Arthroscopic Methods Research Articles

Arthroscopic Treatment of Lateral Epicondylitis: Tenotomy Versus Debridement

To compare the outcome of 2 arthroscopic techniques for treating recalcitrant lateral epicondylitis. The study included patients undergoing arthroscopic treatment of lateral epicondylitis during 2 different time periods: April 2005 to October 2007 (tenotomy) and May 2009 to June 2010 (debridement). By using a patient-administered form, baseline information including QuickDASH (disabilities of the arm, shoulder and hand) score (primary outcome), visual analog scale (VAS) of pain, and VAS of function was recorded prospectively. To have the same follow-up period of minimum 4 years in the 2 groups, the follow-up was conducted at 2 different points of time. Of a total of 326 patients fulfilling the requirements for inclusion in the study, 283 patients (87%) were followed up (144 male and 139 female, median age 46 [21 to 65] years), 204 (87%) in the tenotomy group and 79 (88%) in the debridement group. In both groups, a significant improvement in the QuickDASH was found at the follow-up compared with baseline: from 60 to 12 in the debridement group (P < .001) and from 59 to 13 in the tenotomy group (P < .001). No statistically significant difference was found in baseline or follow-up QuickDASH, VAS of pain, VAS of function, or failure (reoperation) rate between the 2 groups. The mean length of sick leave was 2 weeks shorter in the debridement only group (P = .007). Both arthroscopic methods lead to a significant improvement of pain and function, and no statistically significant difference was found in any outcome parameters between the 2 techniques at this minimum 4-year evaluation. The results indicate that tenotomy of the extensor carpi radialis brevis may be an unnecessary step in the arthroscopic treatment of lateral epicondylitis Debridement only is a potentially less costly procedure, and the current finding of a mean 2 weeks shorter sick leave in the debridement only group proposes a substantial cost saving in a societal perspective. Level IV, therapeutic case series.

Displaced Posterior Cruciate Ligament Avulsion Fractures: A Retrospective Comparative Study Between Open Posterior Approach and Arthroscopic Single-Tunnel Suture Fixation

To retrospectively compare the clinical outcomes of displaced tibial-side posterior cruciate ligament (PCL) avulsion fractures treated with open reduction and screw fixation versus arthroscopic suture fixation. From 2005 to 2013, all displaced PCL tibial-side avulsion fractures treated surgically-initially by an open posterior approach andlater by arthroscopic-assisted suture fixation-were retrospectively reviewed. The cases with radiographic evidence ofgreater than 3 mm of displacement and/or grade II or III laxity on the posterior drawer test were included in the studygroup. The associated injuries were duly treated. A conservative rehabilitation protocol was followed until radiologic fracture union occurred. The patients' clinicoradiologic assessment data at 1 year of follow-up were used for comparison between the open and arthroscopic groups. Forty-seven patients were available with 1 year of follow-up: 27 in the open group and 20 in the arthroscopic group. More than 90% of patients in both groups rated their knee function as normal or nearly normal. At 1 year of follow-up, knee function in terms of the Lysholm score (mean of 95.3 with 95% confidence interval [CI] 92.85 to 97.75 in open group and mean of 94.8 with 95% CI 91.38 to 98.22 in arthroscopic group; P= .812), Tegner activity level (mean of 6.8 with 95% CI 6.16 to 7.44 in open group and mean of 7.0 with 95% CI 6.44 to 7.66 in arthroscopic group, P= .677), International Knee Documentation Committee evaluation, and 1-leg hop test was comparable in both groups. The postoperative arthrometric laxity measurements with a KT-2000 arthrometer (MEDmetric, San Diego, CA) were better in thearthroscopic group, with 0 to 3 mm of laxity in 85% of cases in the arthroscopic group versus 74% in the open group.Avulsed fracture fragments were usually united by 3 months after surgery. No significant complication was noted. Both arthroscopic and open methods of treatment for PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiologic healing, and stable knees at short-term follow-up. Level III, retrospective comparative study.

