Clinical Results Of Arthroscopic Repair Research Articles

Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability.

Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair. Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries. The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries. Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries. Level III.

Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

Background: Long-term studies on arthroscopic repair of large subscapularis (SSC) tears over the first facet with or without supraspinatus (SSP) tear are limited. Purpose: To assess the structural and clinical outcomes of arthroscopic repair of large SSC tears using magnetic resonance imaging (MRI) and identify the factors related to SSC retear and poor outcomes. Study Design: Case series; Level of evidence, 4. Methods: This study involved 109 patients (84.0 ± 36.2 months of follow-up) who underwent arthroscopic repair of large SSC tears (Yoo and Rhee classification type III [n = 81] or IV [n = 28]) between 2011 and 2019. All patients underwent MRI at 6.1 ± 0.4 months after surgery, and 79 of 109 patients (72.5%) were followed up over 7 years. Clinical outcomes (active range of motion, functional scores, and belly press strength) and final poor clinical outcomes (reoperation, osteoarthritic change, and poor clinical outcome) were recorded. SSP tear size, rotator cuff atrophy and fatty infiltration (Goutallier classification), SSC tendon integrity (intact, intermediate, definite tear), and SSP tendon integrity (Sugaya classification) were evaluated by MRI. Results: The overall SSC retear rate was 8.3% (9/109) (type III, 2/81 [2.5%]; type IV, 7/28 [25.0%]; P < .001). SSC Goutallier grade 4 showed a higher retear rate than grade 3 (7/33 [21.2%] vs 2/33 [6.1%]; P = .149). A large SSP tear (in millimeters) (odds ratio [OR], 1.5; P = .003), SSC Goutallier grade 4 (OR, 10.8; P = .047), and SSP Goutallier grade 3 or 4 (OR, 0.02; P = .013) were independent factors for SSC retear. Clinical outcomes, except for external rotation, were poorer in patients with SSC retear than in those without retear. Final poor clinical outcomes were observed in 27 of 79 patients (34.2%); female sex (OR, 7.7; P = .007), SSC retear (OR, 8.2; P = .025), and SSP retear (OR, 4.7; P = .031) were independent factors. Conclusion: Arthroscopic repair of large SSC tears has shown promising structural outcomes for type III tears but not type IV tears. SSC retear was affected by SSC atrophy, as well as SSP tear size and atrophy. Approximately one-third of the final poor clinical outcomes could be predicted, and SSC retear, SSP retear, and female sex were associated with long-term poor clinical outcomes, underscoring the importance of carefully selecting patients for arthroscopic repair of large SSC tears.

Clinical Outcome of Arthroscopic Repair for Isolated Meniscus Tear in Athletes

Increased knowledge of the long-term destructive consequences of meniscectomy has created a shift towards operative repair of isolated meniscus lesions. However, in the literature the results of isolated meniscal repair in athletes currently remain underreported. Our objective was to investigate the clinical and functional outcomes as well as survival and return to sport in patients who underwent meniscal repair after isolated meniscal tear, with a focus on athletes (both professional and recreational) in the study population. This retrospective study included 52 athletes who underwent knee surgery for isolated meniscal tear between 2014 and 2020. Patients with concomitant ligamentous and/or chondral injury were not included in this study. The mean age of the patients was 25.5 years (ranging from 12 to 57 years). The mean follow-up period of all patients was 33.3 months (ranging 10 to 80 months). The mean purpose of the study was to report the return to sport. The International Knee Documentation Committee rating (IKDC), Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) and Tegner activity level were determined at the follow-up. Failure was defined as re-operation with meniscectomy or revision meniscal repair. In total, 44 out of 52 patients (85%) returned to their previous sports activities. At follow-up, the mean Lysholm score was 90, representing a good to excellent result. Assessment of KOOS (mean value 88.8) and IKDC (mean value 89) scores also showed good to excellent results. A mean level of Tegner scale was 6.2, indicating a relatively high level of sports participation. Failure was encountered in 8 out of 52 knees (15%). Therefore, isolated meniscal repair resulted in good to excellent knee function and most athletes can return to their previous level of sports participation.

