Osteonecrosis of the Shoulders in Pediatric Patients Treated for Leukemia or Lymphoma: Single-Institutional Experience.

BACKGROUND: Osteonecrosis of the hips and knees is an often debilitating adverse event in children treated with glucocorticoids for leukemia and lymphoma but the impact of shoulder involvement has been understudied. Thus, we investigated the severity and functional impairment of shoulder osteonecrosis in a well-characterized population of pediatric patients treated for acute lymphoblastic leukemia or lymphoma. METHODS: We retrospectively reviewed orthopaedic clinic and physical therapy evaluations to determine range of motion (ROM), pain, and impact of magnetic resonance-defined osteonecrosis (ON) on activities of daily living. Adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.03. RESULTS: We identified 35 patients (22 female), median age at cancer diagnosis 14.2 (range, 4.3 to 19) years; median age at ON diagnosis 16.7 (range, 5.5 to 28) years. Median time to last follow-up from diagnosis of primary malignancy was 6.4 (range, 0 to 12.7) years and from diagnosis of ON was 4.0 (range, 0 to 8.9) years. Twenty-two patients had magnetic resonance evidence of ON; 43 shoulders involved at least 30% of the articular surface of the capital humeral epiphyses.Common Terminology Criteria for Adverse Events mean scores for initial assessments of 55 shoulders (29 patients) showed moderate negative impact of ON on activity of daily living (1.94), decreased ROM limiting athletic activity (0.98), and mild to moderate levels of pain (1.38). Analysis of this group's most recent assessment showed improvement in pain and ON over time, with an average pain grade of 0.58 indicating no pain to mild pain, and 1.37 for ON grade, indicating asymptomatic to mildly symptomatic impact on activities of daily living. We also found minimal worsening average ROM grades (1.11). CONCLUSIONS: Shoulder ON is an underappreciated adverse late effect of therapy in children treated for leukemia/lymphoma which can limit quality of life and functionality. In most cases, pain and disability can be improved with treatment. LEVEL OF EVIDENCE: Level IV-case series.

Single-incision repair of acute distal biceps ruptures by use of suture anchors.

The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures by use of suture anchors. Sixty consecutive patients underwent distal biceps repair after an acute rupture between January 1997 and January 2001 by use of a limited antecubital incision and suture anchors. Fifty-three patients could be evaluated at a mean follow-up of 38.1 months. A limited transverse incision was made in the antecubital fossa. The retracted biceps tendon end was identified, retrieved, and lightly debrided. Two suture anchors were placed in the radial tuberosity, and the tendon was reapproximated. Final follow-up consisted of physical examination, radiographs, and Andrews-Carson elbow score tabulations. According to the Andrews-Carson scores, there were 46 excellent and 7 good results. In 2 patients, heterotopic ossification developed that resulted in a mild loss of forearm rotation and mild pain. In 1 patient, a temporary radial nerve palsy developed, which resolved completely within 8 weeks. Repair of acute distal biceps tears via a limited antecubital incision and suture anchors is a safe, effective technique.

Recent advances in arthroscopic repair of traumatic anterior glenohumeral instability.

Traumatic anterior instability is the most common type of glenohumeral instability. Although surgical treatment with an open technique has produced excellent results, there has been a trend toward arthroscopic treatment. As understanding of instability advances along with improvements in surgical techniques and instrumentation, arthroscopic results are fast approaching those seen with open procedures. Studies done at the authors' institution showed a 97% satisfactory outcome at short-term followup with 93% stable shoulders in a patient population with high physical demands. Others recently reported similar results. As more surgeons become familiar with the techniques, it is thought that arthroscopic Bankart reconstructions will be the preferred method in the future.