Including Rotator Cuff Research Articles

Heterogeneous MR arthrography findings in patients with subacromial impingement syndrome – Diagnostic subgroups?

BackgroundSubacromial Impingement Syndrome (SIS) is frequently diagnosed, but treatment results vary greatly. It is increasingly reported that SIS symptoms are caused by various underlying mechanisms that need distinctive treatment strategies. We evaluated a set of specific MRI Arthrography (MRA) characteristics that have been related with underlying mechanisms for SIS in the literature, in patients with SIS. MethodsIn 47 patients diagnosed with SIS, MRA characteristics were evaluated and categorized into categories of potential underlying mechanisms: (1) extrinsic: e.g. acromion shape; (2) intrinsic: e.g. tendinosis; (3) dynamic: e.g. signs of glenohumeral (micro-)instability. Control values were obtained from the literature. With cluster analysis, potential patient subgroups were assessed. ResultsIn 17 (36.2%) patients originally diagnosed with SIS, specific other conditions were found, including rotator cuff tears and labrum lesions. In the remaining 30, all had positive signs of at least one of the predefined underlying mechanisms. Patients could be categorized into 2 groups: predominantly findings corresponding with extrinsic/structural causes, or with dynamic/(micro)instability. ConclusionsMRA characteristics in patients with SIS symptoms are heterogeneous and many patients have specific other shoulder conditions causing symptoms. Patients without specific other conditions have MRA characteristics associated with either extrinsic (structural), or dynamic (e.g. micro-instability) underlying mechanisms.

Results of Arthroscopically-Assisted Core Decompression for Avascular Necrosis of the Proximal Humerus

Objectives:Avascular necrosis (AVN) of the proximal humerus treatment is challenging. Early recognition and treatment prior to collapse may potentially prevent or delay subsequent progression. Arthroscopically-assisted core decompression of the proximal humerus is one treatment option for AVN. However, there is little published data regarding outcomes of this procedure. This study represents the largest-to-date cohort of patients who underwent arthroscopically-assisted core decompression of the proximal humerus.Methods:A retrospective review was performed to analyze the outcomes of patients who underwent arthroscopically-assisted core decompression for proximal humeral AVN. All patients had associated shoulder pain that had failed non-operative management. A comprehensive review of operative reports and imaging were examined to verify the use of an arthroscopically-assisted surgical technique without violation of the articular surface. Concomitant shoulder pathology was surgically addressed at the time of decompression. Patient charts were retrospectively reviewed for pre- and post-operative pain as well as shoulder range of motion. Pre-operative and post-operative x-rays were examined for evidence of progression of AVN lesions. A review of documentation for post-operative shoulder injections or repeat surgery was completed. Subjective American Shoulder and Elbow (ASES) outcomes were compared pre- and post-operativelyResults:Eleven consecutive patients and 13 consecutive shoulders were identified who underwent arthroscopically-assisted core decompression of the proximal humerus AVN by the two senior surgeons from 2004-2013. No patients were excluded. Six males and five females were identified with an average age of 45 years at surgery. Average follow-up length was 2.6 years. Four shoulders underwent synovectomy and core decompression alone. Concomitant procedures included rotator cuff repair in 5, subacromial decompression in 4, distal clavicle excision in 6, and biceps tenodesis in 1 shoulder(s). Radiographically, the majority of shoulders (8) remained stable without progressive sclerosis or collapse. Two shoulders demonstrated progressive sclerosis, and articular collapse was seen in 1 shoulder. The average pre-operative ASES score was 19.3, compared to 44.8 at post-operative follow-up (p=.001). Pre-operative shoulder elevation averaged 156 degrees, while post-operative range of motion averaged 170 degrees (p=.81). The majority of patients had mild or moderate pain pre-operatively, while 4 patients required narcotics for severe pre-operative pain. Visual analogue pain averaged 8.4 pre-operatively, compared to 4.9 at most recent follow-up (p=.0004). While post-operative pain initially improved in all patients, the majority of patients had return of mild, intermittent pain with longer follow-up. Two patients who took narcotics pre-operatively continued to require narcotics at final follow-up. Six shoulders had undergone therapeutic shoulder injections post-operatively. No patient had required repeat surgery.Conclusion:Arthroscopically-assisted core decompression is an option for the treatment of proximal humeral AVN. Visual analogue pain and ASES functional outcomes were reliably improved at average follow-up of 2.6 years. Three shoulders demonstrated radiographic AVN progression, while the majority of lesions remained stable. Six shoulders underwent post-operative injections for pain.