Clinical outcomes of all-inside meniscal repair using pre-loaded suture anchors

Purpose: This prospective study aims to evaluate clinical results of arthroscopic repair of meniscal tears using clinical scores and functional outcome measures while establishing clinical evaluation as a dependable method of evaluating the healing process of a repaired meniscus. Methods: From June 2019 to October 2020, 203 patients with a mean age of 24 (range, 18-54) years with 203 meniscal tears underwent arthroscopic all-inside meniscal repair using a pre-loaded suture anchor. All tears were located in either the red-red or red-white zone. Simultaneous anterior cruciate ligament reconstruction was performed in 170 (84%) of the patients. Postoperatively, patients were evaluated based on clinical examination using Barrett’s criteria wherein the presence of locking, joint-line tenderness, swelling or positive McMurray test were considered to indicate clinical failure. Further, we also used the International Knee Documentation Committee score, Lysholm score and Short-Form 36 score for postoperative evaluation. Results: At average of 1.2 years follow-up, the success rate of arthroscopic meniscal repairs in this series was 94% (191 clinically healed menisci out of 203) according to the criteria of Barrett et al. The IKDC, Lysholm and SF-36 scores had significantly improved postoperatively. Conclusions: Arthroscopic all-inside repair using a pre-loaded suture anchor (FastFix 360) is a safe and effective procedure for treating meniscal tears, and clinical evaluation was found to be a dependable method of evaluating the results of a healed, repaired meniscus.

Arthroscopic Fixation of Avulsion Fractures of the Lesser Tuberosity of the Humerus: Clinical Outcomes With a Mean 3.5-Year Follow-up

Background:Avulsion fracture of the lesser tuberosity (AFLT) of the humerus has traditionally been treated with open reduction internal fixation using screw fixation. The clinical outcomes of arthroscopic repair with suture anchors remains unknown.Hypothesis:It was hypothesized that arthroscopic fixation with suture anchors would result in good clinical outcomes for the treatment of AFLT.Study Design:Case series; Level of evidence, 4.Methods:This study included 15 patients who underwent arthroscopic repair of AFLT of the humerus between January 2014 and October 2017. All patients had 3-dimensional computed tomography scans and magnetic resonance imaging to evaluate the avulsed fracture and concomitant injuries before surgery. The arthroscopic double-row and suture-bridge techniques were used based on the morphology of the avulsion fractures. Functional outcomes were assessed with range of motion, the visual analog scale (VAS) for pain, the Subjective Shoulder Value (SSV), the American Shoulder and Elbow Surgeons (ASES) score, and the University of California, Los Angeles (UCLA) shoulder score. The bear-hug test, liftoff test, and internal rotation resistance test at 90° abduction and external rotation (IRRT 90°) were used to evaluate subscapularis tendon integrity.Results:The mean follow-up time was 3.5 years (range, 3-5 years). Comminuted fractures with 1 large part and ≥1 small pieces were seen in 12 cases, partial tear of the supraspinatus in 2 cases, Bankart lesion in 2 cases, and superior labrum anterior to posterior injury in 2 cases. There was a statistically significant improvement from the baseline to the final follow-up in the VAS (from 6.9 ± 1.5 to 1.1 ± 1), SSV (from 30.7 ± 5.1 to 90.5 ± 11.6), ASES (from 28.5 ± 7.7 to 92.3 ± 4.5), and UCLA (from 29.5 ± 6.3 to 94.2 ± 8.3) scores (P < .001 for all). All patients showed full range of shoulder motion and bilateral symmetric strength on physical examination with the bear-hug test, liftoff test, and IRRT 90° test.Conclusion:The arthroscopic repair of AFLT resulted in excellent reduction and healing of the displaced fragment. At the final follow-up, clinical and functional results were good. Associated injuries occurred in 40% of patients but did not affect outcomes.

