Medial Tears Research Articles

Repair Integrity and Functional Outcomes After Arthroscopic Suture-Bridge Rotator Cuff Repair

We evaluated the clinical and imaging outcomes of arthroscopic suture-bridge repair of full-thickness rotator cuff tears. From May 2007 to April 2008, seventy-nine patients with a full-thickness rotator cuff tear consecutively underwent arthroscopic suture-bridge repair. The mean age of the patients was 58.3 years (range, thirty-eight to seventy-eight years), and the mean duration of follow-up was 30.6 months (range, twenty-four to forty-four months). Seventy-three patients underwent postoperative ultrasonography or magnetic resonance imaging; seventy-one underwent the imaging at a minimum of two years postoperatively, and the remaining two did so after the operation because of persistent symptoms. The clinical results of seventy-seven patients (all except two who had undergone revision) were evaluated at a minimum of two years postoperatively. University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were used for clinical and functional evaluations before surgery and at the time of final follow-up. The imaging follow-up rate was 92%, and the follow-up rate for clinical evaluation was 100%. The re-tear rate after suture-bridge repair was 15%. The re-tear rate of the medium, large, and massive tears (as classified according to the anterior-to-posterior diameter of the tear) was 12%, 21%, and 22%, respectively. Massive and large tears tended to show a higher re-tear rate than did medium tears, but the difference was not significant (p = 0.417 and p = 0.964, respectively). The mean UCLA, ASES, and Constant-Murley scores improved from 21.6, 50.4, and 52.7 preoperatively to 30.9, 86.2, and 74.7 at the time of final follow-up (p < 0.001). However, the clinical outcomes after the operation did not differ significantly between the patients who had healing of the tear and those who did not (p = 0.438, p = 0.625, and p = 0.898 for the UCLA, ASES, and Constant-Murley scores, respectively). Arthroscopic suture-bridge repair of full-thickness rotator cuff tears was followed by a re-tear rate of 15% as seen with imaging and resulted in significant improvement of functional outcomes and clinical results compared with the preoperative findings.

A Load-Sharing Rip-Stop Fixation Construct for Arthroscopic Rotator Cuff Repair

Despite advancements in arthroscopic rotator cuff repair techniques, achieving tendon-to-bone healing can be difficult in the setting of poor-quality tendon. Moreover, medial tendon tears or tears with lateral tendon loss may preclude standard techniques. Rip-stop suture configurations have been shown to improve load to failure compared with simple or mattress stitch patterns and may be particularly valuable in these settings. The purpose of this report is to describe a technical modification of a rip-stop rotator cuff repair that combines the advantages of a rip-stop suture (by providing resistance to tissue cutout) and a double row of load-sharing suture anchors (minimizing the load per anchor and therefore the load per suture within each anchor).

Multimodal and interdisciplinary management of an isolated partial tear of the posterior cruciate ligament: a case report

ObjectiveThe purpose of this case report is to describe the evaluation and conservative management of an isolated posterior cruciate ligament (PCL) tear. Clinical FeaturesA 32-year-old man with a traumatic right knee injury after tripping was initially diagnosed with medial patellar retinaculum tear at a multidisciplinary clinic. The patient received physiotherapy but reinjured the knee after returning to the sports field 3 weeks later. Subsequent clinical testing and magnetic resonance imaging confirmed a grade II isolated PCL tear. Intervention and OutcomeFollowing the PCL tear diagnosis, a multimodal treatment approach over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and an exercise program emphasizing eccentric muscle action was implemented. Lunges, 1-leg squats, and trunk stabilization exercises were extensively used. Three months postinjury, the patient successfully returned to sports activity with no further complications. ConclusionThe patient in this case report demonstrated successful return to preinjury functional status. This case highlights a multidisciplinary approach through the utilization of chiropractic, physiotherapy, and exercise therapies.

