Degenerative Tears Research Articles

Low serum vitamin B12 levels are associated with degenerative rotator cuff tear

BackgroundVitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. The purpose of this study was to investigate whether serum Vit B12 levels were correlated with degenerative rotator cuff (RC) tear.MethodsEighty-seven consecutive patients with or without degenerative RC tear were enrolled as study participants. Possible risk factors (age, sex, medical history, bone mineral density, and serum chemistries including glucose, magnesium, calcium, phosphorus, zinc, homocysteine, Vitamin D, Vit B12, homocysteine, and folate) were assessed. Significant variables were selected based on the results of univariate analyses, and a logistic regression model (backward elimination) was constructed to predict the presence of degenerative RC tear.ResultsIn the univariate analysis, the group of patients with degenerative RC tear had a mean concentration of 528.4 pg/mL Vit B12, which was significantly lower than the healthy control group (627.1 pg/mL). Logistic regression analysis using Vit B12 as an independent variable revealed that Vit B12 concentrations were significantly correlated with degenerative RC tear (p = 0.044). However, Vit B12 levels were not associated with tear size.ConclusionLow serum levels of Vit B12 were independently related to degenerative RC tear. Further investigations are warranted to determine if Vit B12 supplementation can decrease the risk of this condition.

To study risk factors of degenerative rotator cuff tear

Background: Rotator cuff has been a known entity for orthopaedic surgeons for more than two hundred years [1]. Rotator cuff disease is a common condition that causes shoulder pain and functional disability with a prevalence rate of 2.8-15%, affecting approximately 40% of population who are more than 60 years of age and substantially impacting on individual’s function [2]. Aims and Objectives: To study risk factors in patients with symptomatic atraumatic rotator cuff tear –Age, Obesity, Gender, Smoking, Diabetes mellitus, Hypertension, Hand dominance, Use of corticosteroid injections, Hyperlipidemia, Osteoarthritis of knee. Materials and Methods: Inclusion criteria § Pain in the shoulder of duration more than three weeks. § Normal range of motion of the shoulder. § One or more than one positive clinical tests for rotator cuff tear. Diagnostic imaging like ultrasound and magnetic resonance imaging pointing to diagnosis of rotator cuff tear. Exclusion criteria § History of trauma. § History of any surgery. § Patients using assisted devices for walking. Results:Our study proved that the metabolic factors of diabetes, BMI, age, hand dominance, osteoarthritis of knee, hypertension, gender were independent significant risk factors associated with the development of atraumatic rotator cuff tears. Out of all the risk factors evaluated, osteoarthritis of knee, age, obesity were the most significant risk factors for atraumatic rotator cuff tear. Conclusions:Out of all risk factors evaluated, osteoarthritis of knee, obesity and age were the most important risk factors for atraumatic rotator cuff tear Evaluation of various risk factors results in enhanced understanding of the prevention and management of various other common conditions and comorbidities associated with degenerative rotator cuff tears [26].

No decrease in incidence of arthroscopic meniscectomy in a Canadian province.

Arthroscopic meniscectomy (APM) is the most common procedure in orthopedic surgery, despite increasing evidence questioning its benefit over conservative management for treatment of degenerative meniscal tears. The purpose of this study is to determine the epidemiology and trends of APM in Saskatchewan, a Canadian province, over a 20year period. Physician billing codes were used to identify patients who underwent APM in Saskatchewan between January 1, 1998 and December 31, 2017. Records were obtained from eHealth Saskatchewan, a provincial health database. Data was analyzed for overall incidence and age-specific trends of APM. A total of 35,099 APMs were performed during the study period. The population of Saskatchewan ranged from 992,314 to 1,150,782 (median 1,017,368) during this time interval, with 81 orthopedic surgeons performing APM. Overall incidence rate of APM did not change significantly over time. No decrease was observed in patients presumed to have degenerative tears (≥ 50years). The number of meniscectomies in patients ≥ 50years was significantly greater during the second decade of study compared to the first (OR 1.48, p < 0.01). Conversely, the increase in incidence rate among older patients was not statistically significant (R2 = 0.125, n.s.). Overall incidence rate of APM in Saskatchewan has not decreased during the last 20years. Furthermore, APM frequency increased over time for individuals ≥ 50years. Several regional factors may have contributed to these findings, including the large proportion of Saskatchewan residents engaged in physically demanding work and barriers to accessing physiotherapy services. Given recent evidence disputing the benefit of APM over conservative measures, this study highlights the need for improved dissemination of evidence, as well as the importance of an individualized treatment plan to address patient-specific factors. Level IV.

