Posterior Tears Research Articles

Tendon transfers to help you avoid reverse shoulder replacement

Treatment of irreparable rotator cuff tears (RCTs) with minimal degenerative changes in an active, high demand patient remains challenging. While reverse shoulder replacement is an option, durability in the setting of high demand use remains unknown. Alternatively, tendon transfers are an attractive alternative that require no long term restrictions on use. The latissimus dorsi and pectoralis major are typically described as treatment options for irreparable posterior superior and anterior superior RCTs respectively. Recently, anatomic and biomechanical studies have questioned the use of these transfers suggesting that the lower trapezius may be the ideal transfer for posterior superior tears. Similarly, the latissimus dorsi is a more anatomic transfer to reconstruct anterior superior tears. As such, the lower trapezius and latissimus have become our standard treatment options for posterior superior and anterior superior irreparable tears respectively. Tendon transfers represent an attractive alternative to reverse shoulder replacement when treating a patient with an irreparable tear and minimal arthritis.

MR arthrographic characterization of posterior capsular folds in shoulder joints.

This was a retrospective study of 604 consecutive shoulder MR images and MR arthrograms obtained from April 2010 to January 2018. Extension in the vertical-oblique plan of the posterior synovial fold on MR arthrography was identified according to the posterosuperior, posteroinferior, superoposterior, and inferoposterior portions. The morphologies of the posterior synovial folds on MR arthrography were divided three subtypes. Morphologic appearances of the posterior labrocapsular complex on conventional MR images were described with four subtypes. A posterior synovial fold in the shoulder joint was identified in 35 of 604 (5.8%) MR arthrography patients. 8 of 35 posterior synovial fold identified on MR arthrography were confirmed at arthroscopy. The most common MR arthrographic type of the posterior synovial fold was triangular-this was detected in 17 of 35 (48.6%) patients. The most common MRI morphology of the posterior labrocapsular complex was doubled posterior labrum. This was detected in 15 of 35 (42.9%) patients. 17 % of patients with posterior synovial folds who were diagnosed with MR arthrography had normal MRI features. The most common localization of the posterior synovial fold was posterosuperior and posteroinferior portions of the posterior labrocapsular structures. The mean of the shortest distance between the posterior synovial fold and the posterior labrum was significantly higher in the positive arthroscopic synovial fold group than in the negative arthroscopic synovial fold group (p = 0.047). Posterior synovial folds, normal capsular anatomic variants, are seen rarely on MR arthrography, and tend to be in the posterosuperior and posteroinferior portions of the posterior capsule. Some types of the posterior synovial fold can mimic a posterior labral tear in conventional MRI. On a direct MR arthrographic image, a posterior capsular synovial fold may be a normal anatomic variant. A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. The results of our study may allow differentiation of normal variations from abnormalities in patients with symptomatic shoulder joint.

Diagnostic utility of the Active Compression Test for the superior labrum anterior posterior tear: A systematic review.

The Active Compression Test has been proposed to have high diagnostic accuracy for superior labrum anterior to posterior tears. The aim of this systematic review was to compile the available evidence for this test and evaluate its diagnostic accuracy. The databases PubMed, Embase, Cochrane, CINAHL, and SCOPUS were searched for case control, diagnostic studies that evaluated the Active Compression Test between 1999 (date of test introduction) and February 2018. Two independent review authors screened the search results, assessed the risk of bias using QUADAS-2, and extracted the data. Eighteen studies (pooled sample = 3091) were included in this review. Twelve out of 18 studies either had high or unclear risk of bias (66.6%). Results from the pooled analysis of all 18 studies provided that the Active Compression Test is more sensitive (71.5: 95% CI = 68.8, 74.0) than specific (51.9: 95% CI = 50.7, 53.1) and only marginally influenced posttest probability from a pretest probability of 31.7-40.72% with a positive finding and a pretest probability of 31.7-20.33% with a negative finding. The Active Compression Test has both limited screening and confirmation ability; therefore, we do not advocate for its use in clinical decision making.