Comparaison entre une réparation partielle et une réparation complète des ruptures massives de la coiffe des rotateurs. Un suivi de cinq ans minimum

BackgroundMassive rotator cuff surgical management can be challenging. Controversy exists in the literature regarding the potential benefit of full head coverage for arthroscopic rotator cuff repair. The purpose of this study was to compare re-tear rate and clinical outcome of arthroscopic repair of massive rotator cuff tears in relation to the achievement of full humeral head footprint coverage or not. HypothesisWe hypothesized that there will be no difference in re-tear rate and clinical outcomes between full and partial coverage rotator cuff repairs. Patients and MethodsA retrospective analysis of all adult patients with a massive rotator cuff tear who underwent arthroscopic repair with a minimum five years follow-up was performed. Outcomes analyzed included re-tear rate, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, and the Penn Shoulder Score. Correlation and subgroup analyses were performed in order to evaluate whether age, symptom duration, tear size, coverage percentage, and fatty infiltration had any effect in outcome. ResultsThe average ASES score was 76.3±25.2, and average Penn Shoulder Score was 75.8±23.1 at 7.9 years mean follow-up in 27 patients analyzed. Re-tear rate was similar between full and partial footprint coverage repair with 2 versus 4 failures, respectively (p=0.64). ASES and Penn Shoulder scores were 84.2 and 83.7 for full rotator cuff repair versus 70.6 and 71.1, for partial coverage repair (p=0.20 and p=0.22, respectively). The percentage of head coverage and the tear size were both found to be significantly correlated with outcome, with coefficient of determination R2 of 0.40 and 0.217, respectively, while a global fatty degeneration index GFDI <1.5 was associated with improved functional outcome. DiscussionNo difference in failure rate and functional outcome was detected between full and partial coverage rotator cuff repair. The size of the tear and fatty infiltration were inversely correlated with functional score while the percentage of coverage achieved was positively correlated with favorable outcome. Level of evidenceIII; retrospective comparative study.

Comparison between partial and full coverage repair in massive rotator cuff tears. A minimum five year follow-up

BackgroundMassive rotator cuff surgical management can be challenging. Controversy exists in the literature regarding the potential benefit of full head coverage for arthroscopic rotator cuff repair. The purpose of this study was to compare re-tear rate and clinical outcome of arthroscopic repair of massive rotator cuff tears in relation to the achievement of full humeral head footprint coverage or not.Hypothesis We hypothesized that there will be no difference in re-tear rate and clinical outcomes between full and partial coverage rotator cuff repairs. Patients and methodsA retrospective analysis of all adult patients with a massive rotator cuff tear who underwent arthroscopic repair with a minimum five years follow-up was performed. Outcomes analyzed included re-tear rate, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, and the Penn Shoulder Score. Correlation and subgroup analyses were performed in order to evaluate whether age, symptom duration, tear size, coverage percentage, and fatty infiltration had any effect in outcome. ResultsThe average ASES score was 76.3±25.2, and average Penn Shoulder Score was 75.8±23.1 at 7.9 years mean follow-up in 27 patients analyzed. Re-tear rate was similar between full and partial footprint coverage repair with 2 versus 4 failures, respectively (p=0.64). ASES and Penn Shoulder scores were 84.2 and 83.7 for full rotator cuff repair versus 70.6 and 71.1, for partial coverage repair (p=0.20 and p=0.22, respectively). The percentage of head coverage and the tear size were both found to be significantly correlated with outcome, with coefficient of determination R2 of 0.40 and 0.217, respectively, while a global fatty degeneration index GFDI <1.5 was associated with improved functional outcome. DiscussionNo difference in failure rate and functional outcome was detected between full and partial coverage rotator cuff repair. The size of the tear and fatty infiltration were inversely correlated with functional score while the percentage of coverage achieved was positively correlated with favorable outcome. Level of EvidenceIII; retrospective comparative study.

Is arthroscopic surgery as successful as open approach in the treatment of lateral ankle instability?