The heritability of doctor-diagnosed traumatic and degenerative meniscus tears

To estimate the genetic contribution to traumatic and degenerative meniscus tears for men and women across the lifespan. We linked the Swedish Twin Register with individual-level national healthcare data to form a 30-year, population-wide, longitudinal twin cohort. To study genetic contribution to meniscus tears, we estimated the heritability and familial risk using incident traumatic and degenerative tear diagnostic codes in a cohort of 88,414 monozygotic and dizygotic twin-pairs, aged ≥17 years. During follow-up, 3,372 (3.8%) of 88,414 twins were diagnosed with a traumatic or degenerative meniscus tear. The heritability was 0.39 (95% CI=0.32-0.47) for men and 0.43 (95% CI=0.36-0.50) for women, and did not vary by age. Environmental factors that were unique to each twin in a pair explained a greater proportion of the variance than genetic factors, both for men (0.61, 95% CI=0.53-0.68) and women (0.57, 95% CI=0.50-0.64). Separate analyses of traumatic vs degenerative meniscus tears yielded similar results. For the first time, we have estimated the genetic contribution to doctor-diagnosed meniscus tears using a twin study design. We found a relatively low to modest heritability for meniscus tears (∼40%). The heritability was also fairly stable over the lifespan, and equal in both men and women. Our findings suggest that environmental risk factors are a more important contributor to both traumatic and degenerative doctor-diagnosed meniscus tears than genetic factors.

Supraspinatus tear—a mechanical outlet impingement lesion?

Abstract Background The etiology of degenerative supraspinatus tendon (SSP) tear is still subject to discussion. Objectives Our objective was to correlate clinical, radiological, and intraoperative signs of mechanical outlet impingement in patients with degenerative SSP tears. Materials and methods This prospective study included 100 patients with degenerative SSP tears that required surgery. Preoperatively, clinical impingement signs and radiological parameters (critical shoulder angle [CSA], acromion type according to Bigliani, acromion index [AI]) were recorded. Intraoperatively, the extent of the rupture and grinding marks on the bottom of the acromion were assessed. Results Of the 100 patients, 59 had clinical impingement signs preoperatively; 90 patients had at least one positive radiological sign (CSA &gt; 35°, AI &gt; 0.67, acromion type II or III). In 23 patients a partial tear, in 55 patients a full thickness tear, and in 22 patients an additional infraspinatus tendon tear were found. In 10 cases no grinding marks at the bottom of the acromion during arthroscopy were found. In 75 cases moderate grinding marks and in 15 cases severe marks with bare bone at the bottom of the acromion were found. There was no statistically significant correlation between preoperative impingement signs and arthroscopic grinding marks (p = 0.83) or between clinical signs and radiological parameters (p = 0.44). There was no significant correlation between extent of the rupture, extent of grinding marks or radiological impingement parameters (p = 0.16; p = 0.26). Conclusion We could not verify a correlation between clinical and radiological impingement sign and arthroscopic impingement parameters. Based on our study, degenerative SSP tear cannot be characterized as the result of a mechanical outlet impingement.

Perioperative anaesthetic considerations for rotator cuff repair surgeries: A current concept review

Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.