Meniscal tear morphology independently affects pain relief following arthroscopic partial meniscectomy in middle-aged patients.

To analyze the influence of meniscal tear pattern on clinical outcomes following arthroscopic partial meniscectomy in middle-aged patients with medial meniscal tears. A total of 123 patients (130 knees) aged ≥ 50years who underwent arthroscopic partial meniscectomy for medial meniscal tears were evaluated. Inclusion criteria were none to moderate medial knee osteoarthritis [Kellgren-Lawrence (KL) grade ≤ 3] and a minimum of 2-year follow-up (median 4.6 years; range 2.1-8.0years). Meniscal tears observed during arthroscopic examination were classified into six types: radial tear of the middle segment, posterior root tear, horizontal tear of the posterior segment, flap tear, minor tear, and complex tear. Postoperative outcomes were classified into effective (group 1) and non-effective (group 2) according to the pain relief administered 1month postoperatively and at the final follow-up. Demographic variables, KL grade, type of meniscal tear, and postoperative follow-up period were evaluated. Forty knees (38%) were classified into group 1. Of the six types of tears, radial tear of the middle segment [odds ratio (OR) 4.1, 95% confidence interval (CI) 1.1-20.9] and flap tear (OR 12.9, 95% CI 1.8-140.7) were significant predictors of good outcome on multivariate logistic regression analysis. In middle-aged patients with medial meniscal tears, radial tear of the middle segment was independently associated with less pain following arthroscopic meniscectomy. Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails. Case-control study, Level III.

Meniscus Repair in the Posterior Third: The All-Inside Option

The benefits of meniscal preservation have been well established in the literature. There is a growing trend toward meniscal repair in recent years. All-inside repair techniques and instrumentation have rapidly evolved and enable the surgeon to manage complex meniscal pathology, often more safely and efficiently and less invasively than classical inside-out repair. The posterior third of the meniscus presents added challenges in regards to proper access to the tears as well as proximity to vital neurovascular structures. This article outlines the senior author's Nicholas A. Sgaglione preferred technique for all-inside repair of posterior third medial and lateral meniscus tears.

Meniscus Repair of the Anterior Third: The Outside-In Option

Outside-in meniscal repair is an effective and often most optimal technique for addressing tears involving the anterior one-third of the meniscus. It can be performed without an assistant with standard arthroscopy instrumentation. Although the technique may be used for tears in the anterior two-thirds of both the lateral and medial meniscus, it is most commonly utilized for anterior one-third tears, which are not often accessible with other techniques. Knowledge of the anatomy of the saphenous and peroneal nerves in relation to flexion of the knee is paramount to avoiding iatrogenic injury. The technique involves passing sutures through spinal needles that are placed percutaneously from outside-in across the meniscal tear. There are various modifications of the basic technique that may be performed depending on available instrumentation and surgeon preference. Although repairable anterior one-third tears are not as common as posterior horn tears, proficiency with the outside-in technique can be quite valuable and often ideal in this setting. Multiple authors have reported excellent healing rates. With proper attention to needle placement, complications are rare.

Autologous internal limiting membrane flap for retinal detachment due to posterior retinal tears over choroidal atrophy in highly myopic eyes

PurposeTo review a series of highly myopic eyes with retinal detachment undergoing pars plana vitrectomy with autologous internal limiting membrane (ILM) flap placed over posterior retinal breaks located in areas...

Effect of Posterior Glenoid Labral Tears at the NFL Combine on Future NFL Performance.

