Two rotator cuff tear repair techniques for sovraspinatus tendon tear: transosseous sharc-ft vs single row repair.

BACKGROUND: Despite rotator cuff repair techniques have developed significantly in last decade, pushed by the progress in technology and materials, the treatment of rotator cuff tears and re-tears is still a big challenge for shoulder surgeons. The aim of this study is to perform clinical and radiological evaluation (ultrasound and MRI) of patients treated with transosseous sharc-ft, and single row techniques for sovraspinatus rotator cuff tear at 6, 12 and 24 months follow up. METHODS: Twenty-eight consecutive patients who underwent arthroscopic repair for rotator cuff tear were enrolled in the study and divided in two different groups: group A (14 patients) underwent a single row technique repair; group B (14 patients) underwent a transosseous sharc-ft technique repair. All participants had MRI or ultrasound examination confirmed fullthickness tears of sovraspinatus tendon before surgery. All the patients underwent clinical evaluation at 45 days, 3 months, 6 months, 12 and 24 months post-operatively with VAS, Dash, Constant and ASES score. Diagnostic ultrasound examination was performed at 6 months follow up while the MRI examination at 1 and 2 year follow up. RESULTS: The whole primary variables didn't show any significant difference and the groups were homogenous (age, Goutallier fatty infiltration, VAS, DASH, Constant, ASES). Some statistically significant differences are visible at discrete variables in a specific time: Dash at 12 months and Constant at 24 months show a significant improvement versus single-row technique. CONCLUSION: The arthroscopic transosseous repair technique with sharc-ft showed excellent results with little significant statically difference between this technique and the single row for this kind of lesion after 1 year of follow-up. Clinical data from this study confirmed, with the help of ultrasound examination and MRI, the excellent clinical outcome obtained by the patients. Further studies are needed to find differences between these techniques in the repair of large and massive rotator cuff lesions. (www.actabiomedica.it).

Imaging of the Unstable Shoulder.

BACKGROUND: Unstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations.Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence.The goal of imaging depends on clinical scenario and patient characteristics. METHOD: Careful selection and evaluation of the imaging procedures is therefore essential to identify, characterize and quantify the lesions. Proper imaging in unstable shoulder cases is critical to the choice of treatment to prevent recurrence, and to plan surgical intervention. RESULTS: In acute setting, radiographs have to roughly detect and characterize the bone defects present. At about 7 days, it is recommended to perform a MR to demonstrate lesions to labrum and/or ligaments and bone defects: in acute setting, the MRA is not necessary, because of effusion and hemarthrosis that behave as the contrast medium.In recurrence, it is fundamental not only to detect lesions but characterize them for planning the treatment. The first study to do is the MRI (with a magnetic field of at least 1.5 Tesla), and if possible MRA, above all in younger patients. Then, on the basis of the pathologic findings as bipolar lesion or severity of bone defects, CT can be performed. PICO method on 2D or 3D CT is helpful if you need to study a glenoid bone loss, with the "en face view" of glenoid, while a 3D CT reconstruction with the humeral head "en face view" is the gold standard to assess an Hill-Sachs lesion. CONCLUSION: The clinical diagnoses of anterior shoulder instability can be different and acknowledgement of imaging findings is essential to guide the treatment choice.Imaging features are quite different in chronic than in acute scenario. This requires appropriate indications of many different imaging techniques.

Morphological Study: Ultrastructural Aspects of Articular Cartilage and Subchondral Bone in Patients Affected by Post-Traumatic Shoulder Instability.

Post-traumatic shoulder instability is a frequent condition in active population, representing one of most disabling pathologies, due to altered balance involving joints. No data are so far available on early ultrastructural osteo-chondral damages, associated with the onset of invalidating pathologies, like osteoarthritis-OA. Biopsies of glenoid articular cartilage and sub-chondral bone were taken from 10 adult patients underwent arthroscopic stabilization. Observations were performed under Transmission Electron Microscopy-TEM in tangential, arcuate and radial layers of the articular cartilage and in the sub-chondral bone. In tangential and arcuate layers chondrocytes display normal and very well preserved ultrastructure, probably due to the synovial liquid supply; otherwise, throughout the radial layer (un-calcified and calcified) chondrocytes show various degrees of degeneration; occasionally, in the radial layer evidences of apoptosis/autophagy were also observed. Concerning sub-chondral bone, osteocytes next to the calcified cartilage also show signs of degeneration, while osteocytes farther from the osteo-chondral border display normal ultrastructure, probably due to the bone vascular supply. The ultrastructural features of the osteo-chondral complex are not age-dependent. This study represents the first complete ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of articular cartilage and sub-chondral bone. Preliminary observations here collected represent the morphological basis for further deepening of pathogenesis related to shoulder instability, enhancing the relationship between cell shape and microenvironment; in particular, they could be useful in understanding if the early surgical treatment in shoulder instability could avoid the onset of OA. Anat Rec, 300:1208-1218, 2017. © 2016 Wiley Periodicals, Inc.