Reparação artroscópica de lesões pequenas e médias do tendão do músculo supraespinal: avaliação dos resultados clínico-funcionais após dois anos de seguimento

OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136o, lateral rotation of 58o and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156o with an average gain of 20o, and the average final lateral rotation was 57o with an average gain of 9o. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Treatment of Meniscus Tears During Anterior Cruciate Ligament Reconstruction

To define the incidence of meniscectomy, meniscus repair, and meniscus tears left in situ during anterior cruciate ligament (ACL) reconstruction. A systematic search of PubMed and 7 sports medicine journal databases was performed to determine the treatment of meniscus tears during ACL reconstruction. Inclusion criteria were English language, publication in the last 10 years, clinical trials, all evidence levels, and skeletally mature or immature knees. Exclusion criteria were revision ACL reconstruction, concomitant ligament reconstruction, and studies with exclusion or inclusion criteria regarding meniscus surgery during ACL reconstruction. Of 634 articles identified, 159 met the inclusion criteria, encompassing 19,531 patients. There were 11,711 meniscus tears; they were treated by meniscectomy in 65% (7,621 tears), treated by repair in 26% (3,022 tears), or left in situ in 9% (1,068 tears). Only 19 studies analyzed the treatment of meniscus tears according to the tibiofemoral compartment. These reported medial compartment tears were treated by meniscectomy in 63%, treated by repair in 27%, and left in situ in 9%. Lateral compartment tears were treated by meniscectomy in 71%, treated by repair in 14%, and left in situ in 14%. Only 24 studies identified the type of meniscus repair procedure performed. In 33 studies (21%) repair was performed more frequently than meniscectomy. Meniscectomy is performed 2 to 3 times more frequently than meniscus repair during ACL reconstruction. We were unable to analyze the effect of the location and type of meniscus tear, sex, age, or chronicity of injury on the treatment of meniscus tears. The number of potentially repairable meniscus tears that were treated by resection could not be identified. This study found that meniscectomy was performed in 65% of meniscus tears. This is concerning because studies have shown that, regardless of knee stability obtained after ACL reconstruction, meniscectomy accelerates degenerative joint changes. Level IV, systematic review of Level I to IV studies.

Changes in tendon length with increasing rotator cuff tear size

To investigate the change in tendon length with increasing size of rotator cuff tears in patients receiving arthroscopic rotator cuff repair. This is a prospective evaluation of 100 consecutive patients who met the inclusion criterion of a U-shaped or crescent-shaped full-thickness tear and who were treated by arthroscopic rotator cuff (supraspinatus and/or infraspinatus) repair from 2009 to 2010. The anterior-to-posterior dimension of the cuff tear was estimated under arthroscopic guidance, and the medial-to-lateral dimension was estimated on pre-operative MRI. The tendon length, from its distal end to the musculotendinous junction, was estimated under arthroscopic observation after arthroscopic rotator cuff repair. The relationships between tendon length and the anterior-to-posterior and medial-to-lateral dimensions of the cuff tear were analyzed. The average tendon length in patients with full-thickness tears was 17.0 mm. The tendon length decreased significantly with an increase in cuff tear size, for both the anterior-to-posterior (r = -0.328, P = 0.001) and medial-to-lateral dimensions (r = -0.681, P < 0.001). When the full-thickness tears were grouped according to the lengths of the anterior-to-posterior and medial-to-lateral dimensions, tendon length differed significantly among the groups (P = 0.008 and P < 0.001, respectively). In full-thickness tears, the rotator cuff tendon length decreased with increases in the anterior-to-posterior and medial-to-lateral dimensions of the tear size, with a higher correlation between tendon length and the medial-to-lateral dimension. During arthroscopic rotator cuff repair, passing a suture too medially for complete footprint coverage using a strong fixation technique can lead to excess tension and medial cuff tears. II.