Background:Posterior labral injuries have been recognized as a particularly significant clinical problem in collision and contact athletes.Purpose:To evaluate the effect that posterior labral tears have on early National Football League (NFL) performance based on position, associated injuries, and operative versus nonoperative management.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review of all participants in the NFL Combine from 2009 to 2015 was performed using medical and imaging reports documented at the combine. Magnetic resonance imaging scans were analyzed for tear location, associated injuries, and evidence of previous surgical interventions. Each player’s NFL draft position, as well as number of games played, number of games started, and snap percentage in his first 2 NFL seasons were collected for performance analysis and were compared with a control group of uninjured counterparts.Results:Players with posterior labral tears were selected significantly later in the draft than those in the control group (draft position, 171.6 vs 156.1, respectively; P = .017). Although no single individual position was significantly affected by posterior labral tears, linemen (both offensive and defensive) with posterior labral tears were drafted significantly later than those without tears (draft position, 164.0 vs 137.7, respectively; P = .018) and had a significantly lower percentage of snaps in their first NFL season (23.8% vs 27.7%, respectively; P = .014). Players who underwent surgical management before the combine had a significantly higher percentage of snaps in their second NFL season than those who were managed conservatively (31.4% vs 22.3%, respectively; P = .022). None of the concomitant injuries recorded (superior labral anterior-posterior tears, glenoid bone loss, reverse Hill-Sachs lesions, rotator cuff tears, reverse humeral avulsions of the glenohumeral ligament, and posterior labral tears combined with anterior tears) significantly affected the draft position, number of games played, number of games started, or snap percentage for the cohort as a whole or any specific position.Conclusion:Posterior labral tears did negatively and significantly affect early NFL outcomes for collegiate football players across several different metrics, especially among linemen. While operative management did not produce significantly superior performance in most outcome measures, it may allow for better longevity of the shoulder and warrants further investigation. Concomitant shoulder injuries did not significantly affect early NFL outcomes in this cohort.

Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears.

The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test. Multivariable regression showed that static ATT increases only with tibial slope (β = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (β = 0.19; p = 0.041), medial meniscal tears (β = 1.27; p = 0.007), complete ACL tears (β = 2.06; p < 0.001), and to decrease with age (β = - 0.09; p < 0.001). Multivariable regression also indicated thathigh-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010). Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors. Cohort study, Level IV.

Auckland Cataract Study III: Refining Preoperative Assessment With Cataract Risk Stratification to Reduce Intraoperative Complications

To assess intraoperative complications of phacoemulsification surgery in public teaching hospital settings using modified preoperative risk stratification systems. Prospective cohort study. Preoperative risk stratification of 500 consecutive cataract cases using the New Zealand Cataract Risk Stratification (NZCRS) scoring system. Recommended allocation of higher-risk phacoemulsification procedures to experienced surgeons in public teaching hospital setting. Intraoperative complications relative to adherence to stratification recommendations. NZCRS classified 192 cases (38%) as high-risk, recommended for fellows or consultants (attendings). Primary surgeons were residents (n= 142, 28%), fellows (n= 88, 18%), and consultants (n= 270, 54%). Overall rate (N= 500) of any intraoperative complication was 5.0%. Where NZCRS scoring recommendations were observed (n= 448) the intraoperative complication rate was 4.5% but in "nonadherence" cases (n= 52 residents operating on higher-risk cases) this nearly doubled (9.6%). Postoperative complications occurred in 5.2%, primarily cystoid macular edema (3.7%). Postoperatively, mean unaided visual acuity was 6/12 (20/40) and best-corrected visualacuity improved from 6/20 (20/63) preoperatively to 6/10 (20/32) postoperatively (P < .05). The NZCRS system aids identification of higher-risk cataract cases and appropriate case-to-surgeon allocation and may increase surgeon awareness of risk factors. Compared to 2 previous studies under similar conditions in the same institution, the NZCRS system was associated with a 40% reduction in intraoperative complications (8.4% to 5%). The rate of posterior capsular tear was 0.6% (P= .035) compared to 2.6% in baseline phase and 1.4% in a prior risk stratification phase. Risk stratification seems to reduce intraoperative phacoemulsification complications in public teaching hospital settings.

