Acute Effects of Whole-Body Electrostimulation Combined with Stretching on Lower Back Pain.

Data from recent studies suggest that whole-body electromyostimulation (WB-EMS) is a time-effective and tailored intervention for chronic lower back pain (CLBP). The aim of this non-randomized controlled study was to compare the efficacy of a WB-EMS training and the association between WB-EMS specific training with passive stretching (Well Back System, [WBS]) on CLBP. Forty patients with CLBP, 43-81 years old, were assigned to one of the two groups: WB-EMS (n=20) and WB-EMS+WBS (n=20). Both groups completed 12 sessions (8 weeks) of the WB-EMS protocol (2×20 minutes/week). The second group performed core-specific exercises with WB-EMS plus 6 extra stretching sessions (30 minutes each). Primary study endpoints were based on changes on the visual analogue scale (VAS) and changes on the Oswestry Low Back Disability Questionnaire (ODI). Secondary study endpoints were percentage changes of maximum trunk flexion (Sit & Reach, [SR]) and changes in consumption of painkillers. Both interventions significantly improved VAS, ODI, and SR values (p range: 0.04;<0.001). However, the change of VAS (-46% vs. -17%, p<0.001), ODI (-53% vs. -17%, p<0.001), and SR (+ 7 vs.+3 cm, p=0.001) were significantly higher in the WB-EMS+WBS group compared to the WB-EMS group. The working method with WB-EMS+WBS can be a joint-friendly, individualized form to decrease CLBP.

An update on osteochondritis dissecans of the knee.

Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient's skeletal maturity, as well as the size and location of the lesion. Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion. Stable lesions with intact articular cartilage may be treated by drilling of the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. Every attempt should be made to retain the osteochondral fragment when possible. Instable lesions should be fixed or "replaced" with salvage procedures to prevent the onset of early osteoarthritis in this young population. Furthers studies are needed to improve the knowledge and optimizing non-operative and surgical treatment and to develop noninvasive diagnostic tools to predict with more accuracy the fragment's stability.

Human adipose-derived stromal cells transplantation prolongs reproductive lifespan on mouse models of mild and severe premature ovarian insufficiency.

BACKGROUND: Although recent studies have investigated the ability of Mesenchymal Stromal Cells (MSCs) to alleviate short-term ovarian damage in animal models of chemotherapy-induced Premature Ovarian Insufficiency (POI), no data are available on reproductive lifespan recovery, especially in a severe POI condition. For this reason, we investigated the potential of MSCs isolated from human adipose tissue (hASCs), since they are easy to harvest and abundant, in ameliorating the length and performance of reproductive life in both mild and severe chemotherapy-induced murine POI models. METHODS: Mild and severe POI models were established by intraperitoneally administering a light (12 mg/kg busulfan + 120 mg/kg cyclophosphamide) or heavy (30 mg/kg busulfan + 120 mg/kg cyclophosphamide) dose of chemotherapy, respectively, in CD1 mice. In both cases, a week later, 1 × 106 hASCs were transplanted systemically through the tail vein. After four additional weeks, some females were sacrificed to collect ovaries for morphological evaluation. H&E staining was performed to assess stroma alteration and to count follicle numbers; immunofluorescence staining for αSMA was used to analyse vascularization. Of the remaining females, some were mated after superovulation to collect 2-cell embryos in order to evaluate their pre-implantation developmental capacity in vitro, while others were naturally mated to monitor litters and reproductive lifespan length. F1 litters' weight, ovaries and reproductive lifespan were also analysed. RESULTS: hASC transplantation alleviated ovarian weight loss and size decrease and reduced alterations on ovarian stroma and vasculature, concurrently preventing the progressive follicle stockpile depletion caused by chemotherapy. These effects were associated with the preservation of the oocyte competence to develop into blastocyst in vitro and, more interestingly, with a significant decrease of chemotherapy-induced POI features, like shortness of reproductive lifespan, reduced number of litters and longer time to plug (the latter only presented in the severe POI model). CONCLUSION: Human ASC transplantation was able to significantly reduce all the alterations induced by the chemotherapeutic treatment, while improving oocyte quality and prolonging reproductive functions, thus counteracting infertility. These results, strengthened by the use of an outbred model, support the potential applications of hASCs in women with POI, nowadays mainly induced by anticancer therapies.