Open Versus Arthroscopic Mosaicplasty of the Knee: A Cadaveric Assessment of Accuracy of Graft Placement Using Navigation

The purpose of this study was to compare an open freehand mosaicplasty technique with an arthroscopic technique for the treatment of osteochondral lesions by measuring the instrument deviation, quantifying this deviation, and providing numerical information on the difference in the outcomes of these techniques. Four cadaveric knees were used. Reference markers were attached to the femur, tibia, and donor/recipient site guides. A total of 10 osteochondral grafts were harvested and inserted into recipient sites arthroscopically and 10 similar grafts were inserted freehand. The angles of graft removal and placement were calculated for each of the surgical groups compared. Ostensibly, a navigation system was used as an aid, to measure the graft placement parameters. Statistical analysis revealed that there was no statistically significant difference between the arthroscopic method and the freehand method regarding the angle of graft removal at the donor site (P = .162), recipient site plug removal angle (P = .731), and recipient site graft placement angle (P = .630). In the freehand group, the mean angle of graft removal at the donor site was 12°, the mean angle of recipient site plug removal was 10.7°, and the mean angle of recipient site plug placement was 10.6°. Using the arthroscopic technique, the mean angle of graft removal at the donor site was 17.14°, the mean angle of recipient site plug removal was 12.0°, and the mean angle of recipient site graft placement was 10.14°. Our study revealed there was no statistically significant difference regarding precision and accuracy during harvesting, recipient site preparation, and plug placement between the 2 techniques. Controversy exists whether an open or arthroscopic osteoarticular transfer system (OATS) technique provides superior accuracy. According to our results, there is no statistically significant difference regarding better visualization, precision, and accuracy between the freehand and arthroscopic techniques. However, larger number of specimens are required for study.

Welcome to JWS for 2015!

This special focus issue, which was organized by Toshi Nakamura, is devoted to arthroscopic and open treatment methods for foveal disruptions of the DRUJ. This difficult problem is discussed in detail both from a diagnostic and management perspective by some of the innovators in this field. The authors give a variety of different techniques that can be used in different situations, which gives the treating surgeon myriad treatment options. The Journal of Wrist Surgery also welcomes the greater involvement of our assistant editors, Guillaume Herzberg, MD and Toshiyasu Nakamura, MD, who will be coordinating the future special focus issues and taking on a greater role in the editing process. Special thanks to Kelly Coffey and Kenny Chumbley and to all of our overseas copyeditors and printers for another fantastic year and for the continued oversight of Graham Brumfield. I wish all of our readers and Journal of Wrist Surgery contributors a Happy New Year and look forward to working with all of you in 2015.

A Simplified Approach for Arthroscopic Repair of Rotator Cuff Tear with Dermal Patch Augmentation

Here, we describe an arthroscopic method specifically developed to augment rotator cuff repair using a flexible acellular dermal patch (ADP). In this method, an apparently complex technique is simplified by utilizing specific steps to augment a rotator cuff repair. In this method, using a revised arthroscopic technique, rotator cuff repair was performed. This technique allowed easy passage of the graft, excellent visualization, minimal soft tissue trauma, and full four-corner fixation of an ADP. Twelve patients underwent rotator cuff repair with augmentation using the combination of this method and ADP. Due to the technique and biomechanical characteristics of the material, the repairs have been stable and with high patient satisfaction.

Functional outcomes of arthroscopic treatment of lateral epicondylitis.