Effects of Tendon Degeneration on Predictions of Supraspinatus Tear Propagation

Rotator cuff tendons undergo degeneration with age, which could have an impact on tear propagation. The objective of this study was to predict tear propagation for different levels of tissue degeneration using an experimentally validated finite element model of a supraspinatus tendon. It was hypothesized that greater amounts of degeneration will result in tear propagation at lower loads than tendons with less degeneration. Using a previously-validated computational model of supraspinatus tendon, 1-cm tears were introduced in the anterior, middle, and posterior thirds of the tendon. Cohesive elements were assigned subject-specific failure properties to model tear propagation, and tendon degeneration ranging from "minimal" to "severe" was modeled by modifying its mechanical properties. Tears in tendons with severe degeneration required the smallest loads to propagate (122-207N). Posterior tears required greater loads compared to middle and anterior tears at all levels of degeneration. Stress and strain required for tear propagation decreased substantially with degeneration, ranging from 8.5MPa and 32.6% strain for minimal degeneration and 0.6MPa and 4.5% strain for severe degeneration. Overall, this work indicates that greater amounts of tendon degeneration lead to greater risk of tear propagation, supporting the need for early detection and treatment of rotator cuff tears.

Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking

BackgroundThe location of the meniscus tear has been reported to influence kinematics in anterior cruciate ligament deficient (ACLD) knees. Medial meniscus posterior horn tear (MMPHT) often occurred after ACL rupture. Whether MMPHT influences the kinematics and kinetics in ACLD knees has not been reported yet. Research questionThe purpose of this study was to investigate three-dimensional (3D) kinematics and kinetics in ACLD knees with and without MMPHT (ACLD + MMPHT, ACLDs) during level walking. MethodsFifteen patients with isolated unilateral ACLD, ten with unilateral ACLD + MMPHT, and twenty-two healthy controls underwent gait testing between January 2014 and December 2016. Participant characteristics, as well as gait parameters, were compared among control, ACLDs and ACLD + MMPHT knees. ResultsCompared to the healthy controls, the ACLD knees with and without MMPHT showed significant extension deficiency at maximum extension (flexion: ACLDs: 7.83 ± 4.3°, ACLD + MMPHT: 11.09 ± 7.8°, control: 3.12 ± 4.6°, p = 0.005) and lower extension moments during terminal stance phase of gait. Compared with the healthy controls, significantly increased external tibial rotation during pre-swing phase and lower rotation moments at terminal stance phase were observed in the ACLD + MMPHT knees, but not in the ACLDs knees. No significant differences in gait parameters were observed between ACLDs and ACLD + MMPHT knees during stance phase of walking. SignificanceThe ACLD knees with medial meniscus posterior horn tear exhibited extension deficiency, increased external tibial rotation, lower extension and internal rotation moments during the terminal stance phase compared to healthy control knees, presenting a combination of “stiffening gait” and “pivot shift gait” pattern. The ACLDs knees only presented extension deficiency and lower extension moments compared with healthy control knees, presenting a “stiffening gait”. Medial meniscus posterior horn tear did not significantly affect gait patterns during stance of walking in ACLD knees.

Characteristics of Operative Shoulder Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014.

