What's new in shoulder and elbow surgery.

Abstract

The sources for this annual update on shoulder and elbow surgery were presentations and symposia at meetings of the American Orthopaedic Society for Sports Medicine (Specialty Day, Dallas, Texas, February 16, 2002), the Arthroscopy Association of North America (Specialty Day, Dallas, Texas, February 16, 2002; Twenty-first Annual Meeting, Seattle, Washington, April 19-22, 2002; and Twentieth Fall Course, San Antonio, Texas, November 29-December 2, 2002), the American Academy of Orthopaedic Surgeons (Sixty-ninth Annual Meeting, Dallas, Texas, February 13-17, 2002), and the American Shoulder and Elbow Surgeons (Specialty Day, Dallas, Texas, February 16, 2002, and Eighteenth Annual Meeting, Napa, California, September 2001). ### Rotator Cuff #### Basic Science Several studies have employed sophisticated animal models to investigate rotator cuff repair and healing. Coleman reported on a chronic rotator cuff injury and repair model involving sheep. Infraspinatus contractile forces and histological findings were evaluated at various times following either immediate or delayed tendon repair. Longer delays to repair led to greater decreases in force and more modest recovery following repair. Muscle biopsies confirmed progressive fatty infiltration that was partially reversed after tendon repair in the group with a six-week delay before repair but not in the group with an eighteen-week delay before repair. This model has important implications regarding the recovery of strength following the repair of chronic rotator cuff tears. Rodeo presented a study on growth factor-enhanced rotator cuff tendon-bone healing in a sheep model. Histological analysis demonstrated greater new-bone and fibrovascular tissue formation in the treated animals. A substantial increase in attachment strength was noted in the treated animals at twelve weeks. The study demonstrates the ability of a growth factor to influence changes at the tendon-bone interface. MacGilivray evaluated the augmentation of rotator cuff repairs with a bioabsorbable scaffold in a goat model. Biomechanical testing showed no significant improvement in load to failure when a tendon …