The aim of this study is to evaluate the functional results of arthroscopic lateral epicondylitis (LE) treatment in patients in whom conservative treatment proved insufficient. Between 2011-2014, 29 patients with LE (15 women, 14 men; mean age: 46 years; range: 33-79) who received at least 6 months of conservative treatment methods and did not achieve full recovery and thus underwent arthroscopic surgery were included in this study. One patient was excluded from the functional assessment. Mean follow-up was 20.5 months (range: 7-42). Mean preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores were 81.1±17.5 and 34.7±26.8 (p<0.0001), respectively, and Mayo Elbow Performance Scores (MEPS) were 48.5±11.5 and 101.2±22.9 (p<0.0001), respectively. Twenty-one patients (75%) were satisfied with the functional outcome. As a result, LE treated with the arthroscopic method, with its low complication rate, successful degenerated tendon debridement, and decortication of the lateral epicondyle, is a useful method for intervention in pathologies such as annular plica, loose body, synovial hypertrophy, and radiocapitellar chondropathy.

Open versus arthroscopic treatment of post-traumatic stiff elbow

Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11˚ to 103.94˚. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46˚ to 101.53˚. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthroscopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.

Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation.

The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation. A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used. The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22-60 years). The mean follow-up period was 13.61 months (range: 9-24 months). The mean CC distance on the operated side was 9.23 mm (range: 8-15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18-42) increased to 84.4 (range: 70-90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11-28) and decreased to 0.4 (range: 0-3) at the final follow-up (p<0.001). Mean preoperative VAS score was 6.0 (range: 5-8), which decreased to 0.6 (range: 0-3) at the final follow-up (p<0.001). The percutaneous double-button fixation technique is a safe, practical, and effective fixation method that can be used as an alternative to arthroscopic and open methods for acute Type III AC joint dislocations.

Recurrent Anterior Glenohumeral Instability-Arthroscopic Results of Bankart Repair

Objectives:In the treatment of traumatic anterior shoulder instability there is still not formed a ideal consensus. Although the results of the open technique for repairing Bankart lesions detected in these patients, in recent years with the development of arthroscopic methods, arthroscopic Bankart repair with the successful results are obtained. We aimed to present our results of Bankart repair with the arthroscopic method.Methods:The study included 42 patients who underwent arthroscopic Bankart repair in our clinic between the years 2011-2014. Mean age was 26.3 (18-37). Preoperative and postoperative pain and functions of the patients were assessed using the Constant and Rowe scores. The mean follow-up period was 19 months (range 6 to 30 months). Patients with at least two dislocations were included in the study. The mean number of dislocations was 4.8 (2-10). The mean time from the first trauma to surgical intervention was 2.5 years (range 0.5 to 10 years). Patients with multidirectional instability were excluded. Repair was performed using double-stranded double with the standard anterior portal. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Before surgery for all patients, a detailed clinical examination, conventional radiography and conventional MRI were evaluated. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities.Results:The mean passive shoulder abduction was 155 (145-170) degrees and mean external rotation was measured 80 (60-90) degrees. The mean preoperative Rowe score was 42 points, while the postoperative score was 89.1 points at the last time follow up. The difference was statistically significant (p <0.05). The Constant score was 52 preoperatively and increased to 85 points after the surgery. The difference was statistically significant (p <0.05). The mean loss of external rotation was observed %28.75 and the last time follow up decreased to %8.2. The difference was statistically significant (p <0.05). All of the patients returned to their daily activities and no dislocation has been occurred.Conclusion:Although, in the past, the results of arthroscopic repair were less satisfactory compared to open and mini open surgery. This condition has changed remarkably. The results of arthroscopic repair in our study were good enough compared to open surgeries. Also in patients who underwent arthroscopic repair, length of hospital stay is shorter, less pain and less scar tissue occurs after the surgery. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.