Background:Injuries to the upper extremity among collegiate athletes are reported to account for approximately 20% of all injuries; however, little is known about the proportion of these injuries that require surgery.Purpose/Hypothesis:The purpose of this study was to examine all shoulder injuries that required a surgical intervention and were recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). We hypothesized that contact would be the mechanism causing injuries most at risk for needing surgery and that dislocations would be the injuries most likely to require an operative intervention.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Injury surveillance data between 2009-2010 and 2013-2014 for operative collegiate shoulder injuries and their associated sport exposures were analyzed.Results:A total of 185 operative shoulder injuries occurred over 3,739,004 athlete-exposures (AEs), for an overall incidence of 0.49 per 10,000 AEs. The sports with the highest incidence of operative injuries were men’s football (1.31/10,000 AEs), men’s wrestling (1.14/10,000 AEs), men’s ice hockey (0.60/10,000 AEs), women’s gymnastics (0.44/10,000 AEs), and men’s swimming (0.41/10,000 AEs). Men were significantly more likely than women to sustain operative injuries for all sports combined. Of the injuries that required surgical treatment, superior labrum from anterior to posterior (SLAP) tears (46.4%), other non-SLAP glenoid labrum tears (46.2%), anterior shoulder dislocations (33.3%), and posterior shoulder dislocations (30.0%) were seen most often. There was no significant difference in injury proportion ratios (IPRs) for injuries requiring surgery when comparing contact versus noncontact mechanisms of injury (IPR, 1.0 [95% CI, 0.6-1.6]). The incidence of operative injuries sustained during competition was significantly higher compared with during practice.Conclusion:The sports with the highest incidence of operative shoulder injuries were men’s football, men’s wrestling, men’s ice hockey, and women’s gymnastics. Operative shoulder injuries were more likely to occur during competition. SLAP tears, other non-SLAP glenoid labrum tears, and anterior shoulder dislocations had the highest incidence of requiring surgery. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from identifying collegiate sport participants who are at highest risk for sustaining an operative injury. This may assist in planning medical care and setting expectations, which may be critical to a young athlete’s career.

Superior Labral Anterior to Posterior Tear Management in Athletes.

Background:The diagnosis and treatment of Superior Labrum Anterior to Posterior (SLAP) tears have been evolving and controversial. The lack of clear diagnostic criteria on physical examination, Magnetic Resonance Imaging (MRI), and arthroscopic evaluation clouds the issue. The high rate of MRI diagnosed SLAP lesions in the asymptomatic population of athletes and non-athletes warrants consideration when planning treatment for those with shoulder pain.Objective:To provide information on the evaluation, diagnosis and management of SLAP tears in athletes.Methods:The results of a structured non-operative rehabilitation program are discussed and compared to traditional surgical techniques. The evolution of the author’s treatment algorithm is presented. Results: The successful return to overhand throwing is more common with non-operative treatment than with surgical.Conclusion:A rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery for most throwers with SLAP lesions.

Superior Capsular Release After Failed Combined Superior Labral Repair And Biceps Tenodesis For Slap Tear

Introduction:Optimal treatment of type II superior labrum anterior and posterior (SLAP) tears is controversial. There has been a recent trend towards biceps tenodesis over SLAP repair in older patients. Few surgeons have performed combined biceps tenodesis and SLAP repair with inferior results.Case Report:This case describes a 46-year-old patient who had persistent pain and stiffness after combined biceps tenodesis and SLAP repair for a type II SLAP tear. His pain and motion improved after arthroscopic superior capsular release.Conclusion:Failed SLAP repair is often multifactorial and a thorough workup is needed. Combined biceps tenodesis and SLAP repair can cause pain, stiffness, and dysfunction which can be successfully treated with arthroscopic superior capsular release.

Prevalence of Shoulder Labral Injury in Collegiate Football Players at the National Football League Scouting Combine.