Study of Functional Outcome in Terms of Pain and Range of Movements in Degenerative Rotator Cuff Tear by Transosseous Sutures in Elderly

Introduction: The surgical treatment of Rotator cuff repair ranges from open to arthroscopic assisted mini open repair to full arthroscopic repair. The anterior approach or lateral deltoid approach has its advantages and disadvantages depending upon the site and the extent of the rotator cuff tear. Aim and objective: To assess the functional outcome of mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures in elderly in terms of pain and range of movements. Methodology: The present study was prospective observational study conducted on Patients with degenerative rotator cuff tears presenting at Department of Orthopaedics. Patients underwent mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures. Follow-up of patients was done immediate after suture removal, at six weeks, at twelve weeks, twenty-four weeks following the surgery. Pre-op and Final follow up evaluation was done for each patient using VAS scale and range of movement. Shoulder index using ASES scores were noted. Results and discussion: Majority of the patients (52%) were males and (48%) were females. 44% cases were between 61 to 70 years of age. In our study in follow up at 6,12, 24 weeks, range of motion was found to be increasing during subsequent follow ups. (p<0.001) The average ASES scores improved from 20.83 to 81.15 (Range 58-67) at final follow up (p<0.0001).

Conservative management vs. surgical repair in degenerative rotator cuff tears: a systematic review and meta-analysis.

To analyze the available evidence comparing the clinical and functional outcomes of physiotherapy vs. surgical repair in the management of degenerative rotator cuff tears (RCTs), and to perform a meta-analysis to clarify the possible superiority of one approach vs. the other. A literature search was carried out on the PubMed, Scopus and Web of Science databases on May 30th, 2020, to identify all the randomized trials comparing surgery to conservative management of degenerative rotator cuff tears. The following data were extracted from each included study: patients' demographics, study design and level of evidence, follow-up times, treatment groups, evaluation scores adopted, overall clinical findings. The quality of the trials was assessed using the Cochrane Risk of Bias Assessment. A total of 7 studies, including 326 patients and dealing with conservative treatment vs. surgical repair for rotator cuff tears, were included in this study. Although surgery provided superior results both in terms of VAS (p=0.017) and Constant score (p<0.0001) compared to conservative management at 1 year follow-up, this superiority did not reach the "minimal clinical important difference". Otherwise, a few data are available about long-term outcomes, thus there is insufficient evidence about the role of surgery to prevent the progression of tendon wear. A proper rehabilitation program is able to provide similar results compared to surgery at a short term follow-up in degenerative RCTs. Further long term data are necessary to understand if tendon repair might have a protective role towards worsening of degeneration thus providing better clinical outcome than conservative management.

Сравнительный анализ эффективности артроскопии и комплексной терапии при лечении дегенеративных разрывов менисков у больных с остеоартрозом коленного сустава

Aim: to evaluate the efficacy of conservative treatment in patients with degenerative meniscal tear (DMT) in the setting of knee osteoarthritis (OA) as an alternative to combined treatment. Patients and Methods: a prospective comparative study included 236 patients aged 45–65 years with DMT in the setting of stage I–III OA according to the Kellgren-Lawrence classification (70 of them — men). Group 1 consisted of 122 patients (86 of them — women) who underwent combined treatment: arthroscopy for DMT of the knee joint and complex therapy in the postoperative period: NSAIDs (celecoxib), a combined drug from the group of symptom-modifying slow-acting drugs SYSADOA (chondroitin sulfate + glucosamine sulfate), exercise therapy, physiotherapy. Group 2 (n=114) received only complex therapy. Control tests (pain assessment on the visual analog scale (VAS), WOMAC scale, life quality assessment on the EQ-5D scale, treatment satisfaction) were performed 10 and 20 weeks after the therapy initiation. Results: there was a statistically significant (p&lt;0.05) improvement in VAS and WOMAC indicators, which continued to decline by week 20 after 10 weeks of both combined and conservative treatment. Also, it did not depend on gender, age, concomitant pathology, but on the body mass index and OA stage according to the Kellgren-Lawrence classification, which was confirmed by the results of the correlation analysis. Patients’ treatment satisfaction and improvement in their life quality were noted in 50% of patients in both groups. Conclusion: arthroscopic meniscectomy should not be indicated as the first treatment stage in patients with DMT during OA. Complex therapy, including the use of drugs from the NSAID and SYSADOA groups at the recommended doses, has demonstrated high treatment efficacy and safety of patients with DMT during OA. KEYWORDS: knee arthritis, degenerative meniscus tear, arthroscopy, celecoxib, chondroitin sulfate, glucosamine sulfate, life quality. FOR CITATION: Bessarab M.S., Krasnov G.O., Charchyan A.M., Khoroshkov S.N. et al. Comparative analysis of the arthroscopy efficacy and complex therapy in the treatment of degenerative meniscal tears in patients with knee osteoarthritis. Russian Medical Inquiry. 2021;5(2):71–77. DOI: 10.32364/2587-6821-2021-5-2-71-77.