Weight training injuries: part 2: diagnosing and managing chronic conditions.

The repetitive nature of weight training and the often heavy loads involved provide fertile ground for chronic injuries. Common chronic injuries include rotator cuff tendinopathy and stress injuries to the vertebrae, clavicles, and upper extremities. In addition, muscle hypertrophy, poor technique, or overuse can contribute to nerve injuries such as thoracic outlet syndrome or suprascapular neuropathy. Chronic medical conditions that are known to occur in weight trainers include vascular stenosis and weight lifter's cephalgia. Management of chronic problems will vary by condition, but relative rest and correction of poor technique are important for many.

Arthritis at the shoulder joint.

The shoulder is a complex joint with numerous structures contributing to mobility and stability. Shoulder pain is a common clinical complaint that may be due to a wide spectrum of disorders including rotator cuff disease, instability, and arthropathy. Primary osteoarthritis of the shoulder joint is uncommon because it is a non-weight-bearing joint. Significant osteoarthritis of the glenohumeral joint is unusual in the absence of trauma, and the detection of advanced degenerative changes in patients without a known history of trauma should alert the clinician to search for other disorders. This article reviews the pathogenesis, clinical manifestations, and key imaging findings of the common categories of the arthritis affecting the glenohumeral joint.

Electromyographic analysis: shoulder muscle activity revisited.

Restoring optimal strength and biomechanics of a pathologic shoulder knowledge of activity patterns of healthy glenohumeral muscles is mandatory. Yet, data on normal shoulder muscle activity are not always conclusive. The study was undertaken (a) to evaluate muscle activity patterns in the healthy shoulder using surface and fine-wire electromyography (EMG), and (b) to assess method's suitability in the clinical setting especially regarding painfulness and practicability. Surface and fine-wire EMG was performed on 11 healthy subjects (2f/9 m, Ø age 28 years) to assess 14 muscles including rotator cuff muscles during 8 planar standardised shoulder movements (abduction, forward flexion, internal and external rotation in neutral, 45° and 90° abduction). Pain was assessed using the visual analogue scale before testing, after inserting the fine-wire electrodes, after maximal voluntary contraction, before and after exercises, and after electrode removal. The most important finding regarding EMG activity patterns in the healthy shoulder was that the subscapularis activity was found to play a major role in abduction and forward flexion. Furthermore, this study was able to show that EMG measurements, especially fine-wire EMG, is prone to high failure rates (up to 32%); however, pain was not a limiting factor. The present study (1) revealed a new insight, especially finding the subscapularis activity playing a major role in abduction and forward flexion of the healthy shoulder; and (2) motion analysis system and the use of fine-wire electrodes were prone to failure; however, pain was not a limiting factor. Basic Science, Electrodiagnostic Study.

Tennis injuries: epidemiology, pathophysiology, and treatment.

Tennis places high loads on the joints of players, with supraphysiologic forces being generated at the shoulder and elbow hundreds of times per match. Acute injuries tend to affect the lower extremity; chronic injuries usually involve the upper extremity. Commonly encountered upper extremity conditions include rotator cuff injury, internal impingement, superior labral tears, and epicondylitis of the elbow. Serving is the most strenuous stroke in tennis, with the highest peak muscle activity in the shoulder and forearm occurring during this stroke. The kinetic chain links upper extremity, lower extremity, and core muscle segments by transmitting coordinated activation and motion; in this regard, any pathologic process that disturbs the groin, hip, and abdominal musculature can further result in an increased risk of injury to the shoulder and upper extremity. Evolution in equipment and in play surfaces has also affected the type and frequency of injuries. Prevention programs that address the muscular imbalances throughout the kinetic chain may help reduce the incidence of both acute and chronic injuries experienced by tennis athletes.