Background:Labral tears confirmed by magnetic resonance imaging (MRI) are a relatively common injury among collegiate athletes and can influence a player’s ability to compete at the professional level.Purpose:To determine the prevalence of MRI-confirmed shoulder labral injuries in collegiate football players entering the National Football League (NFL) Combine and to further describe these injuries by tear location, player position, history of surgical intervention, and associated concomitant shoulder injuries.Study Design:Descriptive epidemiology study.Methods:Data from 2009 to 2015 were retrospectively collected through review of the injury data registry available to the medical and training staff of all NFL teams following the completion of the NFL Combine. After players with potential labral tears were identified through history and examination, their MRIs were reviewed by 2 fellowship-trained orthopaedic sports medicine surgeons. Players diagnosed with a labral tear confirmed by MRI were separated for further analysis.Results:A total of 2285 players were analyzed for the presence of labral tears at the NFL Combine. Overall, 377 shoulders (in 340/2285 players; 14.9%) demonstrated MRI evidence of labral tear; whereas linebackers had the highest rate of labral tear (19.2%), linemen had significantly higher risk for labral injury in at least 1 shoulder (odds ratio, 1.31; 95% CI, 1.02-1.67; P = .029) compared with nonlinemen. Of the 377 shoulders analyzed, 115 (30.5%) exhibited an anterior labral tear, 131 (34.7%) had a posterior labral tear, and 131 (34.7%) had combined anterior and posterior tears. One hundred twenty (31.8%) shoulders had superior labral anterior-posterior (SLAP) tears. A total of 203 (53.8%) shoulders demonstrated evidence of previous surgical intervention on imaging.Conclusion:Injury involving the labrum is relatively common among participants at the NFL Combine, especially linebackers and linemen. Further investigation is necessary to determine the impact these injuries have on player draft position and NFL performance.

Effect of Anterior Glenoid Labral Tears and Glenoid Bone Loss at the NFL Combine on Future NFL Performance.

Background:Anterior glenohumeral instability is a common abnormality in the young, athletic population, especially in those participating in contact or collision sports.Purpose:To examine the effect of anterior labral tears, their associated injuries, and their management on future National Football League (NFL) performance.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review of all NFL Combine participants from 2009 to 2015 was performed using medical and imaging reports compiled at the NFL Combine. These notes and images were reviewed and analyzed for involved structures, associated injuries, and evidence of previous surgical interventions. The respective NFL draft position, number of NFL games played, number of NFL games started, and NFL snap percentage for each player’s first 2 seasons were collected and compared with a control group and within subgroups.Results:Of the 2285 players at the NFL Combine between 2009 and 2015, there were 206 (9%) anterior labral tears confirmed by magnetic resonance imaging, 20 of which were bilateral, for a total of 226 affected shoulders. There were 908 players who fit the criteria for inclusion in the control group. Overall, there were no significant differences between players with anterior labral tears and the control players in terms of draft position (P = .259), games played in their first 2 NFL seasons (P = .391), games started in their first 2 NFL seasons (P = .486), or snap percentage in their first (P = .268) and second (P = .757) NFL seasons. In general, sustaining a concomitant injury with an anterior labral tear (superior labrum from anterior to posterior [SLAP] tear, glenoid bone loss, Hill-Sachs lesion, rotator cuff tear, humeral avulsion of the glenohumeral ligament, and anterior tear combined with posterior tear) negatively affected a player’s NFL draft position when compared with those with an isolated anterior labral tear (P = .003). There was no significant difference between operative and nonoperative management for anterior labral tears in terms of any performance metric.Conclusion:A history of anterior labral tears was not significantly associated with future NFL performance. While players with isolated injuries were drafted significantly earlier than those with concomitant injuries, combined injuries did not affect players’ games played, games started, or snap percentage in their first 2 NFL seasons. Glenoid bone loss did significantly decrease draft position; however, the severity of bone loss did not affect draft position, and there were no significant associations between glenoid bone loss and games played, games started, or snap percentage.