Micro-fragmented stromal-vascular fraction plus microfractures provides better clinical results than microfractures alone in symptomatic focal chondral lesions of the knee.

PURPOSE: To evaluate clinical outcomes over a 1-year period in patients affected by symptomatic focal chondral lesions of the knee treated with micro-fragmented stromal-vascular fraction plus microfractures compared to microfractures alone. METHODS: Two groups of 20 patients were arthroscopically treated with microfractures for a symptomatic focal chondral defect of the knee. At the end of surgery, in the experimental group, micro-fragmented stromal-vascular fraction was injected into the joint. Primary end point was WOMAC score at 12 months. Secondary end points were any adverse events, Oxford Knee Score, EQ-5D score, VAS for pain, analgesic and anti-inflammatory consumption. RESULTS: All the patients were evaluated at 12-month follow-up. No adverse reactions were noted. Analgesic and anti-inflammatory consumption was similar in both groups. At 1-month follow-up, no differences were noted between groups when compared to pre-operative scores. At 3-month follow-up, patients in both groups improved from the baseline in all variables. Significantly lower VAS scores were found in the experimental group (4.2 ± 3.2 vs. 5.9 ± 1.7, p = 0.04). At 6- and 12-month follow-ups, patients in the experimental group scored better in all outcomes with a moderate effect size; in particular, better WOMAC scores were obtained at 12 months, achieving the primary end-point of the study (17.7 ± 11.1 vs. 25.5 ± 12.7; p = 0.03). CONCLUSIONS: Injection of micro-fragmented stromal-vascular fraction is safe and, when associated with microfractures, is more effective in clinical terms than microfractures alone in patients affected by symptomatic focal chondral lesions of the knee. Results of the current study provide information that could help physicians to improve their counseling for patients concerning ADMSCs. LEVEL OF EVIDENCE: Level 1-therapeutic study.

Histological Study of Discoid Lateral Meniscus in Children and Adolescents: Morphogenetic Considerations.

Background Discoid lateral meniscus is the most frequent variant of the meniscus. Few studies have focused on the histology of discoid menisci. The aim of the present study was to report the histological findings of discoid lateral meniscus in children and adolescents, after arthroscopic partial resection, to give a possible explanation of its developmental etiology. Methods Five patients aged 9, 10, 13, 15, and 17 years were operated on for a 1-piece excision of a discoid lateral meniscus, and the specimens were histologically examined. Results The extracellular matrix showed a different distribution and characteristics depending on the different side of the meniscus. Irregularly oriented collagen fibers in discoid lateral meniscus were found. Cells of different shapes were observed depending on the surficial or deep location in the tissue. There were no blood vessels in the inner part of discoid lateral meniscus. Conclusion The findings of the current study seem to confirm that discoid lateral meniscus arises from variant morphogenesis. Furthermore, the altered distribution and shape of the cells and disorganization of collagen fibers (irrespectively of the age of the patients) may predispose discoid lateral meniscus to degeneration, damage, and tear in young patients also. Level of Evidence Level of evidence 4 (case series).

Irreducible Posterolateral Fracture Dislocation of the Knee in an Elderly Patient Treated with Rotating Hinge Total Knee Replacement.

Knee dislocation is one of the few real orthopaedic emergencies. It is a serious but relative uncommon injury, representing less than 0.02% of all orthopaedic injuries. Especially posterolateral knee dislocation is much rarer condition that is often missed or misdiagnosed. The main feature of this very rare condition is to be irreducible by closed reduction due to the interposition of soft tissues inside the enlarged medial joint space, such as the medial capsule and retinaculum, vastusmedialis, and medial meniscus. The pathognomonic sign of a posterolateral knee dislocation is the anteromedial distal thigh transverse "pucker" or "dimple sign." We report the case of an 87-year-old man who sustained an irreducible posterolateral fracture dislocation of the knee after being hit by car which has been treated with rotating hinge knee replacement with 1-year of follow-up.

Discoid lateral meniscus in children and adolescents: a histological study.