To evaluate the clinical results of arthroscopic repair and open Ahlgren-Larsson method in patients with chronic lateral ankle instability. We retrospectively evaluated 60 patients who were operated in our clinic between 2010 and 2018 with the diagnosis of chronic lateral ankle instability. Preoperative and postoperative clinical evaluations were performed with AOFAS ankle-hindfoot score, FAOS, and VAS scores. Sixty patients with chronic lateral ankle instability were evaluated. 28 patients were treated with Ahlgren-Larsson method, and 32 patients were treated with arthroscopic repair. Follow-up duration was 35 ± 12months for the open surgery group and 19 ± 2months for the arthroscopic surgery group. The mean age of the arthroscopy group was 44 ± 9; the mean age of the open surgery group was 46 ± 11. There was no significant difference between the groups in terms of demographic features (age, sex, BMI). Postoperative clinical improvement was observed in both groups. There was no statistically significant difference between the groups in terms of functionality. However, there was a statistically significant difference in VAS in terms of pain and patient satisfaction in favor of arthroscopy group. Ahlgren-Larsson method and arthroscopic repair technique are safe and effective for chronic lateral ankle instability. Arthroscopic technique may be preferred for pain and patient satisfaction as it is less invasive and less morbid. II.

Evaluation of clinical results after arthroscopic meniscus repair and partial meniscectomy

Aim: The aim of our study was to evaluate the clinical results of arthroscopic repair and partial meniscectomy in the patients who had with meniscal tear.Material and Method: A total of 113 patients who were admitted to our clinic for meniscal tear between 2009 and 2017 were included in our study. Sixty one patients who underwent arthroscopic meniscal repair and 52 underwent partial meniscectomy. All inside meniscal repair technique was used for all meniscal repairs. Clinical assessments included physical examination findings, Lysholm score, the IKDC score and visual analog score(VAS). Barret criteria were used for the clinical assessment of healing status.Results: The patients who underwent meniscal repair, 54 (88.5%) were male 7 (11.5%) were female. The mean age was 32 (19- 45) years. Our mean follow-up period was 47 (range; 24-109) months. Number of patients underwent only meniscal repair was 29 and concurrent anterior cruciate ligament reconstruction was 32. According to the Barret’s criteria’s patients had 18% surgical failure. The patients who underwent partial meniscectomy33 were male 19 were female. Our mean follow-up period was 29.5 (range; 24-101) months. Eight patients (15.4%) had surgical failure. IKDC, Lysholm and VAS scores were statistically significantly improved postoperatively both in repair and partial meniscectomy groupConclusion: Meniscus repair should be performed whenever possible independent from age of patient. When repair is not possible, partial meniscectomy also have good results at least in short term follow-up.

Efficacy of platelet-rich plasma in arthroscopic repair for discoid lateral meniscus tears

BackgroundTo evaluate the clinical results of arthroscopic repair with or without platelet-rich plasma (PRP) for tears of the discoid lateral meniscus (DLM).MethodsTwenty-nine patients with DLM tears within a stable knee were arthroscopically treated with meniscal suture repair. Of those, 14 were augmented with platelet-rich plasma (PRP), and 15 were performed without PRP augmentation. Patients were evaluated at baseline (the day before surgery) and then 12 and 24 months after the last injection. Evaluation included the Lysholm score, and Ikeuchi grade, Visual analogue score (VAS) for pain and failure rate. Failure was defined by patients developing symptoms of joint line pain, locking, swelling or requiring repeat arthroscopy.ResultsThere was no difference in the failure rate in the PRP group (1 of 14) compared with the non-PRP group (2 of 15) (P = 0.58). Statistically significant improvement in Lysholm score, Ikeuchi grade and VAS for pain was documented at the last follow-up compared with baseline in both PRP and non-PRP group. No significantly difference was found between the PRP group and non-PRP group on Lysholm score, Ikeuchi grade and VAS for pain at the last follow-up. In the univariate analysis of each variable, younger age (P = 0.036) and longer follow-up duration (P = 0.043) were statistically associated with a better function improvement. Whereas in multivariate analysis, only younger age (P = 0.004) was significantly associated with a better function improvement.ConclusionWith regard to clinical evaluations in arthroscopic repair for DLM tears, PRP group had similar effect in pain relief and functional improvement to non-PRP group at mid-term follow-up. Future larger prospective studies with a longer follow-up are needed to determine whether PRP should be used with DLM repair.

Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport.

There is a paucity of evidence regarding mid- to long-term clinical outcomes of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL). This study investigated clinical outcomes, return to sport and the frequency of associated shoulder lesions. Eighteen patients underwent arthroscopic repair of a HAGL lesion between 2008 and 2015. Clinical outcome was evaluated using the Rowe Score, the Quick DASH Score (Q-DASH), the Oxford Shoulder Instability Score (OSIS), the ASES Score and Range of Motion (ROM). Return to sports and associated shoulder lesions were documented. Sixteen patients agreed to complete the shoulder scores and nine patients were available for clinical examination. Median time to follow-up was 59 months (range 16-104). The median Rowe Score and Q-DASH Score improved significantly from 33 to 85 points and 61 to 7 points, respectively (p = 0.001, p = 0.001). The median OSIS and ASES Score were 20 and 91 points. External rotation was significantly reduced compared to the contralateral side (p = 0.011). One recurrent dislocation was reported. No neurologic or vascular complications after surgery were reported. Five out of the nine patients did not return to sports at the same level. Associated shoulder lesions were found in 89% of the cases. Arthroscopic repair of a HAGL lesion is a reliable method to restore shoulder stability with good clinical results. However, limitations in external rotation and a reduction in sporting ability may persist at 59 months follow-up. Concomitant lesions are common. Case series, level IV.

Comparative Study on Clinical Results of Arthroscopic Repair of Anteroinferior, Superior, and Combined Glenoid Labral Tear: A Two-Year Follow-Up Study

This study is first of its kind that compared clinical results of arthroscopic repair of anteroinferior, superior, or combined anteroinferior and superior labral lesion. The most significant finding is that 2-year outcomes of the three lesions are comparable, in terms of pain, shoulder functional scores, ROM, and failure rate. However, patients with superior labral lesion were older at surgery. Anteroinferior and superior glenoid labra are common anatomical locations susceptible to traumatic injuries which lead to shoulder instability. Both can be repaired arthroscopically, however, differences in surgical outcomes were largely unknown, especially on the association and difference between type II superior labral tear from anterior to posterior (SLAP) lesion and combined anteroinferior and superior labral lesion. The objective of this study is to compare and correlate the clinical results of arthroscopic repair of combined labral lesion with those of anteroinferior labral lesion and type II SLAP lesion. A comparative study, involving patients who underwent primary arthroscopic labral repairs by two fellowship-trained Sports surgeons was conducted. Patients below 40 year-old, who were admitted between 2010 and 2014 and have been followed up for at least 2 years, were included in the study. Patients with associated rotator cuff injury, posterior labrum injury, significant bony defect or humeral avulsion of glenohumeral ligament injury were excluded. They were divided into 3 groups based on arthroscopic findings: Group A consisted of 61 patients with anteroinferior labral lesion, Group B consisted of 16 patients with type II SLAP lesion, and Group C consisted of 19 patients with combined labral lesion. The outcomes measured in the study were pain score, shoulder functional scores (Constant Shoulder Score, UCLA Shoulder Score, and Oxford Instability Score), range of motion (ROM, in both forward flexion and abduction directions), and failure rate (re-dislocation or subluxation) at 2-year follow-up. Kruskal Wallis Test and Fisher’s Exact Test were applied for continuous and categorical variables, respectively. Except that patients from Group B were older (28.8 vs. 22.2 for Group A and 22.0 for Group C) at the time of surgery, no significant differences exist among the three groups in patients’ demographics and relevant clinical data. Pain scores were comparable, with a slightly higher reported value for Group B at 2-year. There were no differences among the three groups in shoulder functional scores. Slightly higher improvements in functional scores were observed in Group B compared to the other two groups, without statistical significance. Both forward flexion and abduction ROMs have improved significantly from pre-operative values, for all three groups; however, they were not significantly different among each other at the 2-year follow-up. Improvements in ROM were highest in Group C, but these did not achieve statistical significance. Failure rate was also similar in all groups, regardless of the types of lesion. This study is first of its kind, which tries to establish the relationship of combined labral lesion with either anteroinferior or superior labral lesion, in terms of clinical results of arthroscopic repair. Patients with type II SLAP lesion underwent surgery at an older age. Combined labral lesion is a potential concomitant lesion in anteroinferior labral lesion or SLAP lesion, and comparable results can be expected in terms of pain, shoulder functional scores, ROM, and failure rate, despite the more extensive lesion size. Combined anteroinferior and superior labral lesion behaves more like isolated anteroinferior labral lesion than superior labral lesion.