Recurrent Anterior Glenohumeral Instability-Arthroscopic Results of Bankart Repair

Objectives:Congenital dislocation of patella (CDP) is a condition which is often associated with disorders of quadriceps mechanism. CPD may occur as flexion contracture of knee which are associated with syndromes, and also may occur in different forms as an isolated anomaly which are characterized by dislocation of patella by flexion or extension of knee or spontaneously reduction of patella. Here, we aimed to present the long-term results of a case of CPD which is occurred as an isolated anomaly.Methods:A seven years old male patient admitted with the complaints of limitation in the right knee joint and difficulty in walking. Physical and radiological examinations of the patient were performed, and patient hospitalized with CPD preliminary diagnosis. The right knee joint flexion and extension range of motions were significantly limited when compared with left knee joint. Range of motion of knee flexion was 100° and limitation of extension was 30°. Also the patient had difficulty in walking due to weakness of extensor mechanism. The patella located laterally to the lateral femoral condyle, and it was in fixed position by palpation. Reduction of patella wasn’t achieved by passive flexion and extension of knee. The patella was sited laterally to the lateral femoral condyle in anteroposterior (AP) knee radiography. And in tangential radiography; it was seen that the patella dislocated to the lateral side. And also, there was insufficiency in the development of patellar femoral surface, and trochlear dysplasia was observed. According to these physical and radiological findings patient was operated with the diagnosis of CPD and modified Roux-Goldthwait surgical technique was performed. Postoperatively patient followed in long leg cast that is performed in 30° knee flexion and internal rotation. Any complications were not seen at the follow-up of patient.Results:Patient was followed nearly 6 years. At the last follow-up it was seen that range of motions of knee joint reached to normal degrees. And in AP radiography; it was seen that patella is in anatomic location. Also tangential radiography showed that patella is in accordance with patellar femoral surface. Interestingly, the trochlear dysplasia was improved and gained its normal anatomic structure.Conclusion:CPD is a rare congenital anomaly of the knee. It may frequently accompany with syndromes, and also may appear isolated anomaly. The functional effects can cause various symptoms. Appropriate surgical treatment is effective in the improvement of functions and instability.

Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Objectives:The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomyMethods:Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery.Results:Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patientsConclusion:Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: a preliminary report.

This paper presents our initial findings on the use of arthroscopic hip reduction in conjunction with acetabuloplasty to treat patients of walking age who had congenital dislocation of the hip. Arthroscopic reduction with acetabuloplasty was performed on nine children of walking age with nine dislocated hips. The average age of the patients was 21.4months (14-41months). Arthroscopic reduction was performed using a two-portal method with a 2.7-mm mini cannulated arthroscopic instrument. We used a subadductor portal and a high anterolateral portal. The obstacles preventing reduction-hypertrophic teres ligament, pulvinar, capsular constriction, hypertrophic transverse ligament-were eliminated. We treated one grade 4 hip, four grade 3 hips and four grade 2 hips, as classified by Tönnis. We were able to perform arthroscopic reduction on all of the hips. The main obstacles preventing reduction were a capsular constriction and a hypertrophic teres ligament. During the investigation period, which averaged 15.4months (6-29months), no repeat dislocation occurred. According to the Tönnis classification system for avascular necrosis, there were two cases of a grade 2 necrosis of the femoral head. The average preoperative AC angle was 40° (34°-47°). The average AC angle at the follow-up examination was 18.7° (11°-27°). We can conclude that the standardized arthroscopic surgical technique presented here can also be used to safely perform arthroscopic reduction in toddlers. The new arthroscopic method is an alternative to open reduction for selective hip dislocations. We believe this approach can be used to treat dislocated hips that are classified as grades 2 and 3 dislocations according Tönnis. Early results are promising. Medium-term results are needed to make a definitive statement on the rates of necrosis of the femoral head.

Early clinical results of arthroscopic remplissage in patients with anterior shoulder instability with engaging hill-sachs lesion in iran.

To assess the outcome of the remplissage arthroscopic surgical method in patients with anterior shoulder dislocation associated with Hill-Sachs lesion. Ten patients with anterior shoulder dislocations and Hill-Sachs lesions were entered into this study and were operated on by the remplissage arthroscopic surgical method. They were followed up 22 months after surgery in order to evaluate the outcome of the treatment, including recurrence of dislocation and motion limitation. During the internal follow up period, no case of recurrence was found. Motion limitation during the follow up period was not significant (internal rotation limitation=5°±1°, and external rotation limitation=4°±1°). Our findings suggest that the remplissage arthroscopic surgical method is an acceptable, safe and reliable treatment for anterior shoulder dislocation with engaging Hill-Sachs lesion.

