Mini-deltoid splitting rotator cuff repair: do results deteriorate with time?

To determine whether the results of arthroscopically assisted rotator cuff repair deteriorate with time, 60 shoulders were evaluated on 2 separate occasions. There were 7 small, 16 medium, 20 large, and 17 massive tears. Patients were evaluated with a detailed questionnaire that included the UCLA shoulder scale and physical examination. Average initial follow-up was at 21 months (range, 12 to 68 months), and the second follow-up was at an average of 62 months (range, 24 to 103 months); only 4 patients had a change of more than 3 points on the UCLA scoring scale. No statistically significant difference was found in pain, function, range of motion, strength score, satisfactory results (80% on both occasions), and UCLA score (30.8 v 31.4) at second follow-up. The results of our study indicate that there is no significant deterioration over time of results of rotator cuff repair using the mini-deltoid splitting technique.

Arthroscopic treatment of pigmented villonodular synovitis of the knee.

Pigmented villonodular synovitis (PVNS) is a rare disease, with multiple forms, anatomic sites, and treatment methods having been described. During a 10-year period, 14 patients, 7 male and 7 female, average age 35 years (range, 19 to 64 years) were treated for PVNS with arthroscopic partial or total synovectomy. Average follow-up was 42 months (range, 8 to 83 months). Twelve patients had diffuse and 2 had a localized form. Results were assessed subjectively, clinically, and radiographically, and were rated as excellent, good, fair, or poor. There were no complications and 10 patients (72%) were rated as excellent or good, 2 patients (14%) as fair, and 2 patients (14%) as poor. The recurrence rate was 14% and occurred in the group with diffuse PVNS. Radiographs did not show any bone erosion. The most widely accepted treatment for PVNS is synovectomy, and both open and arthroscopic synovectomy have been advocated as treatment. Advantages of arthroscopic treatment include accurate evaluation of the knee joint, treatment of other pathology, more rapid rehabilitation, decreased risk of joint stiffness, and less pain. In our experience, it appears that arthroscopic synovectomy is an effective method of treatment of this disorder.

Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow.

A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the range of motion. Toward extension, the mean peak strain in the anterior band was tight for the normal and bone anchor groups, but lax in the bone tunnel group. Toward extension, the mean peak strain in the posterior band was lax in all elbows. Toward flexion, the strain in the anterior band was lax in the normal and bone anchor groups, but tight in the bone tunnel group. The mean of the peak strains for the posterior band toward flexion was tight for all elbows. Mean valgus load strength of normal elbows was 22.7 +/- 9.0 N.m. The bone tunnel and bone anchor mean strengths were 76.3% and 63.5%, respectively, of normal elbow strength. We concluded that the bone anchor reproduced the normal anatomy and mechanical function of the ulnar collateral ligament more closely than the bone tunnel, and that both reconstruction methods were significantly weaker than the normal ulnar collateral ligament. However, we found no significant difference in reconstruction strength between bone anchor and bone tunnel.

Revision anterior cruciate ligament surgery: experience from Miami.

Failed anterior cruciate ligament reconstruction as defined by recurrent patholaxity is increasingly commonplace. This report presents the findings of 54 patients who had unsuccessful intraarticular anterior cruciate ligament reconstruction to correct persistent instability and who subsequently underwent revision anterior cruciate ligament surgery. Before revision, patients were evaluated by clinical examination, KT-1000 arthrometer, radiographs, Lysholm knee score, Tegner activity scale, and subjective questionnaire. The results were compared at a mean of 32 months following revision surgery. There was an average of 16 months from index procedure to the time of revision. Autogenous patellar tendon grafts were used in 61% of the cases with 30% of these harvested from the contralateral knee. Fresh frozen patellar tendon was used in 35% and autogenous hamstring tendons in 4%. Revision was successful in objectively improving stability in all patients with an average KT-000 of 2.8 mm. Autogenous tissue grafts provided greater objective stability when compared with allograft tissue with average KT-1000 of 2.2 and 3.3, respectively. Functionally, however, there was no significant difference in outcome between the 2 groups. Harvesting of the contralateral patellar tendon was found to have no adverse long term effect. Subjectively, the results were significantly worse depending on the degree of articular cartilage degeneration. Only 54% of patients returned to their preanterior cruciate ligament injury activity level. Competence in various anterior cruciate ligament reconstruction techniques will facilitate revision surgery especially in avoiding preexisting tunnels and hardware. Correct graft placement and addressing the secondary restraints are critical to successful revision surgery.

Plasma fluorescein decay determination during fluorophotometry.

Two useful methods for determination of the decay curve of non-protein bound fluorescein (NPBF) in plasma up to 1 hour after intravenous fluorescein injection are described and evaluated. The course of NPBF is approximated in method 1 by a sum of two exponential decay functions and in method 2 by a power of time function. The parameters in these functions are calculated with the use of concentration values measured in two blood samples taken at about 5 min. and 60 min. after injection. Calculations in method 1 include the amount of fluorescein injected. The accuracy of each method was evaluated in 7 volunteers by measuring NPBF concentration in 15-28 blood samples taken after fluorescein injection at intervals of 5 min. or less. The mean relative deviation between calculated and measured concentration values amounted to 9.2% +/- 4.3 SD and 12.7% +/- 4.5 SD for method 1 and 2, respectively. The time integral of NPBF concentration in plasma up to one hour after injection was calculated according to the results of both methods and compared with integral values obtained by linear interpolation between concentration values measured in the 15-28 plasma samples. The mean relative deviation for the 7 volunteers amounted at 15 min. to 2.8% and 17% and at 60 min. to 11% and 18% for method 1 and 2, respectively. The maximal difference between the blood-retinal barrier permeability value for NPBF calculated with and without taking glucuronation into account was estimated to be 20% for an average glucuronation percentage of 70% or less.