Rehabilitation following rotator cuff repair: a survey of current UK practice.

Rotator cuff disorders, including rotator cuff tears, are common and can be treated conservatively or surgically. Data suggest that the incidence of surgery to repair the rotator cuff is rising. Despite this rise, the most effective approach to postoperative rehabilitation, a critical component of the recovery process, is not well developed. The present study aimed to describe current practice in the UK in relation to rehabilitation following rotator cuff repair. An electronic survey was developed and disseminated to UK based physiotherapists and surgeons involved with rotator cuff repair. One hundred valid responses were received. Although there is a degree of variation, current practice for the majority of respondents consists of sling immobilization for 4 weeks to 6 weeks. During this time, passive movement would be commenced before active movement is introduced towards the end of this phase. Resisted exercise begins 7 weeks to 12 weeks postoperatively, alongside return to light work. A progressive resumption of function, including manual work and sport, is advised from approximately 13 weeks. In the context of the current literature, it might be suggested that the current approach to rehabilitation following rotator cuff repair for the majority of respondents is somewhat cautious and has not progressed for over a decade.

Laminar Tendon Composites with Enhanced Mechanical Properties.

A strong isotropic material that is both biocompatible and biodegradable is desired for many biomedical applications, including rotator cuff repair, tendon and ligament repair, vascular grafting, among others. Recently, we developed a technique, called "bioskiving" to create novel 2D and 3D constructs from decellularized tendon, using a combination of mechanical sectioning, and layered stacking and rolling. The unidirectionally aligned collagen nanofibers (derived from sections of decellularized tendon) offer good mechanical properties to the constructs compared with those fabricated from reconstituted collagen. In this paper, we studied the effect that several variables have on the mechanical properties of structures fabricated from tendon slices, including crosslinking density and the orientation in which the fibers are stacked. We observed that following stacking and crosslinking, the strength of the constructs is significantly improved, with crosslinked sections having an ultimate tens ile strength over 20 times greater than non-crosslinked samples, and a modulus nearly 50 times higher. The mechanism of the mechanical failure mode of the tendon constructs with or without crosslinking was also investigated. The strength and fiber organization, combined with the ability to introduce transversely isotropic mechanical properties makes the laminar tendon composites a biocompatiable material that may find future use in a number of biomedical and tissue engineering applications.

Evaluation of muscular activity duration in shoulders with rotator cuff tears using inertial sensors and electromyography

Shoulder disorders, including rotator cuff tears, affect the shoulder function and result in adapted muscle activation. Although these adaptations have been studied in controlled conditions, free-living activities have not been investigated. Based on the kinematics measured with inertial sensors and portable electromyography, the objectives of this study were to quantify the duration of the muscular activation in the upper trapezius (UT), medial deltoid (MD) and biceps brachii (BB) during motion and to investigate the effect of rotator cuff tear in laboratory settings and daily conditions. The duration of movements and muscular activations were analysed separately and together using the relative time of activation (TEMG/mov). Laboratory measurements showed the parameter’s reliability through movement repetitions (ICC > 0.74) and differences in painful shoulders compared with healthy ones (p < 0.05): longer activation for UT; longer activation for MD during abduction and tendency to shorter activation in other movements; shorter activation for BB. In daily conditions, TEMG/mov for UT was longer, whereas it was shorter for MD and BB (p < 0.05). Moreover, significant correlations were observed between these parameters and clinical scores. This study thus provides new insights into the rotator cuff tear effect on duration of muscular activation in daily activity.

Humeral Stress Edema

Stress injury to the distal humerus has been reported as a cause of chronic arm pain among competitive tennis players. As the serve is technically similar to an overhead throwing motion, it is conceivable that this injury could occur in other overhead athletes. Overuse injuries, including rotator cuff tears, ulnar collateral ligament injuries, and joint sprains have routinely been reported in quarterbacks, but there are few reported cases of upper extremity bony stress injuries in these athletes. Magnetic resonance imaging aids in the diagnostic evaluation of an upper extremity injury as it can identify numerous structural injuries and early stress changes within bone. Accurately diagnosing stress reactions helps prevent progression toward stress fracture, which is possible if conservative measures are initiated early in the rehabilitation period. In this article, we report the case of an elite college quarterback who presented with localized elbow pain while throwing.