Arthroscopic Rotator Cuff Tear Transosseous Repair System: The Sharc-FT Using the Taylor Stitcher.

Transosseous rotator cuff tear repair was first described in 1944. Over the years, it has represented the gold standard for such lesions. Through open and mini-open approaches, as well as the arthroscopic approach, the transosseous repair system represents one of the most reliable surgical techniques from a biological and mechanical perspective. Nevertheless, further improvements are required. This article describes an arthroscopic rotator cuff tear transosseous repair system, developed in collaboration with NCS Lab (Carpi, Italy): the Sharc-FT using the Taylor Stitcher. Our first experience in the clinical application of the arthroscopic technique using the transosseous suture system has shown encouraging clinical outcomes, confirming its efficacy. The patient satisfaction rate was high, and no patient expressed concern about the implant. The complication rate was very low. By improving the suture technique in the treatment of rotator cuff tears, a remarkable increase in the success rate in the treatment of this pathology could be reached; nevertheless, complications such as retears of the rotator cuff still occur.

Distal radius articular fractures: a comparison between ORIF with angular stability plate and percutaneous Kirschner wires.

PURPOSE OF THE STUDY: To analize and compare vantages and disadvantages in long-term of two different  techniques to treat distal radius articular fractures: ORIF with plate versus percutaneous pinning with K-wires. MATERIALS AND METHODS: We reviewed 77 distal radial articular fractures treated surgically from 2005 to 2009. Fractures were divided in two homogeneous groups according to patient age, gender, fracture-type and follow-up. The first group was treated with ORIF using angular stability volar plate, while the second one with closed reduction, K-wires percutaneous pinning and ante-brachial plaster casting. Functional outcomes were assessed with MAYO and DASH score, wrist range-of-movement and handgrip. Radiographic parameters were calculated in the post-operative and long-term x-rays. RESULTS: ORIF group showed better mean DASH and MAYO score, range of movement and handgrip strength compare to K-wires group. Expecially in type C fractures and in younger patients (<65 years). Minor differences were observed in type B fractures. About complications: two cases of surgically-treated medial nerve compression in ORIF group and one in K-wire group, one case of algodystrophy in K-wire group. Referring to radiographic parameters, long term values show data positive for ORIF. CONCLUSIONS: Though several studies about these techniques has been performed, but no scientific evidence proves the superiority of one surgical treatment. C-type need to be treated with plate in young patients or in elderly patients with high functional demand. Elderly patients with low functional demand can achieve satisfactory results also with percutaneous pinning, especially in Btype fractures.

Assessment of bone defects in anterior shoulder instability.

Glenohumeral bone defects are a common finding in shoulder instability and they are strongly correlated with recurrence of dislocation and failure following arthroscopic Bankart repair. Most authors agree that open surgery should be considered in the presence of certain conditions: glenoid bone loss > 25%, a lesion involving > 30% of the humeral head, an engaging Hill-Sachs lesion, bipolar bone lesions even without engagement. A careful imaging evaluation must therefore be performed in order to identify, quantify and characterize the bone defects. Even though magnetic resonance has important additional value in the assessment of the glenoid labrum and rotator cuff, computed tomography scan is the examination of choice for studying bone defects. Several methods have been proposed to quantify the extent of the glenoid bone defect; the most accurate ones utilize two-dimensional computed tomography images with multiplanar reconstructions (PICO method) or more sophisticated three-dimensional reconstruction software. Conversely, the literature lacks studies that accurately quantify humeral bone defects and, above all, that demonstrate definitively the clinical and prognostic significance of the lesion location and size.

Displaced mid-shaft clavicular fractures: surgical treatment with a pre-contoured angular stability plate.

The treatment for displaced mid-shaft clavicle fracture is highly controversial. In the last years, several biomechanical studies showed better functional results after surgical treatment. The purpose of this study is to evaluate the use of pre-contoured angular stability plate in this type of fracture. From June 2005 to July 2009, we have surgically treated 89 patients with displaced clavicle fracture. We have reevaluated 68 patients for a total of 70 interventions. Outcomes were assessed with Constant score, Dash questionnaire and X-rays. The mean follow-up period was 2 years. Excellent and good results were achieved for all the patients revaluated. The mean Constant score was 94.1 pt, and DASH score was 4.1. We had two cases of nonunion (2.9 %), while there was no case of infection and vascular or nervous lesions. A review of the international literature indicates that there is not a largely accepted gold standard for the treatment for displaced mid-shaft clavicle fractures. In the last 10 years, biomechanical and clinical studies have shown that nonoperative treatment for this type of fractures, with marked shortening or diastasis of the clavicle superior to 2 cm, may result in lower functional outcomes or higher percentage of nonunion. Nowadays, a lot of surgical options are available for the treatment for displaced mid-shaft clavicle fractures. Our experience with pre-contoured angular stability plates has shown excellent clinical outcome. On the basis of our study, we support the use of pre-contoured angular stability plate.