The Arthroscopic Rotator Interval Closure: Why, When, and How?

The contribution of the rotator interval (RI) to the overall stability of the glenohumeral joint remains under debate. With improvements in the interpretation of both physical examination and diagnostic imaging findings, the diagnosis of RI pathology is becoming easier to identify. The clinical implications of RI pathology, however, still remain controversial. Injury to RI may contribute to glenohumeral instability, and both biomechanical and clinical studies have shown improvements in anterior shoulder stabilization following RI closure. The benefits of RI repair in the setting of posterior shoulder and multidirectional instability, however, are unclear. The optimal surgical technique is also unclear, and a variety of open and arthroscopic methods have been described. The purposes of this article are to review the surgical anatomy relevant to RI closure, discuss the biomechanical rationale for repairing the RI, and provide our preferred technique for performing arthroscopic RI closure.

Application of optical coherence tomography enhances reproducibility of arthroscopic evaluation of equine joints

BackgroundArthroscopy is widely used in various equine joints for diagnostic and surgical purposes. However, accuracy of defining the extent of cartilage lesions and reproducibility in grading of lesions are not optimal. Therefore, there is a need for new, more quantitative arthroscopic methods. Arthroscopic optical coherence tomography (OCT) imaging is a promising tool introduced for quantitative detection of cartilage degeneration and scoring of the severity of chondral lesions. The aim of this study was to evaluate the inter-investigator agreement and inter-method agreement in grading cartilage lesions by means of conventional arthroscopy and with OCT technique. For this aim, 41 cartilage lesions based on findings in conventional and OCT arthroscopy in 14 equine joints were imaged, blind coded and independently ICRS (International Cartilage Repair Society) scored by three surgeons and one PhD-student.ResultsThe intra- and inter-investigator percentages of agreement by means of OCT (68.9% and 43.9%, respectively) were higher than those based on conventional arthroscopic imaging (56.7% and 31.7%, respectively). The intra-investigator Kappa coefficients were 0.709 and 0.565 for OCT and arthroscopy, respectively. Inter-investigator Kappa coefficients were 0.538 and 0.408 for OCT and arthroscopy, respectively.ConclusionsOCT can enhance reproducibility of arthroscopic evaluation of equine joints.

Open versus Arthroscopic Treatment of Post-Traumatic Stiff Elbow

Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11° to 103.94°. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46° to 101.53°. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthro-scopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.

Preliminary Results of Double-Bundle Anterior Cruciate Ligament Reconstruction and Technique-Specific Problems

Background: In this study, we determined the efficiency of anterior cruciate ligament (ACL) reconstruction using the double-bundle technique and addressed technique-specific problems. Patients and Methods: Twenty-nine patients who underwent ACL reconstruction due to ACL rupture with the arthroscopic double-bundle ENDOBUTTON CL method using autogenous hamstring tendons were evaluated. All patients were males and the mean age was 24.3 years (range 20 - 41 years). The mean follow-up period was 36.4 months (minimum 16 and maximum 53 months). Diagnosis was based on medical history and physical examination. Lachman, anterior drawer and pivot shift tests were performed. The patient diagnosis was verified with X-ray roentgenogram and magnetic resonance imaging (MRI). Tunnel mergence and graft hanging problems were discussed. Results: Pre- and postoperative clinical assessments of the patients showed the mean Lysholm score increased from 60.2 (48 - 72) preoperatively to 91.5 (85 - 98) at the final visit, whereas the mean Tegner score increased from 5.58 (3 - 9) preoperatively to 6.03 (4 - 9) at the final visit. According to the International Knee Documentation Committee (IKDC) knee ligament standard evaluation system, five patients were classified as B (17%); 11 patients were classified as C (38%); and 13 patients were classified as D (45%) before the surgery. At the postoperative evaluation, 17 (59%) patients were classified as A; 11 (38%) patients were classified as B; and 1 (3%) patient was classified as C. Conclusion: The double-bundle technique using hamstring tendons and femoral braces is an efficient and satisfactory method for ACL reconstruction.