Reliability and validity of the Finnish version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section.

BackgroundThe American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is one of the most widely used shoulder outcome tools in clinical work and in scientific studies. However, it has not been validated in the Finnish language. The aims of this study were to cross-culturally adapt the ASES to the Finnish language and to study the psychometric properties of the self-report section of the ASES.MethodsA total of 105 patients with shoulder symptoms answered the questionnaires of the ASES, a single disability question, the Simple Shoulder Test (SST), and the Short-Form 36 Health Survey (SF-36). The reliability of the ASES questionnaire was studied using a test-retest procedure at 2-week intervals. Psychometric assessment was performed by testing the construct validity, internal consistency, the criterion validity, and the convergent validity of the ASES.ResultsThe reproducibility and internal consistency of the ASES were 0.83 (95% CI 0.70 to 0.90) and 0.88 (95% Cl 0.84 to 0.91). There were no significant differences between the diagnostic groups in the pain scores from the ASES, and the function score was significantly higher in the instability group compared to the other groups. The convergent validity of the ASES correlated with the SST, r = 0.73 (p < 0.001); the single disability question, r = -0.74 (p < 0.001); and the Physical Component Score of the SF-36, r = 0.57 (p < 0.001).ConclusionsThe Finnish version of the ASES proved to be a reliable and valid tool for assessing shoulder disabilities in patients with different shoulder diagnoses, including rotator cuff disease, instability, and osteoarthritis.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-272) contains supplementary material, which is available to authorized users.

Scapular Winging: A Great Masquerader of Shoulder Disorders: AAOS Exhibit Selection.

The incidence of scapular winging is unclear, but it may be more common than previously thought. It can be difficult to diagnose because the presenting complaint and physical examination may direct the practitioner toward more common shoulder and neck conditions. Ongoing scapular dysfunction may result in inappropriate or failed surgery. Our goals were to (1) describe the common misdiagnoses (instability, labral abnormality, impingement, and cervical spine disease), the clinical scenarios and examination findings leading to diagnostic difficulty, the definitive treatment options available, and the clinical outcomes and complications; and (2) review the important aspects of the patient history, physical examination of the scapula, and associated studies necessary to make the correct diagnosis of scapular winging. We reviewed the literature relative to, and our own experience with, the treatment of scapular winging and identified a series of patients with this condition who were initially misdiagnosed with other shoulder or spine abnormalities. In our literature search, only nine clinical studies reported on a series of patients with scapular winging that was initially misdiagnosed or had a delay in diagnosis (n = 53 patients). We examined these cases for presenting or preexisting diagnoses and for surgical procedures that had been performed before the diagnosis of scapular winging. For patients ultimately diagnosed with scapular winging, initial presentations and diagnoses included rotator cuff disorders (20%), glenohumeral instability (8%), peripheral nerve disorders (6%), cervical spine disease (6%), acromioclavicular disorders (6%), thoracic outlet syndrome (4%), and unknown or unspecified (41%). The most common surgical procedures performed before definitive scapular winging treatment were rotator cuff (22%), instability (22%), nerve (14%), acromioclavicular (12%), cervical spine (5%), and thoracic outlet (4%) procedures. Clinically, scapular winging often mimics more common shoulder abnormalities and can result in unnecessary or unsuccessful surgical procedures. Diagnosis can be readily achieved with simple physical examination and specific provocative maneuvers in conjunction with electromyography and nerve conduction studies. Prompt diagnosis and recognition can avoid substantial shoulder dysfunction.

Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: A Comparison of Minimum Two Year Clinical Outcomes

Objectives:While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis. The goal of this study is to compare the clinical outcomes of open subpectoral biceps tenodesis and arthroscopic suprapectoral tenodesis. Our null hypothesis is that both methods yield satisfactory results with regards to shoulder and biceps function, postoperative shoulder scores, pain relief and complications.Methods:Retrospective cohort study. Patients who underwent either arthroscopic suprapectoral or open subpectoral biceps tenodesis for superior labral or long head biceps pathology with a minimum follow-up of 2 years were included in the study. Patients were excluded if they underwent significant additional shoulder procedures, including rotator cuff repair or procedures to address glenohumeral instability, if there was significant pre-operative range of motion deficits due to frozen shoulder or glenohumeral arthritis, or if they had significant contralateral shoulder pathology or surgery. Subjects were evaluated with several clinical outcome measures and physical examination including range of motion and strength. Range of motion and strength measurements were normalized to the asymptomatic contralateral limb. Power analysis indicated that a minimum of 17 subjects were required in each group (34 total) to determine a clinically meaningful difference in the outcome measures.Results:Between 2007 and 2011, 79 patients met all inclusion and exclusion criteria, which included 30 arthroscopic suprapectoral tenodesis (ASPBT) patients and 49 open subpectoral biceps tenodesis (OSPBT) patients. 23 of 30 (76.7%) ASPBT and 28 of 49 (57.1%) OSPBT patients completed clinical follow-up at an average of 3.1 year postoperative (range 2.2 - 4.3 years). The cohorts were similar in terms of age, gender, BMI, smoking and workers compensation status. Overall outcomes for both procedures were satisfactory. No significant differences were noted in post-operative Constant Murley (ASPBT: 89, OSPBT: 92, p = 0.567), ASES (ASPBT: 89, OSPBT: 88, p = 0.845), SANE (ASPBT: 86, OSPBT: 86, p = 0.982), SST (ASPBT: 10, OSPBT: 10, p = 0.597), LHB Score (ASPBT: 91, OSPBT: 94, p = 0.329), or VR-36 (ASPBT: 80, OSPBT: 79, p = 0.833). No significant range of motion or strength differences (expressed as percent of asymptomatic contralateral limb) were noted between procedures. (Table I).Conclusion:Arthroscopic suprapectoral and open subpectoral biceps tenodesis both yield excellent clinical and functional results for the management of isolated superior labrum or long head biceps pathology. No significant differences in clinical outcomes as determined by several validated outcomes measures were found between the two tenodesis methods, nor were any range of motion or strength deficits noted at minimum two-years post-operatively.

Role of radiographs in shoulder pathology: a clinical review

Role of radiographs in shoulder pathology: a clinical review Oded Hershkovich,1&ndash;3,* Shachar Shapira,1&ndash;3,* Yaron Sela,1,3 Itamar B Botser1,31Department of Orthopedic Surgery, Chaim Sheba Medical Center, 2Medical Corps, Israeli Defense Forces, Tel Hashomer, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel*SS and OH contributed equally to this workAbstract: Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries.Keywords: shoulder, pain, pathology, imaging, radiographs

Incidence of familial tendon dysfunction in patients with full-thickness rotator cuff tears.

BackgroundA familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls.MethodsNinety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P<0.05 was considered significant).ResultsThe average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005).ConclusionIndividuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies.

Platelet-rich therapies for musculoskeletal soft tissue injuries.

Platelet-rich therapies for musculoskeletal soft tissue injuries.

MRI FINDINGS IN THE SHOULDER OF COMPLETELY ASYMPTOMATIC ADOLESCENT ELITE TENNIS PLAYERS

BackgroundShoulder pathology in adult tennis players including rotator cuff pathology is well known. However, early adaptations have not previously been studied in the adolescent elite tennis players.ObjectivesTo describe magnetic resonance...

Arthroscopic findings of coexisting lesions with greater tuberosity fractures.

