Long-term Follow-up of Extensive Peri-anchor (Poly-L/D-lactic Acid) Cyst Formation after Arthroscopic Rotator Cuff Repair: A Case Report.

Suture anchors are commonly used in shoulder surgeries, especially for rotator cuff tears. Peri-anchor cyst formation, however, is sometimes detected on follow-up radiologic image after surgery. The purpose of this report is to discuss the case of a patient who presented with regression of extensive peri-anchor cyst on postoperative 4-year follow-up magnetic resonance imaging and had good clinical outcome despite peri-anchor cyst formation after arthroscopic rotator cuff repair.

Arthroscopic In Situ Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon.

Large to massive rotator cuff tears are challenging to repair, although there are several options for dealing with them. Among them, superior capsular reconstruction was recently introduced as an effective procedure for retaining the static stability of the shoulder joint and preventing the progression to cuff tear arthropathy. The purpose of this technique-based article is to describe a surgical option, called arthroscopic in situ superior capsular reconstruction, for large to massive rotator cuff tears using the long head of the biceps tendon.

Pop-up messages in order communication systems can increase awareness of osteoporosis among physicians and improve osteoporosis treatment.

RATIONALE, AIMS AND OBJECTIVES: The purpose of this study was to verify the effect of pop-up messages (regarding a history of dual-energy X-ray absorptiometry [DXA]) on the identification and management of osteoporosis after osteoporotic hip or spine fractures. We hypothesized that these pop-up messages would increase the awareness and management of osteoporosis among clinicians and patients. METHODS: We introduced pop-up messages regarding a history of DXA in our Order Communication System (March 2012) and evaluated the records of 404 patients who were treated between January 2011 and December 2012. The patients were categorized as being treated without the pop-up messages (Group I, before March 2012) or with the pop-up messages (Group II, after March 2012). We compared their rates of DXA prescription, osteoporosis medication, exercise, mortality and subsequent refractures during a 2-year follow-up. RESULTS: After introducing the pop-up messages, the DXA prescription rate increased from 35.1 to 57.1% (P < 0.001), the osteoporosis medication rate increased from 21.1 to 25.2% (P = 0.05) and the exercise rate increased from 35.6 to 40.5% (P = 0.018). During the 2-year follow-up, the mortality rates were 4.64% in Group I and 6.67% in Group II (P = 0.4). Subsequent refractures were found in 12.9% of Group I patients and 9.52% of Group II patients (P = 0.87). CONCLUSION: The pop-up messages positively affected the behaviours of orthopaedic surgeons and were associated with increased rates of prescription of DXA, osteoporosis medication, and might affect the behaviour of patient, increased exercise rate. Therefore, we recommend using this simple and effective method to improve physicians' awareness of osteoporosis.

A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis.

BACKGROUND: Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment. QUESTIONS/PURPOSES: (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks? METHODS: We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution. RESULTS: There were no differences in the proportion of patients whose bursitis resolved by Week 4 among the three treatment groups (Group C: 25 of 30 [83%], relative risk of resolution failure: 0.68 [95% confidence interval {CI}, 0.27-1.72], p = 0.580; Group A: 17 of 26 [65%], relative risk of resolution failure: 2.19 [95% CI, 0.98-4.87], p = 0.083; Group AS: 23 of 27 [85%], relative risk of resolution failure: 0.59 [95% CI, 0.22-1.63], p = 0.398) (p = 0.073). Steroid injection after aspiration (Group AS) was associated with the earliest resolution (2.3 weeks [range, 1-4 weeks]) when compared with aspiration alone (Group A; 3.1 weeks [range, 2-4 weeks]) and compression bandaging with NSAIDs (Group C; 3.2 weeks [range, 2-4 weeks]), p = 0.015). Longer duration of symptoms before treatment was the only factor associated with treatment failure by 4 weeks (failed resolution: 6 weeks [range, 2-9 weeks]; successful resolution: 4 weeks [range, 0.4-6 weeks]; p = 0.008). CONCLUSIONS: With the numbers available, there were no differences in efficacy when compression bandaging with NSAIDs, aspiration, and aspiration with steroid injection were compared. However, we were powered only to detect a 30% difference, meaning that if there were a smaller difference in efficacy among the groups, we might not have detected it in a study of this size. Our data can be used as pilot data to power future prospective (and likely multicenter) trials. Because olecranon bursitis can recur, and because treatments like aspiration and aspiration with steroid injection can cause complications, unless future trials demonstrate clear efficacy advantages of aspiration and/or injection both at short and longer terms, we suggest that compression bandaging and a short course of NSAIDs may offer the most appropriate balance of safety and efficacy. LEVEL OF EVIDENCE: Level II, therapeutic study.