BACKGROUND: Discoid lateral meniscus is the most frequent variant of the meniscus. Although the histology of normal menisci in children and in adults has been well described, few studies have focused on the histology of discoid menisci. Furthermore, most of the patients in those studies were adults. The aim of the present study was to report the histological findings of discoid lateral meniscus in a group of children and adolescents, aged between 9 and 18, after arthroscopic partial resection, focusing on cellularity, arrangement of collagen fibers, and vascularity of the excised fragments. Furthermore, to report on MRI findings compared to the histological findings in the same region. METHODS: Six patients (one female and five males) aged 9, 10, 13, 15, 17, and 18, were arthroscopically operated on partial meniscectomy (saucerization) of a discoid lateral meniscus, and the specimens were histologically examined. RESULTS: The extracellular matrix showed a different distribution and characteristics depending on the different side of the meniscus. Irregularly oriented collagen fibers in discoid lateral meniscus were found. There were no blood vessels in the inner part of discoid lateral meniscus in all patients but the 18-year old (in which we observed also endothelials cells, edematous tissue and leaking of erythrocytes in the extracellular matrix). In the discoid lateral menisci analyzed, irregularly oriented collagen fibers with blood vessels were found only in the presence of degenerating tissue. CONCLUSIONS: Discoid lateral meniscus is different from a normal meniscus in terms of vascularity and disorganization of collagen fibers.

Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature.

INTRODUCTION: Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). EFFICACY: Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. SAFETY: Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections. CONCLUSIONS: Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis.

Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities.

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28-67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

Transient Common Peroneal and Tibial Nerve Palsy Following Knee Arthroscopy for the Treatment of Discoid Lateral Meniscus.

The number of knee arthroscopies has increased rapidly since the 1980s and are among the most common orthopedic procedures today. It is generally considered a minimally invasive surgery with relatively low morbidity, but it is not without risk of complications. We report the case of a 14-year-old boy who developed a lesion of common peroneal nerve and tibial nerve after knee arthroscopy for a torn discoid lateral meniscus, which was confirmed by electromyogram study.

Do ethnicity and gender influence posterior tibial slope?

BACKGROUND: Ethnicity and gender can affect posterior tibial slope; however, studies on this topic have limitations and are in disagreement. The aim of the present study was to evaluate posterior tibial slope in a large group of consecutive patients, determining whether ethnicity and gender can influence its value. Secondly, to determine intra- and inter-rater reliability of the two radiographic methods adopted. MATERIALS AND METHODS: Posterior tibial slope was calculated (rater 1) in lateral view X-rays of the knee according to the posterior tibial cortex (PTC) and tibial proximal anatomical axis (TPAA) methods. Data were matched with ethnicity and gender. For determination of intra- and inter-rater reliability, 50 random X-rays were selected, and blindly measured by two other raters (2 and 3). RESULTS: A total of 581 radiographs were included (413 white and 168 black knees). Comparing white and black subjects, a statistically significant difference was found for both PTC (4.9 ± 1.2 vs 7.1 ± 2.9, p < 0.0001), and for TPAA (7.7 ± 1.1 vs 10.2 ± 3.0, p < 0.0001). In white subjects, an influence of gender was found only for TPAA (6.4 ± 1.1 in males vs 7.6 ± 1.1 in females, p < 0.0001). In black subjects, an influence of gender was found only for PTC (7.4 ± 3.0 in males vs 6.2 ± 2.9 in females, p = 0.01). Intra-rater reliability was good for both methods for rater 1, and very good for rater 2. Inter-rater reliability among the 3 raters was very good for both methods. CONCLUSIONS: Differences in posterior tibial slope between different ethnic groups exist. Differences observed between genders are conflicting and might be too small to have implications in clinical practice. The TPAA method is recommended for the evaluation of posterior tibial slope because of higher intra- and inter-rater reliability. Level of evidence 3 Case-control study.

Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review.