Proximal humerus fractures comprise approximately 5% of all fractures, with isolated greater tuberosity fractures accounting for approximately 20% of proximal humerus fractures. Although performing shoulder arthroscopy in situations including a fracture is technically demanding, it allows surgeons the opportunity to identify and treat other coexisting lesions that could have otherwise been missed. The incidence of these pathologies in combination with greater tuberosity fractures has not been established. This study aimed to identify the various types of pathologies that may coexist with greater tuberosity fractures but not be detected before fixation. Displaced 2-part greater tuberosity fractures were treated arthroscopically in the authors' department. All patients initially underwent diagnostic arthroscopy during which other coexisting pathologies were detected and assessed, including rotator cuff tears, labral tears (Bankart or superior labral anterior posterior lesions), or long head of the biceps pathologies. Twenty-four patients underwent arthroscopic (n=10) or arthroscopic-assisted (n=14) greater tuberosity reduction and fixation. Thirteen (54.2%) fragments were fully displaced. Four (16.7%) patients had fracture dislocation of the glenohumeral joint. The concomitant soft-tissue pathologies were identified and treated arthroscopically in 22 (92%) patients. Arthroscopic evaluation before greater tuberosity fracture fixation revealed a high percentage of concomitant soft tissue pathologies. These pathologies may be overlooked otherwise, but they are easily detected arthroscopically, enabling their treatment during the same procedure.

Biceps tenodesis is a viable option for salvage of failed SLAP repair

Outcomes of arthroscopic superior labral anterior-posterior (SLAP) repairs have been well reported with generally favorable outcomes. Unfortunately, a percentage of patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment. The purpose of this study was to evaluate the surgical outcomes of biceps tenodesis for failed SLAP repairs. A retrospective review of all patients undergoing biceps tenodesis was completed. Inclusion criteria were previous SLAP repair and subsequent revision biceps tenodesis. Exclusion criteria were additional shoulder procedures including rotator cuff repair, instability procedures, and preoperative frozen shoulder. Objective outcomes were postoperative assessments with Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 36-Item Health Survey. Physical examination was conducted to determine postoperative range of motion and strength compared with the nonoperative shoulder. A cohort of 24 patients was identified, and of these, 17 patients (71%) completed the study at 2 years' follow-up. The average postoperative Constant score was 84.4; American Shoulder and Elbow Surgeons score, 75.5; Single Assessment Numeric Evaluation score, 73.1%; Simple Shoulder Test score, 9.2; and Veterans RAND 36-Item Health Survey score, 76.1. Postoperative range of motion of the operative shoulder returned to near that of the asymptomatic nonoperative shoulder. Workers' compensation status led to inferior results. Options for patients with a failed prior SLAP repair are limited. As a salvage operation for failed SLAP repair, biceps tenodesis serves the majority of patients well, with favorable outcomes by validated measures and excellent shoulder range of motion and elbow strength at 2 years' follow-up. Workers' compensation status may predispose patients to poorer outcomes.

Platelet-Rich Plasma for Zone II Flexor Tendon Repair

Platelet-rich plasma (PRP) has shown promise in the treatment of tendinopathy, including rotator cuff and lateral epicondylitis. Here, we evaluate the effect of PRP on healing in a rabbit zone II flexor tendon model. Thirty New Zealand white rabbits underwent transection and repair of the second and fourth flexor digitorum profundus. Half of the rabbits received autologous PRP intraoperatively, while the other half underwent standard four-strand tendon repair. Tendons were examined at 2, 4, and 8weeks postoperatively. Range of motion and ultimate tensile strength were assessed on the fourth toes, while second toes underwent histologic analysis with hematoxylin and eosin, Masson Trichrome, and Picrosirius Red, for assessment of cell count, collagen content, and collagen maturity. There were no significant differences in ultimate tensile strength between treatments at 2, 4, or 8weeks. There was a trend towards lower tensile strength in the PRP group at 2weeks. There was no statistically significant difference in excursion or range of motion between PRP and control tendons. Cell counts at 4weeks were statistically significantly reduced in the PRP tendons as compared to controls. No difference in collagen content or maturity was detected. In contrast to previous studies, PRP did not significantly improve ultimate tensile strength. PRP-treated tendons exhibited trends towards reduced healing, including a significant reduction in cell counts as well as a smaller increase in collagen deposition over time as compared to controls. Further study is needed to determine the precise effect of PRP on intrasynovial flexor tendon repairs.