedial portal is critical to the safety and efficacy of knee arthroscopy. Our described technique establishes and maintains a properly placed portal with minimal capsular violation using a needle arthrotomy and the outer shaver barrel as a cannula. This technique has the dual benefit of optimizing instrument access to the knee without large portal arthrotomies and reducing postoperative pain and swelling by minimizing fluid extravasation.

Comparative flexion after rotating-platform vs fixed-bearing total knee arthroplasty.

A retrospective review of rotating-platform (n = 113) and fixed-bearing (n = 100) total knee arthroplasties at a minimum 2-year follow-up was performed. All patients in both groups in this study had osteoarthritis and underwent surgery by 1 of the 2 senior authors at 1 of 2 institutions. A cruciate-retaining total knee arthroplasty was implanted with patellar resurfacing in all cases. The only difference between the 2 groups was the design of the tibial bearing and its tibial tray. Through minimization of confounding variables relating to pathology, surgeon, institution, soft-tissue balancing, and type of prosthesis, this study isolates articular design as a variable. We could not demonstrate any significant difference in knee flexion after either fixed-bearing or rotating-platform cruciate-retaining total knee arthroplasty.