BACKGROUND: Sonoelastography (SE) is a new ultrasound-based method adopted in an increased number of scientific reports to analyse normal and pathological tendons. The aim of this study is to provide a systematic overview of clinical applications of SE in normal and pathological tendons. METHODS: A systematic research of PubMed, Ovid, and Cochrane Library electronic databases was performed according to PRISMA guideline. Two Authors searched and evaluated the articles independently; a third Author was involved to solve any disagreement. The Oxford Level of Evidence (LoE) was used to assess each article. RESULTS: There is an increasing interest in the application of SE in the evaluation of healthy and diseased tendons. Many different tendons are amenable for SE evaluation, such as the Achilles and patellar tendons, rotator cuff, common extensor tendons, quadriceps tendon, and the plantar fascia. CONCLUSION: SE appears to be a very useful diagnostic tool, in particular in tendon pathology. This is a dynamic examination, provides an immediate evaluation of the tissue elasticity, and may be useful in recognizing tendon abnormalities and in implementing the information available with conventional US. LEVEL OF EVIDENCE: IV.

Radial Head and Neck Allograft for Comminute Irreparable Fracture-Dislocations of the Elbow.

Fracture-dislocations of the elbow can be difficult to treat, with unsatisfactory results in some cases. In general, it is preferable to preserve the fractured radial head when possible, but some patients present a unique treatment challenge because of extremely comminuted fractures and bone loss. In these cases, the only options available are radial head prosthesis or allograft. The authors present a case of a 45-year-old man with a fracture-dislocation of the left elbow that was treated with an allograft of the radial head and neck because of extreme comminution of the fracture. There have been a few reports about osteochondral allograft transplantation of the radial head, and they all included traumatic or posttraumatic cases treated with a frozen allograft. To the best of the authors' knowledge, this is the first report on the use of osteochondral allograft in the acute setting for the treatment of a comminuted fracture of the radius involving the whole head and neck. The clinical results were satisfactory at the final follow-up, although mild degenerative changes were present, the screws were coming loose, and the radial head had a slight valgus deformity. Radial head allograft can be an option in selected cases of acute fractures with severe comminution and bone loss that are not amenable to a stable internal fixation; for the young and active patient, who is not the best candidate for radial head resection; or in cases in which radial head arthroplasty is not feasible because of severe bone loss. [Orthopedics. 2016; 39(6):e1205-e1208.].

HYADD 4 versus methylprednisolone acetate in symptomatic knee osteoarthritis: a single-centre single blind prospective randomised controlled clinical study with 1-year follow-up.

OBJECTIVES: The aim of the present study was to compare the clinical results and the quality of life in patients with symptomatic knee osteoarthritis randomised to either a new HA (HYADD 4) or corticosteroid (CS). A separate rationale was to evaluate the safety profile of HYADD 4. METHODS: All the patients presenting for unilateral symptomatic primary knee osteoarthritis were prospectively randomly assigned to receive 2 injections of either HYADD 4 or CS, and were evaluated before the injections and at 6, 12, 26 and 52 weeks. Primary end point was WOMAC score at 26 weeks; secondary end points were WOMAC score, VAS for pain, and SF-36 score at any time point. RESULTS: There were 53 females and 22 males in the HYADD 4 group (mean age 71.5±10.6 years), and 50 females and 25 males in the CS group (mean age 68.6±9.9 years). The observed sided effects were mild and their incidence was similar in the two groups. Patients in the HYADD 4 group reported significantly better WOMAC scores at 26 weeks. The patients improved in all considered outcomes after the injections, with a peak of therapeutic effect between 6 and 12 weeks. Patients in the HYADD 4 group obtained significantly better scores than the CS group up to 26 weeks. At the 1-year follow-up no statistically significant differences between treatments were detected. CONCLUSIONS: HYADD 4 did not have significantly higher side effects when compared to CS injections and provided better short-term (but not long-term) control of symptoms in patients with mild to moderate knee osteoarthritis. Patients with less pain and dysfunction at baseline may be the best candidates for HYADD 4 injections.

Surgical repair of isolated triceps tendon rupture using a suture anchor technique: a case report.

Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors.

Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques.

BACKGROUND: a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. METHODS: two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). RESULTS: the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. CONCLUSIONS: the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. LEVEL OF EVIDENCE III TREATMENT STUDY: Case-control study.

Ischemic necrosis of the femoral head: an experimental rabbit model.

