Ultrasound-Guided Versus Blind Subacromial Corticosteroid Injections for Subacromial Impingement Syndrome: A Randomized, Double-Blind Clinical Trial.

BACKGROUND: Subacromial corticosteroid injections are frequently performed for impingement syndrome of the shoulder. To improve the accuracy of injections, ultrasound can be used. PURPOSE: To assess the clinical outcome of ultrasound-guided subacromial injections compared with blind subacromial injections for subacromial impingement syndrome. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: A total of 56 shoulders with subacromial impingement syndrome were randomized into 2 groups: 28 shoulders received a subacromial corticosteroid injection with ultrasound guidance (ultrasound group), and 28 shoulders received a subacromial corticosteroid injection without ultrasound guidance (blind group). The visual analog scale (VAS) for pain with overhead activities and the American Shoulder and Elbow Surgeons (ASES) score were obtained before the injection and at 6 weeks after the injection. RESULTS: The VAS score for pain with overhead activities decreased from 59 ± 5 mm (mean ± SEM) before the injection to 33 ± 6 mm at 6 weeks after the injection in the ultrasound group (P < .001) and from 63 ± 4 mm to 39 ± 6 mm, respectively, in the blind group (P < .001). The decrease in the VAS score was not significantly different between the groups (P > .999). The ASES score increased from 57 ± 2 before the injection to 68 ± 3 at 6 weeks after the injection in the ultrasound group (P < .01) and from 54 ± 3 before the injection to 65 ± 4 after the injection in the blind group (P < .01), with no significant difference between the groups (P = .7). Four shoulders (14%) in the ultrasound group and 6 shoulders (21%) in the blind group eventually needed surgery (P = .7). CONCLUSION: No significant differences were found in the clinical outcome when comparing ultrasound-guided subacromial injections to blind subacromial injections for subacromial impingement syndrome. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12615000562572.

A comparison of outcomes after arthroscopic repair of partial versus small or medium-sized full-thickness rotator cuff tears.

BACKGROUND: Little is known about the outcomes after repair of partial-thickness rotator cuff tears. The aim of this study was to assess the outcome after repair of partial-thickness rotator cuff tears compared with full-thickness tears. Our hypothesis was that repair of partial-thickness tears leads to more shoulder stiffness but fewer retears compared with repair of full-thickness tears. METHODS: A group of 105 consecutive patients who had a full-thickness tear measuring <3 cm2 was compared with a group of sixty-four patients who had a partial-thickness tear. All tears were repaired with use of a knotless single-row arthroscopic repair. The American Shoulder and Elbow Surgeons (ASES) score and standardized patient and examiner-determined outcomes were obtained preoperatively and at six, twelve, and twenty-four weeks and at two years after surgery. Rotator cuff integrity was determined by ultrasound examination at six months and two years after surgery. RESULTS: Examiner-determined postoperative stiffness at six weeks was common in both groups (50% of those with a partial-thickness tear and 47% of those with a full-thickness tear) but was decreased compared with preoperative findings in both groups to 21% and 19%, respectively, at three months and to 15% and 14% at six months. The ultrasound-determined retear rate was small (5% in the partial-thickness group and 10% in the full-thickness group) at six months, but increased to 10% and 20%, respectively, at twenty-four months. The ASES score, patient-determined overall shoulder function, and all pain scores were superior to preoperative scores at six months (p < 0.001) and at twenty-four months (p < 0.001) in both groups. CONCLUSIONS: Arthroscopic repair of partial-thickness and small and medium-sized full-thickness rotator cuff tears was associated with excellent medium-term clinical outcomes with low retear rates. The data did not support our hypothesis: the differences in retear rate and postoperative shoulder stiffness rate found between the two groups did not reach significance.

Repair of partial-thickness rotator cuff tears: a biomechanical analysis of footprint contact pressure and strength in an ovine model.

PURPOSE: The purpose of this study was to determine whether transtendon repair by use of a novel small-diameter knotless anchor showed enhanced mechanical properties compared with tear completion and repair. METHODS: Articular-sided partial-thickness tears were created ex vivo in the infraspinatus of 24 ovine shoulders. The specimens were randomized into 4 groups of 6 each: (1) no repair, (2) transtendon repair, (3) completion of tear with tension-band single-row repair, and (4) completion of tear with double-row repair. Footprint contact pressure and ultimate load to failure were measured in each specimen. RESULTS: Technical failure of the transtendon anchors occurred in 3 of 15 shoulders. Transtendon repair (mean +/- SEM, 0.8 +/- 0.1 MPa) and double-row repair (1 +/- 0.09 MPa) showed 3-fold (P < .001) greater footprint contact pressures than tension-band single-row repair (0.3 +/- 0.03 MPa) and no repair (0.3 +/- 0.02 MPa). The ultimate load to failure for transtendon repair (544 +/- 22 N) was more than 3 times greater than that for the double-row repair (157 +/- 23 N) (P < .001) and the single-row repair (116 +/- 11 N) (P < .001). CONCLUSIONS: Transtendon repair of partial-thickness tears by use of specifically designed anchors biomechanically outperformed tear completion and repair in an ovine model. Transtendon repair showed the best combination of high footprint contact pressure and high ultimate failure load. However, the high insertion failure rate of these transtendon anchors is of concern. CLINICAL RELEVANCE: On the basis of the biomechanical data, transtendon repair of partial-thickness rotator cuff tears may be used as an alternative to tear completion and repair, but the specific transtendon anchors used in this study need further evaluation before their clinical use can be recommended.

Midterm results of cementless total hip replacement in rapidly destructive arthropathy and a review of the literature.

BACKGROUND AND PURPOSE: Rapidly destructive arthropathy (RDA) of the hip is a disease of unknown etiology characterized by a rapid destruction of the acetabular and femoral aspects of the hip joint. The purpose of this study was to assess the outcome of cementless total hip replacement in this category of patients. METHODS: A prospective study was performed of all cases of rapidly destructive arthropathy treated by cementless total hip replacement between 1998 and 2005. There were 6 female patients (8 hips) meeting the criteria of RDA. Median age at surgery was 74 years (range 64-83). Using the Paprosky classification of acetabular defects, five hips had a type 2B acetabular defect and three a type 3A acetabular defect. In all cases a cementless prosthesis was used. In two cases a shelf plasty of the acetabulum was added. Radiographic and clinical follow-up was performed up to 9 years postoperatively (mean follow-up 69 months, range 24-104 months). RESULTS: At radiographic follow-up, no signs of prosthetic loosening or migration were seen. Harris Hip Score improved from 25.8 (SD 7.3, range 11-34) preoperatively to 88.3 (SD 9.7, range 71-98) at latest follow-up. CONCLUSION: Cementless total hip replacement in patients with rapidly destructive arthropathy led to a good result in a series of eight cases at midterm follow-up.