Surgical repair versus conservative management in degenerative rotator cuff tears: systematic review and meta-analysis

Although surgery is generally used to treat acute traumatic rotator cuff tears (RCTs) in young patients, treating degenerative cuff tears remains a challenge for orthopedic surgeons, and no gold standard has been established. This work aims to determine the efficacy of surgical repair versus conservative management in shoulder degenerative RCTs patients. A systematic search was carried out over different medical databases to identify orthopedic surgery studies, which investigated the outcome of the surgical repair versus the conservative management of RCTs patients. We conducted a meta-analysis for the constant and visual analogue scale (VAS) scores as primary outcomes, and on retear (recurrence) rate as a secondary outcome. Seven studies were identified involving 628 patients: 314 in the surgical repair group and 314 in the conservative management group. Our meta-analysis process showed a non-significant difference in mean constant score and VAS score in the surgical repair group compared to the conservative management group (p > 0.05 for each). Also, we found that the overall pooled recurrence rate was 13.2%. This study compared the efficacy and safety of surgical repair versus conservative management in degenerative RCTs. According to our results, there was no difference between both groups in their effect on mean constant score and mean VAS score, also retear after surgical repair may occur at a similar rate. This means that both approaches had a similar efficacy.

Radiographic Predictive Factors of Degenerative Rotator Cuff Tears in a Turkish Cohort

Radiographic Predictive Factors of Degenerative Rotator Cuff Tears in a Turkish Cohort

Semiquantitative single-photon-emission computed tomography /computed tomography study to evaluate concomitant ulnar impaction syndrome in patients presenting with triangular fibrocartilage complex tears.

IntroductionPatients presenting with tears of the triangular fibrocartilage complex (TFCC) can have ulnar positive variance, for which the clinical relevance to concomitant ulnar impaction syndrome (UIS) may be unclear. We hypothesized that maximum standardized uptake value (SUVmax), a semiquantitative single-photon-emission computed tomography/computed tomography (SPECT/CT) value, would distinguish between the traumatic TFCC tear and degenerative TFCC tear associated with the UIS. This study aimed to compare SUVmax between patients with TFCC tear only and patients with TFCC tear and UIS.MethodsA total of 26 patients presenting with TFCC tears on magnetic resonance imaging (MRI) underwent semiquantitative SPECT/CT examinations. The diagnosis of concomitant UIS was made based on positive ulnar impaction tests and MRI findings. We compared the SUVmax between patients with and without concomitant UIS. We also calculated the cutoff value for the diagnosis of UIS using receiver operating characteristic curve analysis.ResultsOf 26 patients, 14 had concomitant UIS, and 12 had TFCC tears only. The SUVmax was significantly higher in patients with concomitant UIS than in those without UIS (p = 0.048). With a SUVmax cutoff value of 4.09 for UIS, sensitivity of 67% and specificity of 82% were obtained.ConclusionsIn the semiquantitative SPECT/CT examinations of patients with TFCC tears, those with concomitant UIS had a higher SUVmax than those without UIS. Semiquantitative SPECT/CT can be helpful in confirming concomitant UIS in patients with TFCC tears.