Arthroscopic repair of full-thickness rotator cuff tears

Background Rotator cuff tears are among the most common conditions affecting the shoulder. Despite their ubiquity, there is substantial debate concerning their management. Arthroscopic repair methods have been developed, with the promise of more rapid patient recovery. Purpose The aim of this study was to describe the surgical technique and to evaluate the clinical results of arthroscopic repair of different-sized full-thickness rotator cuff tears using bone suture anchors. Patients and methods The study was conducted in the Department of Orthopaedic Surgery, El-Hadara Orthopaedic and in Traumatology University Hospital, Alexandria University (Egypt) from 2008 to 2010. Eighty shoulders in 80 patients, 38 men and 42 women, with symptomatic chronic full-thickness rotator cuff tears were included in the study. Arthroscopic cuff repair (using bone suture anchors) with subacromial decompression was applied to all patients. The age of the patients varied from 37 to 78 years with a mean of 61.15 years. There were 38 men (47.5%) and 42 women (52.5%). The patients were prospectively followed up clinically for a mean of 30 months (range: 20-37 months). The clinical assessment was performed with the modified University of California at Los Angeles score (55 points). Results The modified University of California at Los Angeles score improved significantly from a mean of 24.85 points preoperatively (range: 16-38 points) to a mean of 43.83 points postoperatively (range: 16-55 points) (P Conclusion Arthroscopic repair of full-thickness rotator cuff tears using bone anchors offered good results, provided a stable construct that can allow early rehabilitation without failure, and enabled tendon-bone healing. Arthroscopic rotator cuff repair was successful for large and small tears. Moreover, the earlier the operative intervention, the better was the outcome.

Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability

Background:Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared.Materials and Methods:This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software.Results:Six patients (16.22%) had inappropriate condition with ROWE score (score less than 75); of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78). Nine patients (24.32%) had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67). Finally, 22 patients (59.46%) showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56). According to Fisher's exact test, there were no significant differences between the two groups (P = 0.15).Conclusion:The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method.

Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation.

Coracoclavicular (CC) ligament augmentation has been a method to treat acromioclavicular (AC) joint dislocation in recent years. The purpose of this paper is to describe our arthroscopic CC ligament augmentation technique in treating type III and V acute AC joint dislocations and to report the early clinical and radiological results. From 2010 to 2011, twelve patients suffering from acute type III or V AC joint dislocations were arthroscopically treated in our department, by CC ligament augmentation after AC joint reduction. The post-operative outcomes were assessed through physical examination, radiographic examination and the Constant-Murley Shoulder Score. All patients post-operatively experienced anatomical reduction in their AC joint dislocation. No intraoperative complications occurred. At a mean follow-up at 24 months (ranging from 18 to 32 months), the mean Constant-Murley Shoulder Score significantly improved from 24.3 pre-operatively to 91.1 post-operatively. No neurovascular complications or secondary degenerative changes of the AC joint were detected in any of the patients. In one case, a second dislocation occurred 1 month post-operation because the patient had had another traumatic injury. This patient accepted a revision operation, but his AC joint eventually fixated into a subluxated position after his second injury. Based on the resultant successful repair in all cases, the arthroscopic CC ligament augmentation method has thus far proven to be a safe and reliable technique for treatment of acute type III or V AC joint dislocation. The arthroscopic CC ligament augmentation with a flip button/polyethylene belt repair is an efficient method to treat acute type III and V AC joint dislocations which should be popularized. IV.