To describe the morphology of the proximal femoral epiphysis in a rabbit model from the ischemic insult to the end of the revascularization process. Ischemia of the femoral head was induced in 32 rabbits at the 8th day of life, by sectioning the joint capsule and the ligamentum teres and dislocating the femoral head. Rabbits were sacrificed at 4, 8, 12, 18, 21, 26, 34, and 48 days after surgery and femoral heads were observed histologically. During the first days following the ischemic injury, large areas underwent necrotic changes. Both epiphyseal and physeal cartilage were thicker than normal and less trabecular bone formation was evident. Bone marrow was also diffusely necrotic within the secondary center of ossification. After day 12th, reparative process started with formation of extensive areas of fibrocartilage and several secondary centers of ossifications. At that stage femoral head deformity was already evident. In the following days the secondary centers of ossification cohalesced and epiphyseal and physeal cartilage resumed a normal appearance, but the femur showed a permanent deformity. In newborn rabbits, the ischemic injury to the femoral head blocked the ossification of the epiphyseal and physeal cartilage associated to necrotic bone marrow within the secondary center of ossification of the femoral head as well as to extensive areas of necrosis of epiphyseal and physeal cartilage. Extensive areas of fibrocartilage and small newly formed ossification centers within the femoral epiphysis were the results of the revascularization process, and femoral head deformity became stable afterward.

Tendon quality in small unilateral supraspinatus tendon tears. Real-time sonoelastography correlates with clinical findings.

PURPOSE: To investigate the feasibility of real-time sonoelastography in the assessment of the mechanical tendon properties in small unilateral supraspinatus tears, to describe the sonoelastographic properties of the torn supraspinatus tendons and to correlate real-time sonoelastography findings with clinical results and demographic data. METHODS: All the patients presenting for a unilateral rotator cuff tear were prospectively scrutinized. Clinical evaluation included complete physical examination, VAS, Quick DASH, Constant-Murley score, Simple Shoulder Test, ASES score and UCLA score. Radiological evaluation was performed with conventional ultrasounds and real-time sonoelastography; this is a noninvasive method that uses ultrasounds to evaluate the mechanical properties of tissues, reflecting their quality, that can be semi-quantitatively estimated using the strain index. During the enrolment period, 92 patients were scrutinized, and 50 were included in the study. RESULTS: A negative correlation between strain index and VAS for pain, a strong positive correlation between strain index and Constant-Murley score and ASES score were found. Comparable results were observed in male and female patients, but in males, we found a strong positive correlation also for Simple Shoulder Test and UCLA score. CONCLUSIONS: Real-time sonoelastography was a feasible method applicable in the assessment of tendon quality in small supraspinatus tears, and its findings correlated with the clinical results of the patients. In day-by-day clinical practice, this information is very important because quality of tendons is one of the most important prognostic factors for surgeons performing rotator cuff repair. LEVEL OF EVIDENCE: III.

Re-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy: a case report.

BACKGROUND: Discoid lateral meniscus is common in children. Arthroscopic partial resection is indicated in symptomatic cases generally achieving satisfactory results. CASE PRESENTATION: We present a case of an incomplete discoid lateral meniscus of the right knee in an 11 year-old boy, treated with arthroscopic partial resection, which developed a re-growth of the remnant, restoring the pre-operative incomplete discoid shape. To the best of our knowledge this is the first report about re-growth of a discoid meniscus after surgery. Debate still exists regarding the etiology of a discoid meniscus. Some authors proposed it is the persistence of the normal stage during fetal development. However, most other authors believe it is anomalous and arises through variant morphogenesis. The re-growth of the discoid lateral meniscus following surgery in this patient seems to prove this latter theory. The residual growth of the knee involves also the lateral meniscus and that may have contributed to restoring the meniscus to the previous condition. CONCLUSION: This case report demonstrates discoid meniscal re-growth in a child. The growth spurt may have an impact on meniscal regeneration. Re-growth of the discoid lateral meniscus in our patient favors the hypothesis of variant morphogenesis.

Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results.

BACKGROUND: Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. METHODS: The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. RESULTS: The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. CONCLUSIONS: To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case-control study.