All zones arthroscopic meniscal repair - medium term follow-up

Introduction: The menisci are crucial structures of the knee in maintaining function. Meniscal repair has gained importance as meniscectomy causes early arthritis. Arthroscopic repair of meniscus has become the mainstay of management replacing open surgery, because of decreased duration of surgical procedure and better accessibility to the tear location. Methods: This study prospectively evaluated functional outcome in 34 patients who underwent arthroscopic meniscal repair. Tears involving outer (red-red), middle and inner (white-white) zone were included for repair. Complex and degenerative tears were excluded from repair. Follow-up consisted of clinical assessment by using Barrett’s criteria and comparison of pre-operative and post-operative Lysholm knee score. In the absence of joint-line tenderness or effusion, and if the McMurray test was negative, it was considered that the repaired meniscus has healed. Results: After a minimum of 1.5 year follow-up, 32/34 of the cases that underwent meniscal repair were asymptomatic for meniscal tears. The mean Lysholm score increased to 95.2 as compared with the preoperative mean value of 61. Arthroscopic meniscal repair was not associated with any neurovascular or other major complications. Conclusion: Stabilizing the meniscal tear by arthroscopy in all three zones appears to be an effective procedure. Keywords: Meniscal repair, White-white zone, Arthroscopy.

A study of functional outcome of arthroscopic rotator cuff repair in rotator cuff tear patients

Introduction: Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. The purpose of the study was to evaluate the functional outcome of arthroscopic rotator cuff repair in rotator cuff tear patients. Materials and Methods: This prospecutive study included 22 cases of rotator cuff tear patients of either sex fitting the inclusion criteria at the orthopedic department of Sanjay Gandhi Institute of Trauma and Orthopedics, Bangalore from September 2016 to December 2017. Patients included were between 18 to 70yrs of age with MRI proven rotator cuff tear who underwent all arthroscopic rotator cuff repair and willing to participate in study. Exclusion criteria included associated shoulder lesions, revision rotator cuff repair, irreparable tears, acj arthritis and rotator cuff tear arthropathy. Patients admitted with MRI proven Rotator cuff tear after meeting the inclusion and exclusion criteria are selected for the study. They will undergo detailed history, clinical and radiological evaluation. Arthroscopic rotator cuff repair by single row or double row technique using suture anchors by a single trained surgeon. Postoperative rehabilitation as per standard protocol. Postoperative evaluation done at, 3rd month, 6th month and 1 year. Range of motion, UCLA and ASES scoring done at preoperative and postoperative follow-ups. Results: A Prospective study with 22 patients is undertaken to study the functional outcome of Arthroscopic rotator cuff repair. The mean age in our study is 53.5 years majority are in the age group 40 to 60yrs. Out of 22 patients, 13 were male, 9 were female. Major part of our study contained partial thickness tears (59.1%) rather than full thickness tears (40.9%). 81.8 % (18) patients in our study had traumatic tears and 18.2%(4) patients had degenerative tears. There is significant