Type VIII Slap Repair: Patient-Reported Outcomes Of 34 Patients With Minimum 4-year Follow-up

Objectives:Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP II injuries with posterior extension of the labral tear to the 6 o’clock aspect of the glenoid - have been shown in short-term outcome work to be a source of noted shoulder instability, pain, and reduced function/range of motion in both throwing and non-throwing athletes. Limiting our evaluation and effective treatment of these injuries in both the professional athlete and weekend warrior is our lack of mid- and long-term post-operative outcomes after surgical repair. It is hypothesized that Type VIII SLAP repairs would fare poorly, particularly in the throwing cohort, at mid- to long-term follow-up.Methods:With a minimum 4-year follow-up after Type VIII SLAP repair by a single surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain were compared between throwers, contact, and non-contact athletes.Results:With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact athletes, 10 non-contact athletes), with a mean age of 24.4 years were evaluated. Significant (p < .0001) improvements were observed between pre- and post-operative pain, range of motion, and ASES total and functional scores in throwers and non-throwers. Stability improved but was not significant (Table 1). There were no post-operative differences between throwers and non-throwers (Table 2). Pre-operative ASES functional score was significantly lower in contact athletes than in throwers and non-contact athletes (p < .01), but post-operatively improved significantly with no difference between groups (Table 3, 4). Overall, there was no difference in return to sport between groups as 73.7% of throwers and 93.3% of non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of non-throwers (p = .73) returned to the same level. Further, 89.5% of throwers and 100% of non-throwers (p = .49) said that their surgery was worthwhile.Conclusion:Given the paucity of literature, current surgical outcomes of athletes who have undergone Type VIII SLAP repairs is limited, particularly in mid- and long-term function and return to sport. The current findings suggest that surgical repair of Type VIII SLAP lesions contributes to significant improvements in pain, function, and shoulder range of motion that persists >4 years after repair. However, stability changes after injury appear more chronic in nature. Further, thrower and non-throwers appear to have similar outcomes, which has not previously been seen in short term studies.Table 1:Cohort Pain, Stability, and Functional OutcomesPre-OpPost-OpP-valueStability5.7 ± 3.64.5 ± 3.7.23Pain8.0 ± 1.51.3 ± 1.7*** < .0001ROM.76 ± .92.3 ± .5*** < .0001ASESFunctionalScore15.0 ± 4.027.6 ± 3.5*** < .0001ASES Total34.9 ± 12.190.1 ± 12.7*** < .0001Table 2:Thrower vs. Non-Thrower Post-Operative OutcomesThrowerNon-ThrowerP-valueStability3.7 ± 3.65.5 ± 3.7.15Pain1.3 ± 1.81.2 ± 1.6.83ROM2.3 ± .62.3 ± .5.70ASES Functional Score27.4 ± 4.027.9 ± 2.7.68ASES Total88.9 ± 14.091.6 ± 11.2.54Kerlan Jobe Score66.0 ± 28.375.0 ± 28.7.19Table 3:Thrower vs. Contact/Non-Contact Athletes – Patient Characteristics and Pre-Operative Pain, Function, and Range of MotionThrowerContactNon-ContactP-valueAge at OR22.9 ± 8.221.4 ± 5.828.9 ± 12.6.21Age at Follow-Up29.1 ± 9.327.6 ± 5.934.9 ± 11.4.24Post-Op Follow-Up6.3 ± 1.96.2 ± 1.86.0 ± 2.0.95# Anchors4.6 ± 1.35.4 ± 1.35.5 ± .9.22Stability5.7 ± 3.54 ± 4.46.3 ± 4.0.67Pain7.9 ± 1.38.7 ± 1.28.0 ± 2.0.74ROM.5 ± .4.3 ±.61 ± .6.39ASES Functional Score14.8 ± 3.19.3 ± 5.517.7 ± 3.0** < .01ASES Total35.0 ± 9.923.8 ± 14.039.4 ± 14.5.18Table 4:Thrower vs. Contact/Non-Contact Athletes – Post-Operative Pain, Function, and Range of MotionThrower (n=17)Contact (n=5)Non-Contact (n=10)P-valueStability3.7 ± 3.64.2 ± 4.16.3 ± 3.6.23Pain1.3 ±1.8.8 ± 1.81.4 ± 1.6.22ROM2.3 ± .62.6 ± .52.3 ± .5.47ASESFunctionalScore27.4 ± 4.027.6 ± 4.328 ± 1.8.90ASES Total88.9 ± 14.091.8 ± 16.091.5 ± 8.9.83

A novel remaining tendon preserving repair technique leads to improved outcomes in special rotator cuff tear patterns.