Arthroscopic Rotator Cuff Repair With Graft Augmentation of Fascia Lata for Large and Massive Tears

Excellent clinical results of arthroscopic repair of rotator cuff tears have been reported. However, retears after surgical repair of large and massive rotator cuff tears are one of the most common complications. We present single-row repair with graft augmentation of the fascia lata for large and massive rotator cuff tears to reduce tension at the tendon-bone repair site, and this technique may prevent retears of the repaired rotator cuff. A candidate for this technique is a patient who has a large or massive rotator cuff tear in which the torn edge cannot reach the footprint after mobilization of the torn rotator cuff. This technique could provide an excellent option for irreparable large and massive rotator cuff tears.

Age-related Outcome of Arthroscopic Repair of Isolated Type II Superior Labral Anterior to Posterior Lesions

Background: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. Methods: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged Results: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. Conclusions: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

Full-thickness rotator cuff tears in patients younger than 55 years: clinical outcome of arthroscopic repair in comparison with older patients

The purpose of this study was to examine whether younger patients had a similar response to repair of a full-thickness rotator cuff tear (RCT) as older patients. A secondary analysis was conducted of prospectively collected data of patients with full-thickness RCTs. Patients were categorized into patients <55 years of age and patients 55 and older. Patient-related outcome measures of disability at 2 years following surgery were the Short Western Ontario Rotator Cuff (Short WORC), American Shoulder and Elbow Surgeon's (ASES) assessment form, and absolute Constant-Murley score (ACMS). Review of the database between 2001 and 2011 identified 344 patients (median age 62, range 24-90). Of these, 83 (24 %) patients were younger than 55 years of age (median age 48, range 24-54) and 261 (76 %) were in the older age group (median age 66, range 55-90). The median follow-up was 24 months (range 23-25). Patients in the younger age group had a higher prevalence of traumatic events (p = 0.02), had sustained more work-related injuries (p < 0.0001), and had a higher ratio of smaller tears (p = 0.0001). No difference was seen between groups with respect to post-operative scores of Short WORC, ASES, or ACMS. Pre-operative scores, having a work-related claim, increased tear size, and concomitant procedures affected the 2-year outcome scores. This study shows that younger patients with full-thickness RCTs who undergo an arthroscopic repair do as well as older individuals regardless of the measure used to document their recovery. Retrospective outcome study, Level II.

Meniscal repair.

The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

How do massive immobile rotator cuff tears behave after arthroscopic interval slides? Comparison with mobile tears.

the aim of this study was to compare clinical outcomes of contracted immobile massive rotator cuff tears mobilised through an arthroscopic interval slide technique versus massive mobile cuff tears directly repaired without any mobilisation. twenty-five patients who underwent arthroscopic repair for massive rotator cuff tears with a minimum of 18 months follow-up were included. The patients were retrospectively divided into two groups. In group 1, a single or double interval slide was performed to achieve adequate tendon mobilisation. In group 2 (control group), massive rotator cuff tears were arthroscopically repaired without any additional release. Patients were evaluated with validated outcomes scores: subjective and objective Constant score, a Visual Analogue Scale (VAS) for pain, and single Assessment Numeric Evaluation (SANE). the two groups were comparable in terms of age, gender and involvement of the dominant arm. The mean follow-up duration was 31 months in group 1 and 28 months in group 2 (p = 0.4). The two groups showed no significant differences in SANE and VAS results (group 1: SANE 77%, VAS 1.3; group 2: SANE 88%, VAS 1.6), or in total Constant score (group 1: 66.5 ± 11; group 2: 75 ± 14; p = 0.1) and subjective Constant score (Group 1: 31 ± 5; group 2: 30.8 ± 7; p = 0.9). A significant difference was found for the objective Constant score, which was higher in the control group (group 1: 35.5 ± 7; group 2: 44 ± 8; p = 0.009). Subjective clinical outcomes of arthroscopic repair with or without interval slides did not differ and were satisfactory. Objectively, immobile cuff tears showed inferior results. The use of interval slides might be considered a first step or an alternative to more invasive procedures for low demanding patients. Level III, retrospective comparative study.

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.

큰 크기의 회전근 개 파열에서 UU-Tension Band Suture를 이용한 관절경 감시하의 봉합술 - 단순 봉합술과의 비교 -

Purpose: To evaluate the clinical results of arthroscopic repair with UU-Tension Band suture for full thickness rotator cuff tear above 4 cm sized. Materials and Methods: From January 2006 to October 2011, in 71 full thickness tears above 4 cm sized which is possible to arthroscopic repair to medial margin of greater tuberosity. The group I is 71 patients which is arthroscopic repair with UU-Tension Band suture, and the group II is 20 cases which is arthroscopic repair with simple suture. Both groups were compared with a VAS score for pain, Activity of Daily Living, UCLA score, KSS score in pre operation, 7 months, 1 year and last follow-up. Statistical analysis was performed by student t test and paired t est. Mean age was 63.2 (52~80) year old, mean follow-up was 38.4 (13~62) months. Results: The VAS scores for pain decreased from 8.1 at preoperative period to 1.6 at postoperative last follow-up period in group I (p<0.05), the score decreased from 7.6 at preoperative period to 1.8 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). Mean ADL scores increased from 12.5 at preoperative period to 29.0 post operative last follow-up period in group I (p<0.05), the score increased from 11.3 in pre op to 27.5 post-operative last follow-up in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). The UCLA score increased from 12.9 at preoperative period to 28.7 postoperative last follow-up period in group I (p<0.05), the score increased from 13.8 at preoperative period to 30.1 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). In

Arthroscopic Reconstruction of Isolated Subscapularis Tears: Clinical Results and Structural Integrity After 24 Months

The purpose of this study was to evaluate the magnetic resonance imaging (MRI) and clinical results of arthroscopic repair of isolated subscapularis tears at 24 months' follow-up. We prospectively followed up 20 patients with isolated subscapularis tears treated with arthroscopic repair with suture anchors in a 3-year period (January 2006 to December 2008) at our institution. Clinical examination of the patients and functional scores (Constant and University of California, Los Angeles [UCLA] scores) were obtained preoperatively and at 6 months, 12 months, and 24 months postoperatively. MRI and routine radiographs were obtained to evaluate the repair at the last follow-up. Of the patients (mean age, 42 years; age range, 31 to 56 years), 19 (95%) had complete follow-up. Constant and UCLA scores improved significantly after the repair at all postoperative examinations. The Constant score gained 39.7 points to a mean of 81 points (range, 61 to 95 points) at last follow-up, and the UCLA score improved from 16 points to 32 points (range, 25 to 35 points). Of the shoulders, 13 had a concomitant lesion of the long head of the biceps; 12 were treated with biceps tenodesis. At last follow-up, there were 2 retears detected by both MRI and examinations (positive belly-press and liftoff tests). Seventeen patients were satisfied with their results at 24 months postoperatively. Arthroscopic repair of isolated subscapularis tendon tears is an effective technique with good-to-excellent clinical and functional results. Level IV, therapeutic case series.