Outcomes at 20 Years After Meniscectomy in Patients Aged 50 to 70 Years

To report the outcomes of arthroscopic meniscectomy (AM) at 20 years of follow-up through timing/rate of conversion to total knee replacement (TKR) and Knee Injury and Osteoarthritis Outcome Score (KOOS), focusing on detection of specific predictor variables for these outcomes, in patients 50 to 70 years old. We performed a retrospective study of 289 patients, ages at surgery 50 to 70 years, with diagnosis of degenerative meniscal tear who underwent arthroscopic meniscectomy. We collected the following baseline data: age, sex, injured meniscus (medial, lateral, or both), knee alignment, osteoarthritis (OA), associated lesion identified during arthroscopy, and associated procedure performed during arthroscopy. At 20 years of follow-up, we collected rate and timing of TKR conversion, and we evaluated clinical outcomes with KOOS. Female sex (P < .01), older age (P < .01), lateral meniscectomy (P= .02), malalignment (P= .03), and advanced chondral lesion (P < .01) were found to be significantly related to subsequent TKR. No significant correlation was found between amount of resection and subsequent TKR (P= .26). Negative predictor factors to obtain equal or superior to age- and sex-adjusted KOOS scores were age 60 to 70 years at time of AM (P= .03) and lateral meniscectomy (P= .02). We report a 15.7% conversion rate at 20 years from AM to TKR and a mean time between surgeries of 7 years. Subsequent TKR in the 20 years after AM for degenerative meniscus tears were significantly associated with preoperative OA and chondral lesion (Kellgren Lawrence 2; Outerbridge >2), lateral meniscectomy, age at surgery, female sex, and malalignment. Furthermore, age >60 years, lateral meniscectomy, and concurrent anterior cruciate ligament reconstruction were negative predictors for poor clinical outcomes at 20 years. Therefore, if patients present with negative predictor factors, the AM should not be proposed as second-line treatment, and nonoperative management should be continued until TKR is unavoidable. IV, case series.

Increased preoperative greater tuberosity angle does not affect patient-reported outcomes postarthroscopic rotator cuff repair.

BackgroundThe greater tuberosity angle (GTA) is a newly described radiological parameter identified in a 2018 study by Cunningham et al that sought to investigate the effect of GT morphology on cuff tears. Increased GTA has been conceptualized to affect rotator cuff pathology through both extrinsic and intrinsic mechanisms. GTA > 70° was highly predictive of a degenerative rotator cuff tear. This study seeks to examine if increased GTA predicts for worse functional outcomes 2 years postoperatively after arthroscopic rotator cuff repair.MethodsBetween May 2010 and December 2016, 169 patients who underwent arthroscopic rotator cuff repair with subacromial decompression were included in this study. GTA was measured on preoperative radiographs. These patients were evaluated preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Outcomes were assessed with the Visual Analog Scale Pain score, Constant Shoulder Score, and the Oxford Shoulder Score. Power analysis was performed based on the minimal clinically important difference of the Constant Shoulder Score. Statistical analysis was performed by dividing patients into two groups based on GTA: 1) ≤ 70 (control GTA); and 2) >70 (increased GTA) and comparisons were made between the 2 groups.ResultsThe patients’ demographics were comparable between both groups. All 169 patients had statistically significant improvements in all functional scores at 2 years postoperatively. There were no statistically significant differences between the two groups of patients in Visual Analog Scale and functional scores at 3 months, 6 months, 1 year, and 2 year postoperatively. The changes in functional scores from their preoperative baseline were also tabulated, and there were no statistically significant differences between the 2 groups. Finally, there was no significant correlation between GTA with CSS or Oxford Shoulder Score at 2 years follow-up.ConclusionThis study represents the largest single series available investigating the influence of GTA on midterm functional outcomes after arthroscopic rotator cuff repair. Although GTA remains a reliable radiographic predictor of rotator cuff tears, the authors conclude that increased GTA does not negatively influence midterm functional outcomes. As there is also no statistical significance between increased GTA vs. control in relative functional gain 2 years postoperatively, corrective tuberoplasty may not be mandatory during arthroscopic repair of cuff tears. Standard arthroscopic double-row rotator cuff repair with subacromial decompression can still be offered as a suitable treatment option.

Rotator cuff unloading versus loading exercise program in the conservative treatment of patients with rotator cuff tear: protocol of a randomised controlled trial

IntroductionAtraumatic and degenerative rotator cuff tears are common in individuals over 55 years of age. This condition can have a high impact on social life and is associated with chronic...

Is Second Metatarsal Protrusion Related to Metatarsophalangeal Plantar Plate Rupture?