The purpose of this study was to identify the tear pattern that could be anatomically repaired by preserving the remaining tendon on footprint and evaluate clinical outcomes of patients who underwent remaining tendon preserving cuff repair. Of 523 patients with full-thickness rotator cuff tears who underwent arthroscopic repair, 41 (7.8%) patients had repairable rotator cuff tear while preserving the remaining tendon. Among them, 31 patients were followed-up for more than 2years, including 26 patients with posterior L-shaped tear and 5 patients with transtendinous tear patterns. Clinical outcomes were evaluated using ASES and Constant score, SANE score for patient satisfaction, and VAS for pain. MRI was taken for tendon integrity 6months postoperatively. Of the 31 patients, 11 (35.5%) had previous injury history before rotator cuff tear, including 7 (26.9%) of the 26 patients with posterior L-shaped tear and 4 (80%) of the 5 patients with transtendinous tear. The average size of preoperative cuff tear was 17.8 ± 6.8mm in anterior-to-posterior direction and 15.2 ± 5.1mm in medial-to-lateral direction. ASES and Constant score, SANE score, and VAS for pain were significantly (p < 0.001) improved after remaining tendon preserving rotator cuff repair. Rotator cuff tendons of 22(84.6%) patients with posterior L-shaped tear and 4(80%) patients with transtendinous tear patterns were healed. Patients who underwent rotator cuff repair with preservation of the remaining tendon on the footprint obtained satisfactory functional outcomes. Rotator cuff tears in patients who had posterior L-shaped tear extending between supraspinatus and infraspinatus tendons or transtendinous tear pattern with substantial remaining tendon could be repaired using remaining tendon preserving repair technique. Anatomic reduction of torn cuff tendon without undue tension could be achieved using the remaining tendon preserving repair technique.

Evaluation of Anterolateral Ligament Injuries and Concomitant Lesions on Magnetic Resonance Imaging After Acute Anterior Cruciate Ligament Rupture

To evaluate the prevalence and characteristics of anterolateral ligament (ALL) injuries with a ruptured acute anterior cruciate ligament (ACL) and to analyze the presence of concomitant bone contusions and meniscal lesions. From March 2015 to March 2017, we retrospectively analyzed 378 patients who underwent primary ACL reconstructions. Using magnetic resonance imaging, we evaluated the presence of ALL injury and concomitant lesions within 3weeks of the injury. Meniscal tears were also identified on representative arthroscopic images. Followingthe inclusion criteria, we included a total of 275 patients in this study. The mean duration from ACL rupture to magnetic resonance imaging examination was 5.0 ± 6.0days. We visualized ALL in 98.2% of patients, of whom 64% had ALL injuries (10.9%, 4.7%, and 48.4% were complete ruptures, Segond fracture, and partial ruptures, respectively). We found that ALL injuries were most commonly found in the femoral location. The intra- and interobserver agreement on the severity of ALL injury (κ= 0.83 and 0.81, respectively) and the location of ALL injury (κ= 0.85 and 0.84, respectively) were excellent. The association between ALL injury and lateral meniscal lesions was significant (P= .03). Inparticular, the proportion of the lateral meniscal posterior horn radial tears was significantly larger in nonintact ALL than in intact ALL (P= .042). The correlation between the severity of ALL injury and the degree of bone contusion at lateral compartments was significant but weak (P < .001). We found that more than half of acute ACL ruptures have ALL injuries. The presence of ALL injury was significantly associated with the presence of lateral meniscal lesions, especially lateral meniscal posterior horn radial tears, or lateral bone contusions. Interestingly, the severity of ALL injury significantly correlated with the degree of lateral bone contusions. Level III, diagnostic cross-sectional study.