Longitudinal Tear of the Medial Meniscus Posterior Horn in the Anterior Cruciate Ligament–Deficient Knee Significantly Influences Anterior Stability

Background: Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees. Hypothesis: An MMPH tear in an ACL-deficient knee increases the anterior-posterior tibial translation and rotatory instability. In addition, MMPH repair will restore the tibial translation to the level before the tear. Study Design: Controlled laboratory study. Methods: Ten human cadaveric knees were tested sequentially using a custom testing system under 5 conditions: intact, ACL deficient, ACL deficient with an MMPH peripheral longitudinal tear, ACL deficient with an MMPH repair, and ACL deficient with a total medial meniscectomy. The knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 134-N anterior and 200-N axial compressive tibial load. The rotatory kinematics were also measured at 15° and 30° of flexion in a combined rotatory load of 5 N·m of internal tibial torque and 10 N·m of valgus torque. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90° (P < .05). An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60° compared with the ACL-deficient/MMPH tear state (P < .05). The total anterior-posterior translation of the ACL-deficient/MMPH repaired knee was not significantly increased compared with the ACL (only)–deficient knee but was increased compared with the ACL–intact knee (P > .05). A total medial meniscectomy in an ACL-deficient knee did not increase the anterior-posterior tibial translation significantly compared with MMPH tears in ACL-deficient knees at all flexion angles (P > .05). In a combined rotatory load, tibial rotation after MMPH tears or a total medial meniscectomy in an ACL-deficient knee were not affected significantly at all flexion angles. Conclusion: This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. MMPH repair significantly improved anterior-posterior tibial translation in ACL-deficient knees. Clinical Relevance: These findings may help improve the treatment of patients with ACL and MMPH longitudinal tear by suggesting that the medial meniscal repairs should be performed for greater longevity when combined with an ACL reconstruction.

Patellar Tendon Reconstruction with Semitendinosus-Gracilis Autograft

We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. An uneventful postoperative course was complicated by a fall onto a flexed knee and rerupture of the patellar tendon at 3 months following surgery. Intraoperatively, a significant tissue void was seen in the area of the prior repair. The patellar tendon was reconstructed with semitendinosus and gracilis autograft. At 1 year follow-up, the patient had regained a normal gait, had no pain, and had full range-of-motion without extensor lag.

An experimental study of COMP (cartilage oligomeric matrix protein) in the rabbit menisci

Secondary knee osteoarthritis (OA) is currently associated with meniscal injuries, but the pathogenesis is unclear. We analyzed the distribution of cells and cartilage oligomeric matrix protein (COMP) and its changes in the early stages of degeneration in meniscus. Ten New Zealand rabbits underwent anterior cruciate ligament (ACL)-transection of the right knee-joint. Left knee-joints were used as controls. The animals were killed at 4 and 12weeks. Gross injuries in meniscus and articular cartilage were scored. Meniscal tissues were immunostained with a specific antibody against COMP, with Ki-67, using TUNEL-assay and alcian blue stain. The number of cells was counted. At 4weeks post-ACL-transection, 2/5 of the operated knees showed articular damages and medial menisci tears. Menisci showed a weak increase of cells, higher in cells under division and an increase of apoptosis, COMP and proteoglycans. At 12weeks, 5/5 of the medial menisci and 2/5 of lateral menisci presented tears, and osteoarthritic changes were seen in the cartilage of all the operated knees. Meniscal cells reverted to normal number, while active cell division decreased below normal, apoptotic events were still high, COMP remained elevated, and glycosaminoglycans were even more elevated. Extracellular matrix changes and altered cell distribution occur early in the degenerative meniscus. There is a close relationship between changes in the articular cartilage and the menisci at the onset of secondary OA.

Elbow Injury- Pull Ups

HISTORY: A 59-year-old right hand dominate male presented to our orthopedic clinic with complaints of pain on the medial side of his left elbow. He had no previous problems with this elbow until two weeks before his office visit. On that day he was doing a pull up on a standard pull up bar with his hands supinated when he felt a pop with immediate onset of pain in his medial, left elbow. The pain was severe enough that he had to stop working out. He continued to have medial elbow pain with any axial load to his forearm. He had no parasthesias. He was in good health with no systemic illnesses. PHYSICAL EXAMINATION: Upon physical exam he was in no acute distress. When comparing both upper extremities, there was no atrophy, deformity, ecchymosis or swelling of his upper extremity. He had some tenderness over the medial epicondyle. He was also tender 1.5cm distal to his medial epicondyle in the flexor mass, but this tenderness was proximal to the sublime tubercle of the ulna. The patient's elbow motion was 10 to 140 degrees. His medial collateral ligament was intact with no pain to valgus stress testing with the elbow in full extension, 30 degrees and 90 degrees of flexion. He was neurologically intact for all sensory and motor peripheral nerves in both upper extremities. He had full strength to resisted wrist flexion and this testing did not provoke his pain. He had a negative Tinel's at the elbow. DIFFERENTIAL DIAGNOSIS Medial Epicondylitis Tear of the Flexor Mass Ulnar Collateral Ligament Strain Fracture of the medial epicondyle Subluxation of ulnar nerve TESTS AND RESULTSPlain radiographs of the elbow including anterior-posterior and lateral view No abnormalities, medial epicondyle intact Magnetic Resonance Imaging High-grade partial tear of the common flexor attachment at the medial epicondyle with mild myotendenious strain of the pronator teres. The ulnar collateral ligament was intact. FINAL/WORKING DIAGNOSIS: Partial avulsion of the flexor-pronator mass, strain of the pronator teres TREATMENT AND OUTCOMESAllowed full range of motion of elbow but was restricted form weight lifting until follow up at six weeks. Allowed to increase weights to forearm at 6 weeks; advised to not do pull-ups Followed periodically in office until resolution of symptoms and return to sports at 6 months

Revision Arthroscopic Rotator Cuff Repair: A Prospective Study (SS-13)

Introduction We examined the results of revision arthroscopic rotator cuff repairs in a prospective series performed at a single institution. Methods A prospective case series was conducted of revision arthroscopic rotator cuff repairs performed at our institution, from January 1, 2004, to July 1, 2007. Both the index surgery and revision surgeries had to have been carried out at our institution for inclusion in the study. Magnetic resonance imaging (MRI) confirmation of all index tears and subsequent tears were documented prior to surgery. Prospective data collection was obtained preoperatively and postoperatively at 1 week, 6 weeks, 3 months, 6 months and annually thereafter. All patients were evaluated preoperatively and postoperatively using the Constant-Murley shoulder scoring system. Patient demographics were recorded, as were tear size, selected risk factors (tobacco use, workers' compensation, and diabetes), and physical examination. Results There were 2356 rotator cuff repairs at our institution during this time period. Seventy-eight of these patients underwent revision repair. Nine patients were excluded due to lack of adequate follow-up. This left 75 revision arthroscopic rotator cuff repairs in 69 patients available for review. Thirty males and 39 females with a mean age of 53 years (29-78 years) were followed for a mean of 36 months (24-70 months). The revision repair time interval varied from 3 weeks to 55 months (mean 9.7 months). At the time of revision surgery there were 35 small tears, 11 medium tears, 17 large tears, and 12 massive tears identified. In only eight of the revision cases was the rotator cuff tear larger than the index tear. Overall, no statistical difference was found between rotator cuff tear size at the index procedure and at revision surgery (p Conclusion Revision arthroscopic rotator cuff repair resulted in 67% good or excellent outcomes with significant improvement in motion and function as demonstrated by the Constant-Murley shoulder score. Those patients with combined risk factors had poorer functional outcomes. Our review demonstrates that overall shoulder function and symptoms do significantly improve after arthroscopic revision rotator cuff repair.

Análise comparativa do resultado da sutura artroscópica da lesão do manguito rotador em pacientes fumantes e não fumantes

OBJETIVO: Analisar de forma comparativa o resultado da sutura artroscópica da lesão do manguito rotador em pacientes fumantes e não fumantes. MÉTODOS: Foi analisado um grupo de 286 pacientes submetidos à sutura artroscópica de uma lesão primária do manguito rotador no período de 12 de junho de 2002 a 14 de maio de 2008. Os pacientes incluídos no estudo foram avaliados pela escala de UCLA com um seguimento mínimo de 12 meses e médio de 56,52 meses. As variáveis estudadas foram: idade, sexo, lado operado, dominância, perfil de uso de cigarros e índice de UCLA. RESULTADOS: O estudo avaliou um total de 205 pacientes. Foi analisada estatisticamente a média de idade (p = 0,289) e o sexo (p = 0,124) entre o grupo de pacientes fumantes e não fumantes e ambos foram considerados semelhantes. Quando analisamos os pacientes não fumantes (143), verificamos um UCLA médio de 34 (32 a 35). Quando analisamos os pacientes fumantes (51), verificamos um UCLA médio de 33 (29-35). Não houve diferença estatisticamente significativa quando foi avaliado de forma comparativa o UCLA de pacientes não fumantes com o de pacientes fumantes (p = 0,123). Para fins de análise estatística agrupamos as lesões pequenas e médias (107) e comparamos com as grandes e extensas (80) entre pacientes fumantes e não fumantes. Não houve diferença estatisticamente significativa pelo teste de Mann-Whitney quando foi avaliado de forma comparativa o UCLA de lesões pequenas e médias (p = 818). Houve diferença estatisticamente significativa pelo teste de Mann-Whitney quando foi avaliado de forma comparativa o UCLA de lesões grandes e extensas entre os pacientes não fumantes e fumantes, sendo que os pacientes não fumantes apresentaram melhor UCLA (p = 0,038). CONCLUSÃO: O resultado da sutura artroscópica das lesões grandes e extensas do manguito rotador é inferior em pacientes fumantes.

COMPARATIVE ANALYSIS ON THE RESULT FOR ARTHROSCOPIC ROTATOR CUFF SUTURE BETWEEN SMOKING AND NON-SMOKING PATIENTS

Objective: To comparatively analyze the results from arthroscopic rotator cuff suture between smoking and non-smoking patients. Methods: A group of 286 patients who underwent arthroscopic suturing of primary rotator cuff injuries between June 12, 2002, and May 14, 2008, was analyzed. The patients included in the study were evaluated using the UCLA scale, with a minimum follow-up of 12 months and average of 56.52 months. The variables studied were age, sex, side operated, dominance, profile of cigarette use and UCLA index. Results: This study evaluated a total of 205 patients. Mean age (p = 0.289) and sex (p = 0.124) were analyzed statistically between the smoking and non-smoking patients and the two groups were considered to be similar. The average UCLA score for the non-smoking patients (143) was 34 (32 to 35). The average UCLA score for the smoking patients (51) was 33 (29 to 35). There was no statistically significant difference in UCLA score (p = 0.123) between the smoking and non-smoking patients. For the purposes of statistical analysis, we grouped the small and medium tears (107) and compared these with the large and extensive tears (80), between smokers and non-smokers. There was no statistically significant difference using the Mann-Whitney test regarding the small and medium tears (p = 818). There was a statistically significant difference using the Mann-Whitney test regarding the large and extended tears, between the smoking and non-smoking patients, such that the non-smokers showed better UCLA scores (p = 0.038). Conclusion: The results from arthroscopic suturing of large and extensive rotator cuff injuries are inferior among smoking patients.

Fourier transform infrared spectroscopic analysis of normal and torn rotator-cuff tendons

We have used Fourier transform infrared spectroscopy (FTIR) to characterise the chemical and structural composition of the tendons of the rotator cuff and to identify structural differences among anatomically distinct tears. Such information may help to identify biomarkers of tears and to provide insight into the rates of healing of different sizes of tear. The infrared spectra of 81 partial, small, medium, large and massive tears were measured using FTIR and compared with 11 uninjured control tendons. All the spectra were classified using standard techniques of multivariate analysis. FTIR readily differentiates between normal and torn tendons, and different sizes of tear. We identified the key discriminating molecules and spectra altered in torn tendons to be carbohydrates/phospholipids (1030 cm(-1) to 1200 cm(-1)), collagen (1300 cm(-1) to 1700 cm(-1) and 3000 cm(-1) to 3350 cm(-1)) and lipids (2800 cm(-1) to 3000 cm(-1)). Our study has shown that FTIR spectroscopy can identify tears of the rotator cuff of varying size based upon distinguishable chemical and structural features. The onset of a tear is mainly associated with altered structural arrangements of collagen, with changes in lipids and carbohydrates. The approach described is rapid and has the potential to be used peri-operatively to determine the quality of the tendon and the extent of the disease, thus guiding surgical repair.

Arthroscopic Repair of Rotator Cuff Tears Using Absorbable Anchors with a Single-Row Technique

To review outcomes of arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique. 66 patients underwent arthroscopic repair for rotator cuff tears using absorbable anchors with a single-row technique. 51 of them aged 37 to 73 (mean, 57) years had been followed up for a mean of 29 (range, 20-37) months. The extent of the tear was classified as large, medium or small. Functional outcome was assessed using the Constant score. Constant scores and re-tear rates in 3 patient groups (classified by patient age and tear size) were compared. Among the 66 patients, there were 24 large, 29 medium and 13 small cuff tears, and a total of 48, 37, and 18 anchors were used, respectively. Among the 51 patients, the median Constant score improved significantly after arthroscopy (30 vs. 73, p<0.0001). Six shoulders had complete re-tears; their median Constant score was 48 and their adjusted Constant score was 65%. Complete re-tears occurred more often in patients aged >60 years than in those aged 50 to 59 years and <50 years (4/15 vs. 1/22 vs. 1/14), and more often in patients with large tears than in those with medium and small tears (4/24 vs. 2/29 vs. 0/13). Arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique is reliable in patients aged <60 years with small or medium tears.

Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis

the purpose of this study was to determine the effect of a radial tear on degenerative medial meniscus posterior horn tear extrusion and to identify predictors of medial meniscus extrusion. we reviewed the records of 102 knees with medial meniscus posterior horn tears and degeneration that underwent a partial meniscectomy. Tears were classified as root (n = 17) and non-root (n = 85) tears, or as radial (n = 46) and non-radial (n = 56) tears. Groups were compared in terms of absolute and relative meniscal extrusion, and the proportion of knees with major (> 3 mm) extrusion. Multiple regression analysis was used to identify predictors of extrusion. the radial group had greater mean absolute (4 ± 1 vs. 3 ± 1 mm, P = 0.001) and relative (31 ± 11 vs. 23 ± 12%, P = 0.031) extrusion than the non-radial group. The radial group also had a greater proportion of major extrusions than the non-radial group (74% vs. 26%; P = 0.016). In contrast, the root tear and non-root tear groups were similar in terms of mean absolute (3 ± 1 vs. 3 ± 1 mm, P = n.s.) and relative (30 ± 7 vs. 26 ± 13%; P = n.s.) extrusion and in terms of proportion with major extrusions (59 vs. 55%; P = n.s.). Extrusion was found to be associated with a similar strength with both the presence of a radial component and the preoperative Kellgren-Lawrence grade. meniscal extrusion was greater and more severe in knees with a radial tear component than in knees without a radial component. The incidence and degree of major extrusion was similar in knees with root tears and non-root tears. A radial component and knee osteoarthritis severity were similarly predictive of absolute and relative extrusion. Meniscal extrusion in osteoarthritic knees was associated not only with degenerative meniscal tear but also with osteoarthritis severity. Therefore, arthroscopic meniscal procedures, especially meniscal repair, should be cautiously considered in patients with meniscal extrusion.

Isolated avulsion fracture of the subscapularis tendon with medial dislocation and tear of biceps tendon in a skeletally immature athlete: a case report

Isolated avulsion fracture of the subscapularis from the lesser tuberosity of the humerus is rare in the pediatric population and only a couple of cases have been described in the literature. In our case, a 13-year-old young man suffered an avulsion of the subscapularis tendon from the lesser tuberosity of the humerus, accompanied by medial dislocation of the biceps tendon with degeneration and tear. The diagnosis was delayed until he completed several weeks of physical therapy. Special tests performed earlier in the primary care clinic or emergency department could have prevented prolonged symptoms and allowed earlier surgical intervention.

Development of a Traumatic Anterior Cruciate Ligament and Meniscal Rupture Model With a Pilot In Vivo Study

The current study describes the development of a small animal, closed-joint model of traumatic anterior cruciate ligament (ACL) and meniscal rupture. This model can be used in future studies to investigate the roles of these acute damages on the long-term health of an injured knee joint. Forty-two Flemish Giant rabbits received an insult to the left tibiofemoral joint ex vivo in order to document optimal energy and joint orientation needed to generate ACL and meniscal rupture, without gross fracture of bone. Impact energies ranged from 10 J to 22 J, and joint flexion angle ranged from 60 deg to 90 deg. Three in vivo animals were impacted at 13 J with the knee flexed at 90 deg, as this was determined to be the optimal load and joint orientation for ACL and meniscal ruptures, and sacrificed at 12 weeks. Impact data from the ex vivo group revealed that 13 J of dropped-mass energy, generating approximately 1100 N of load on the knee, would cause ACL and meniscal ruptures, without gross bone fracture. Acute damage to the lateral and medial menisci was documented in numerous ex vivo specimens, with isolated lateral meniscal tears being more frequent than isolated medial tears in other cases. The in vivo animals showed no signs of ill health or other physical complications. At 12 week post-trauma these animals displayed marked degeneration of the traumatized joint including synovitis, cartilage erosion, and the formation of peripheral osteophytes. Histological microcracks at the calcified cartilage-subchondral bone interface were also evident in histological sections of these animals. A closed-joint model of traumatic ACL and meniscal rupture was produced, without gross bone fracture, and a pilot, in vivo study showed progressive joint degeneration without any other noticeable physical impairments of the animals over 12 weeks. This closed-joint, traumatic injury model may be useful in future experimental studies of joint disease and various intervention strategies.

Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears

Double-row rotator cuff repair leads to superior cuff integrity and clinical results compared with single-row repair. The study enrolled 68 patients with a full-thickness rotator cuff tear who were divided into 2 groups of 34 patients according to repair technique. The patients were followed-up for at least 2 years. The results were evaluated by Constant score. Despite the biomechanical studies and cadaver studies that proved the superiority of double-row fixation over single-row fixation, our clinical results show no difference in functional outcome between the two methods. It is evident that double-row repair is more technically demanding, expensive, and time-consuming than single-row repair, without providing a significant improvement in clinical results. Comparison between groups did not show significant differences. At the final follow-up, the Constant score was 82.2 in the single-row group and 78.8 in the double-row group. Functional outcome was improved in both groups after surgery, but the difference between the 2 groups was not significant. At long-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair in small to medium tears.

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears: Is There Tendon Healing in Patients Aged 65 Years or Older?

The aim of this study was to assess tendon healing and clinical results of rotator cuff tears (RCTs) repaired arthroscopically in patients aged 65 years or older. Between January 2001 and December 2004, 88 patients with a mean age of 70 years (range, 65 to 85 years) had arthroscopic RCT repair. The repair was performed on 54 women (61%). The dominant arm was involved in 72 patients (82%). RCT included more than 2 tendons in 45 cases. Functional outcomes were assessed by use of the Constant score and Simple Shoulder Test. Tendon healing was estimated by use of a computed tomography (CT) arthrogram, which was obtained 6 months postoperatively, and was classified into 3 categories: stage 1, watertight and anatomic healing; stage 2, watertight and partial healing; and stage 3, not watertight and retear. The mean duration of follow-up was 41 months (range, 24 to 77 months). The mean clinical outcome scores all improved significantly at the time of the final follow-up (P < .01). Computed tomography arthrogram imaging showed 27 shoulders with a stage 1 repair, 20 with a stage 2 repair, and 34 with a stage 3 repair. The retear rate was 42% (34 of 81). The patients with tendon healing stage 1 or 2 had a significantly superior functional outcome in terms of overall scores and strength compared with the stage 3 repairs (P < .01). In our study we had 39 isolated supraspinatus tears (small or medium tears); 11 (28.9%) had a retear (stage 3). Arthroscopic repair in patients aged 65 years or older can yield tendon healing resulting in significant functional improvement. Our data suggest that arthroscopic repair can be considered successful for the older patient specifically when the tear is limited to the supraspinatus tendon. Level IV, therapeutic case series.