OBJECTIVE. The purpose of this study was to determine whether the relative length of protrusion of the second metatarsal, measured on MRI and weight-bearing foot radiography, predicts the diagnosis of second metatarsophalangeal (MTP) joint plantar plate (PP) tear on MRI. MATERIALS AND METHODS. We retrospectively evaluated 166 consecutive patients (211 feet). Patients had undergone weight-bearing foot radiography and forefoot MRI. Using the Coughlin method, two independent observers measured second meta-tarsal protrusion length on radiography and MRI. MRI findings were classified as normal PP, complete PP tear, or degenerative or partial PP tear. RESULTS. Patients had a mean age of 47 ± 14.6 (SD) years, and 131 (78.9%) were women. MRI measurements were highly correlated with radiographic measurements (r = 0.882; 95% CI, 0.866-0.898; p < 0.001). A significant correlation was found between length of protrusion and cases classified as either normal PP or PP tear. Patients with a normal PP had a mean protrusion length of 4.11 ± 1.35 mm on radiographs and 2.61 ± 1.31 mm on MR images, whereas those with a PP tear had a mean protrusion length of 4.75 ± 1.53 and 3.05 ± 1.34 mm, respectively. ROC curve analysis showed that protrusion length cutoff values of 5.47 mm measured on radiographs and 3.17 mm on MR images were correlated with MTP PP tear. CONCLUSION. We identified a linear correlation between second metatarsal protrusion measured on MRI and that measured on radiography, with values about 35% higher for the latter. Our study showed an association between length of protrusion of the second metatarsal and PP rupture and identified a cutoff value for the second meta-tarsal overlength that is associated with these tears.

Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study.

Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears. We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported. Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.

Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears?

Several radiologic parameters representing scapular morphology have been proposed as risk factors for degenerative posterosuperior rotator cuff tear (PSRCT). The causes of PSRCT are multifactorial; many reported risk factors are compound entities. However, no determination, made after adjustment with previously reported risk factors, of which radiologic parameters are independent risk factors for degenerative PSRCT, has been reported. Therefore, this study's purpose was to determine which radiologic parameters representing scapular morphology are independent risk factors for degenerative PSRCT in a general population after adjustment with previously suggested risk factors. This study involved 629 subjects (629 shoulders) drawn from a cohort of rural residents. PSRCT diagnoses were based on magnetic resonance imaging findings. Logistic regression analysis was used to determine the odds ratios and 95% confidence intervals for the following variables: sex, age, height, weight, waist circumference, dominant-side involvement, smoking, alcohol consumption, manual labor, diabetes, hypertension, metabolic syndrome, thyroid dysfunction, serum lipid profile, high-sensitivity C-reactive protein, and radiologic parameters. The evaluated radiologic parameters were the superior displacement of the humeral head (SDHH) and those representing the scapular morphology. The radiologic parameters representing the scapular morphology were lateral acromial angle, acromial slope, acromial tilt, acromial index, and critical shoulder angle (CSA). Univariate logistic regression analyses for all variables, as well as multivariable logistic regression analyses for variables with significant associations and clinical effect sizes in the univariate logistic regression analyses, were performed. In order to determine the cutoff value for significant radiologic parameters, each pair of candidate cutoff values was obtained as follows: 1 candidate, as the lowest significant ordinal value in a univariate analysis, and the other candidate, according to a receiver operating characteristic curve analysis. Then, the cutoff values were determined by selecting the value in each candidate pair that had the larger area under the receiver operating characteristic curve, using the DeLong test. In the multivariable analyses, CSA was significantly associated with degenerative PSRCT after controlling for the following factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH (P ≤ .033). CSA (odds ratio, 1.58 [95% confidence interval, 1.45-1.72]; P < .001) was the only significantly associated radiologic parameter among the studied radiologic parameters representing scapular morphology. CSA (≥35°) is an independent associated factor for degenerative PSRCT after adjustment for the following suggested risk factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH.