Small Tears Research Articles

BARRAGE LASER PHOTOCOAGULATION IN HIGH-MYOPIC PATIENT WITH SYMPTOMATIC RETINAL TEARS BEFORE PHACOEMULSIFICATION: A CASE REPORT

Introduction : Retinal tears can be present in up to 2.4% of cases of lattice degeneration, which is considered an important risk of retinal detachment in a high-myopic patient. Laser photocoagulation has been shown to reduce the risks of retinal detachment before phacoemulsification thus improve in the visual outcome. We report a case of a high myopic patient with symptomatic retinal tears who underwent phacoemulsification that was treated prophylactically with barrage laser photocoagulation.
 Case Illustration : A 43 years-old female with a history of high myopia complained of flashes and floaters on both eyes. She had high myopia measuring -13.0 dioptres and -28.0 dioptres in the right and left eyes respectively. Unaided visual acuity was 2/60 in both eyes. Fundus examination showed lattice degenerations with a small tear found on both eyes with no retinal detachments. She was treated with a barrage laser on both eyes followed by phacoemulsification. On the last follow-up, the retina remained stable and the visual acuity was significantly improved with no development of macular edema or retinal detachment in both eyes.
 Discussion : Although most cases of lattice degeneration do not need intervention, some present a risk of retinal detachment. Barrage laser photocoagulation may have a place in high myopic patient lattice degeneration with symptomatic retinal tears to maintain retinal stability and to obtain the optimal outcome after phacoemulsification.
 Conclusion : Barrage laser photocoagulation is beneficial as a prophylactic treatment of symptomatic retinal tears before phacoemulsification in high-myopic patients.

Role of tear size and tendon degeneration for development of pain in rat models of rotator cuff tear

BackgroundRotator cuff tear (RCT) is a frequent etiology of shoulder pain and disability; however, the triggers for the onset and aggravation of pain remain obscure. In this study, we established novel rat RCT models to examine the impact of tear size and tendon degeneration on pain. MethodsFifty-five adult male Sprague-Dawley rats were allocated into 4 study groups: large tear (L group, n=10); small tear (S group, n=15); small tear with scratching (S+ group n=15); sham surgery (sham group, n=15). Pain-related behaviors were evaluated by weight distribution of forelimbs during a 5-minute free gait using a dynamic weight-bearing apparatus at 2, 4, 6 and 8 weeks. Calcitonin gene-related peptide (CGRP) expressions in ipsilateral dorsal root ganglion (DRG) neurons of C4/5/6 were evaluated at 4 and 8 weeks. The area of scar tissues around the torn tendon, infiltration of inflammatory cells, and severity of tendon degeneration (modified Bonar score) were histologically assessed at 4 and 8 weeks. Additionally, enzyme-linked immunosorbent assay (ELISA) was conducted to evaluate the levels of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) expression in torn tendons and surrounding tissues at 4 weeks. ResultsThe weight distribution ratio (ipsilateral /contralateral side) was significantly decreased in the L and S+ group compared with its baseline and sham group (P<0.05), but the S group showed no significant difference compared with the Sham. The ratio of CGRP-immunoreactive neurons in the DRGs was significantly higher in the L and S+ groups than in the S and sham groups. The histological assessment indicated that scar tissue formation was more extensive in the L group than in the S and S+ groups. Still, there was no significant difference between the S and S+ groups. The Modified Bonar Score was considerably higher in the S+ group than in the S group. Furthermore, ELISA analysis demonstrated no significant disparity in COX-2 levels between the groups; however, NGF levels were substantially higher in the S+ group than in the S and sham groups. ConclusionThe present study provides compelling evidence that large RCT is strongly associated with heightened pain severity in a rat mode. Nevertheless, even a small tear can significantly aggravate pain when the torn tendon is degenerated. CGRP upregulation driven by peripheral NGF possibly played a pivotal role in the genesis and exacerbation of pain in small RCT.

The Zipknot Technique: A Modified Tension Band Repair Technique for Isolated Supraspinatus Tears

Tension band repair frequently is used for small rotator cuff tears. This Technical Note describes a variation using a single knotless suture anchor but with a specific lark’s head knot technique to pass the sutures through the tendon that improves bone–tendon contact and tendon healing while preventing a dog-ear deformity.

Massive rotator cuff tears: algorithmic approach to surgical treatment.

The management of massive rotator cuff tears (MRCT) presents a unique challenge to many orthopedic specialists. Unlike tears that are predicted to do well with primary, complete repair, MRCT are affected by tissue retraction, in-elasticity, bursal scarring, muscle atrophy, and fatty degeneration; operative repair thus portends worse healing rates than smaller tears and is associated with recurrent tear rates of up to 91% based on ultrasonography and magnetic resonance imaging (MRI). Rotator cuff tears are a common condition in patients over the age of 50. Thus, multiple advances in treatment strategies have been made to combat the limited efficacy of complete or partial rotator cuff repair in the setting of a massive or irreparable rotator cuff tears. It is of utmost importance that the operating orthopedic surgeon be familiar with these various treatment modalities to best serve the patient and that they harbor these skills within their armamentarium. This article details a review of the current literature including nonoperative and operative treatments for the management of massive and irreparable rotator cuff tears. The primary objective is to propose a literature-based algorithm for the treatment of massive and often irreparable rotator cuff tears to allow for informed ease in the decision-making process.

Risk factors for intracellular fatty accumulation in rotator cuff muscle: a histologic analysis

Fatty accumulation in rotator cuff muscles has been associated with shoulder dysfunction, risk of repair failure, and poor postoperative outcomes. This study sought to assess risk factors associated with true fatty accumulation based on histologic analysis and determine whether preoperative function directly correlated with this fatty rotator cuff accumulation. Supraspinatus muscle biopsy specimens obtained prospectively from patients undergoing arthroscopic rotator cuff repair were stained with LipidTOX to quantify lipid accumulation. Two-step cluster analysis with Goutallier classification was used to define the fatty and non-fatty rotator cuff groups. We further performed a receiver operating characteristic curve analysis to confirm the group cutoff values. In total, 51 patients (aged 60.1±10.5 years) were included. There were 19 high-grade partial tears, 10 small tears, 7 medium tears, 10 large tears, and 5 massive tears. Both cluster and receiver operating characteristic curve analyses yielded a cutoff value of 30% LipidTOX/4',6-diamidino-2-phenylindole (DAPI) separating the fatty vs. non-fatty groups. In the univariate analysis, patients with fatty rotator cuffs were aged 63.2 years on average compared with 59.7 years in the non-fatty group (P=.038). Female patients made up 57.1% of the fatty cohort, which was statistically higher than the non-fatty group (P=.042). Massive and large tears were more likely to occur in the fatty group (P=.005). In the multivariate analysis, full tendon tears had the largest predictive status of falling into the fatty group (odds ratio, 15.4; P=.008), followed by female sex (odds ratio, 4.9; P=.036). Patients in the fatty group had significantly higher American Shoulder and Elbow Surgeons scores (P=.048) and lower visual analog scale scores (P=.002). This prospective histologic assessment revealed that full-thickness rotator cuff tears and female sex were the largest risk factors for intracellular lipid accumulation. Although tear size correlated with fatty accumulation, the sex disparity is a noteworthy finding that warrants further research.

The High Resistance Loop (H-Loop) Technique for Arthroscopic Repair of Subscapularis

The subscapularis tendon is more challenging and riskier to repair than the posterior upper rotator cuff. The knotless anchor suture in subscapularis repair simplified the repair process and had an excellent postoperative effect. We describe a new knotless anchor stitching method, the H-Loop technique. The simplicity and efficiency of the technique make it particularly suitable for small subscapular tendon tears.

Comparison of Arthroscopic Single-row and Double-row Repair for Rotator Cuff Injuries With Different Tear Sizes: A Systematic Review and Meta-analysis.

There is no clinical gold standard for the indications for single-row (SR) versus double-row (DR) repair according to small, large, or massive rotator cuff tear size. To conduct a meta-analysis to compare the clinical outcomes and retear rates after arthroscopic SR and DR repair for rotator cuff injuries with different tear sizes. Systematic review; Level of evidence, 3. On the basis of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, the PubMed, Embase, Cochrane Library databases, Web of Science, China National Knowledge Infrastructure, and China BioMedical Literature database were searched for relevant studies published before November 1, 2021, using the following search terms: "Rotator Cuff Injuries," "Rotator Cuff Tears," "Arthroscopy," "Arthroscopic Surgery," "single-row," and "double-row"; a total of 489 articles were retrieved. Quality evaluation was conducted for all the studies that met the inclusion criteria. This study evaluated the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and range of motion (ROM) as well as retear rate. A fixed-effects or random-effects model was adopted to calculate the results and assess risk. A total of 10 clinical studies were included, with 404 cases of DR and 387 cases of SR. Regarding overall results, DR had better forward elevation ROM (mean difference [MD] = -4.03° [95% CI, -6.00° to -2.06°]; P < .0001; I 2 = 46%) and a lower retear rate (MD = 2.39 [95% CI, 1.40 to 4.08]; P = .001; I 2 = 0%) compared with SR repair. With regard to small tears (<3 cm), there was no noticeable difference on any of the 3 outcome scores between SR and DR. For large rotator cuff tears (≥3 cm), DR repair showed significantly better ASES scores (MD = -3.09 [95% CI, -6.19 to 0.02]; P = .05; I 2 = 73%) and UCLA scores (MD = -1.47 [95% CI, -2.21 to -0.72]; P = .0001; I 2 = 31%) compared with SR repair. Our meta-analysis revealed that DR had better UCLA scores, ASES scores, and ROM in forward elevation and lower retear rates. In rotator cuff tears <3 cm, there were no statistical differences in clinical outcome between SR and DR.

Relative contributions of the supraspinatus cord and strap tendons to shoulder abduction and translation

The supraspinatus (SS) is formed by a larger anterior bipennate muscle with a cord like tendon and a posterior unipennate muscle with a strap like tendon. There is a tendinous connection between the two SS subunits. Yet, the relative mechanical contribution of the SS cord and SS strap muscular tendinous units to load transmission and subsequent shoulder abduction force is unknown. We hypothesized that a simulated SS cord versus a SS strap tear will generate less shoulder abduction force; and further, an intact SS cord will offset the expected abduction loss from a SS strap tear, but the inverse will not be true. Twenty fresh-frozen cadaveric specimens were tested in a shoulder simulator with physiological load vectors applied to the upper and lower subscapularis, SS cord, SS strap, infraspinatus, and teres minor. The roles of the SS cord and SS strap muscles were delineated by varying their loads, while keeping constant loads on other muscles. The randomized testing trials included a Native condition and four test Cases which simulated tears by dropping the load and force transfer via the SS cord-to-SS strap connection by adding the load. Testing was completed at both 0° and 30° of abduction. During each test shoulder abduction force, rotator cuff strains and humeral translation were measured. Simulated isolated SS cord and SS strap tears lead to a significantly lower shoulder abduction force (p<0.001). A simulated cord tear at 0° and 30° reduced the abduction force by 53% and 38%, respectively. A simulated strap tear at 0° and 30° dropped the abduction force by 27% and 23%, respectively. The decline in abduction force was larger for the SS cord tear versus SS strap tear (p≤0.001). A SS cord tear with full load transfer to the strap was able to recover to native values at both 0° and 30° (p≥0.288). Likewise, a SS strap tear with full load transfer to the SS cord showed a similar recovery to native values at both 0° and 30° (p≥0.155). During full load transfer, the tendon strain followed the loading pattern. A SS cord tear or SS strap tear did not cause a change in humeral translation (p≥0.303). A mechanical findings support the efficacy of nonoperative treatment of small (<10mm) SS tears,11 because an intact SS strap tendon can effectively offset the abduction loss of a torn SS cord tear, and vice versa.

Paper 49: Bridging Reconstruction for Large-to-Massive Rotator Cuff Tears Has a Low Rate of Cuff Arthropathy Progression at A Minimum Five-Year Follow-Up

Objectives: Rotator cuff tears cause pain, muscle weakness, and difficulty with overhead activity. While smaller tears are easier to repair, large-to-massive cuff tears (&gt;3 cm in size) are considered irreparable. For patients with large-to-massive cuff tears, surgical options include maximal repair, superior capsular reconstruction, bridging reconstruction, tendon transfers and reverse total shoulder arthroplasty (rTSA). Bridging reconstruction was developed to improve outcomes and to avoid the morbidity associated with other technique. Bridging reconstruction, also known as graft interposition, has been shown to have superior outcomes as compared to maximal repair with better patient-reported outcomes at two-years post-operatively as recently demonstrated in a randomized controlled trial. These positive results are maintained at five years, however the midterm changes in progression of rotator cuff arthropathy and conversion to rTSA have not been assessed. The purpose is to assess the progression of rotator cuff arthropathy in bridging reconstruction patients at a five-year follow-up. Methods: Forty-four patients who underwent bridging reconstruction between 2012 and 2017 for large-to-massive rotator cuff tears were included. All patients had a minimum five-year follow-up. Data collected included demographics, pre- and post-operative Western Ontario Rotator Cuff (WORC) Index, conversion to rTSA, and X-ray readings (including acromiohumeral distance (as measured on anterior-posterior pre/post-operative radiographs) and Hamada grades for rotator cuff arthropathy). Furthermore, a sub-group analysis was performed on post-operative MRIs for graft status. Results: The mean age at surgery was 59.9± 10.8 years with a mean follow-up of 7.3±1.4 years. The population was mostly male (70.5%). Pre-operatively, seven patients had mild rotator cuff arthropathy with Hamada grade 2-3, and one patient had Hamada grade 4B. The rest of the patients had Hamada grade one preoperatively. At a minimum five-year postoperative follow-up, only one patient had a rTSA, resulting in a survivorship rate of 98%. Two patients (4.6%) had post-operative Hamada grade 4. One patient had progression of cuff arthropathy from pre-operative Hamada 3 to post-operative Hamada 4A. The other patient maintained Hamada grade 4B from pre-operative to post-operative. Patients with progression of cuff arthropathy (i.e. higher post-operative Hamada grade) appear to have a higher possibility of complete post-operative graft tears. [SS1] [JM2] There were no correlations between progression of cuff arthropathy and WORC score at five years. Conclusions: At a minimum 5-year with a mean follow-up of 7.3 years, bridging reconstruction showed 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy with only 4.6% of patients having advanced RCA with Hamada grade 4.

Poster 195: Retrospective Outcomes of Primary Rotator Cuff Repairs Involving Two or More Tendons

Poster 195: Retrospective Outcomes of Primary Rotator Cuff Repairs Involving Two or More Tendons

Can artificial intelligence help decision-making in arthroscopy? Part 1: Use of a standardized analysis protocol improves inter-observer agreement of arthroscopic diagnostic assessments of the long head of biceps tendon in small rotator cuff tears

IntroductionInjuries of the long head of biceps (LHB) tendon are common but difficult to diagnose clinically or using imaging. Arthroscopy is the preferred means of diagnostic assessment of the LHB, but it often proves challenging. Its reliability and reproducibility have not yet been assessed. Artificial intelligence (AI) could assist in the arthroscopic analysis of the LHB. The main objective of this study was to evaluate the inter-observer agreement for the specific LHB assessment, according to an analysis protocol based on images of interest. The secondary objective was to define a video database, called “ground truth”, intended to create and train AI for the LHB assessment. HypothesisThe hypothesis was that the inter-observer agreement analysis, on standardized images, was strong enough to allow the “ground truth” videos to be used as an input database for an AI solution to be used in making arthroscopic LHB diagnoses. Materials and methodOne hundred and ninety-nine sets of standardized arthroscopic images of LHB exploration were evaluated by 3 independent observers. Each had to characterize the healthy or pathological state of the tendon, specifying the type of lesion: partial tear, hourglass hypertrophy, instability, fissure, superior labral anterior posterior lesion (SLAP 2), chondral print and pathological pulley without instability. Inter-observer agreement levels were measured using Cohen's Kappa (K) coefficient and Kappa Accuracy. ResultsThe strength of agreement was moderate to strong according to the observers (Kappa 0.54 to 0.7 and KappaAcc from 86 to 92%), when determining the healthy or pathological state of the LHB. When the tendon was pathological, the strength of agreement was moderate to strong when it came to a partial tear (Kappa 0.49 to 0.71 and KappaAcc from 85 to 92%), fissure (Kappa −0.5 to 0.7 and KappaAcc from 36 to 93%) or a SLAP tear (0.54 to 0.88 and KappaAcc from 90 to 97%). It was low for unstable lesion (Kappa 0.04 to 0.25 and KappaAcc from 36 to 88%). ConclusionThe analysis of the LHB, from arthroscopic images, had a high level of agreement for the diagnosis of its healthy or pathological nature. However, the agreement rate decreased for the diagnosis of rare or dynamic tendon lesions. Thus, AI engineered from human analysis would have the same difficulties if it was limited only to an arthroscopic analysis. The integration of clinical and paraclinical data is necessary to improve the arthroscopic diagnosis of LHB injuries. It also seems to be an essential prerequisite for making a so-called “ground truth” database for building a high-performance AI solution. Level of evidenceIII; inter-observer prospective series.

Variation in Scapulohumeral Rhythm on Dynamic Radiography in Pathologic Shoulders: A Novel Diagnostic Tool.

Alterations in scapulohumeral joint kinematics occur in various shoulder pathologies. Conventional imaging provides a static assessment of soft tissue and morphologic changes. Quantifying the scapulohumeral rhythm (SHR), using Dynamic Digital Radiography (DDR) can offer clinicians a greater understanding of the pattern and extent of motion impairment as well as reliably monitor changes throughout the treatment course. The purpose of this study was to analyze the SHR of patients diagnosed with small (SRCT) and massive rotator cuff tears (MRCT), adhesive capsulitis (AC), and glenohumeral osteoarthritis (GH-OA) and compare their measurements to those of patient controls with healthy shoulders using DDR. The sequences of pulsed radiographs collated in DDR to create a moving image were prospectively analyzed during humeral abduction in normal controls and in 4 distinct shoulder pathology groups: SRCT, MRCT, AC, and GH-OA. GH and ST joint angles were measured at 0-30°, 30-60°, 60-90°, and maximal coronal plane humeral abduction. SHR was defined as the ratio of the change in humeral abduction over the change in scapula upward rotation during humeral abduction and was calculated within the above angle intervals. 121 shoulders were analyzed. 40 normal controls were compared to 13 SRCT, 29 MRCT, 16 AC, and 23 GH-OA. SHR during humeral abduction differed significantly in patients with MRCT (1.91 ± 0.72), AC (1.55 ± 0.37) and GH-OA (2.31 ± 1.01) compared to controls (3.39 ± 0.79). When analyzed across 30o intervals of abduction, there was a significantly lower SHR found at 0-30°, 30-60° and 60-90° in MRCT, AC, and GH-OA across each motion range compared to controls. Control patients had an arc of abduction of 103° ± 32° which was significantly larger than all other pathologies (MRCT: 76° ± 23°, SRCT: 81° ± 21°, AC: 65° ± 27°, GH-OA: 71° ± 35°) and an average scapular abduction of 33° ± 14°, which was significantly less than patients with a MRCT (46° ± 10°) and AC (65° ± 27°). SHR remained significantly lower throughout shoulder abduction in MRCT (43.65%), AC (-54.29%), and GH-OA (32.01%) compared to controls. When isolating for humeral and scapular motion, all 4 pathologies had decreased GH abduction, while AC and MRCT had an increased scapular compensatory motion compared to controls. Quantifying kinematic patterns like SHR using DDR can be implemented as a novel, safe, and cost-effective method to diagnose shoulder pathology and to monitor response to treatment.

Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis.

The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy. This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations. A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05). ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.

Calibration procedure for ultrasonic sensors for precise thickness measurement

The conveyor belt, the most expensive element of the conveyor, during many years of operation is subject to complex wear processes related to the processes of its friction against the debris and structural elements, fatigue processes related to its bending on drums and idler sets, and repeated changes in tension when starting the conveyor and passing through the driving drums. The rate of wear processes is proportional to the time and intensity of the belt operation (the number of cycles of the belt loop around the conveyor). Another character, sudden and random, is the belt damage that occurs during the fall of the spoil onto the belt. Smaller lumps accelerate the friction processes by damaging the surface of the covers (rubber cracks, small tears) and intense friction caused by the acceleration of the excavated material. Larger lumps with energy exceeding the limit values cause the belt to puncture through, tearing out parts of the cover or rim, and damage to the core. As the belt wears off, the energy limits decrease (due to the decreasing belt thickness), which significantly accelerates the rate of its degradation processes. Identifying the rate of change in belt thickness over the entire surface is therefore critical to estimating the remaining life of the belt. The implementation of non-invasive diagnostics of conveyor belts to assess the condition of its core and the degree of abrasion allows for a significant reduction in belt operating costs. It can contribute to the extension of its life by reducing uneven wear and damage to the core. The decision to replace the belt at the right moment allows it to be regenerated. Regular control of the condition of damage and abrasions of the belt can prevent the occurrence of major failures and plan the moments of preventive replacements, which are much cheaper than expensive emergency replacements that can additionally cause enormous production losses. Prediction of the replacement of belt sections and their length allows for proper management of the budget allocated to repair and replacement of belts. Thanks to the obtained detailed information on the degree of belt wear, it is possible to take ad hoc corrective actions to extend the life of the belts and to predict the remaining time of its failure-free operation in the adopted replacement strategy. In Poland, at the Wrocław University of Science and Technology, as a result of many years of research work financed by the National Center for Research and Development, diagnostic systems have been developed to assess the technical condition of conveyor belts. One of such devices is the ultrasonic system for continuous belt thickness measurement, which is being built under the LIDER X project, called BeltSonic. This article presents the method of calibrating this device and the obtained measurement accuracy. Accurately measuring the thickness of the strip over its entire surface is critical to forecasting its remaining life.

Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff

The most common complication of arthroscopic rotator cuff repair is retear, which is more common in larger tears and older patients. We hypothesized that the quality of the torn tendon is important in protecting against retear. Surgeons have traditionally assessed the quality of repaired tendons with a four-point Likert scale. Shear Wave Elastography Ultrasound (SWEUS) is a recent technological advancement that can quantify soft-tissue stiffness. This study aimed to determine how closely a surgeon's intraoperative ranking of tissue quality during rotator cuff repair correlated to postoperative supraspinatus tendon stiffness measured by SWEUS. This was a prospective case series on 50 patients undergoing arthroscopic rotator cuff repair, involving SWEUS measurements of each patient's supraspinatus tendon at 8 days, 6 weeks, 12 weeks, 6months, and 12 months. The intraoperative surgeon score of tissue quality for each patient was ranked on a four-point Likert scale. Each patient's scores were compared to postoperative SWEUS velocity measurements of the supraspinatus tendon postrepair. The SWEUS determined stiffness of supraspinatus tendons at their repaired insertion site postrepair increased by 22% from 6.3 ± 0.2 m/s to 7.7 ± 0.3 m/s over 12 months as the tendons healed (P= .0001). Supraspinatus tendon stiffness was greater in patients with smaller tears (r=-0.50, P=.001) and of younger age (r=-0.58, P= .00001). Surgeons also consistently rated younger patients (rs=-0.49, P= .0001) and smaller tears (rs=-0.56, P= .00001) as having superior intraoperative tendon quality. The correlations between SWEUS velocity and surgeon tissue quality rankings were modest at best and strongest at 12 weeks (rs= 0.27, P= .04). There were modest associations between SWEUS tendon stiffness and surgeon tendon mobility rankings at 6 weeks (rs= 0.26, P= .04) and repair quality rankings at 12 months (rs= 0.36, P= .02). These data support the finding that machines (SWEUS) are better at assessing torn rotator cuff tendon quality and whether that tendon will heal after repair than the 'person' performing the surgery. Supraspinatus tendons lose stiffness as they get older and when the tear is larger, likely explaining why retear post-cuff repair is more common with advanced age and larger tears.

Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique - Minimum 5-years follow-up.

The primary aim of this study was to assess the long-term patient reported outcomes of arthroscopic rotator cuff tear (ARCR) using a single anchor tension band (TB) technique for small and medium supraspinatus tears at minimum 5-years follow-up. A retrospective cohort study of consecutive ARCRs of small and medium supraspinatus tears using a knotless single anchor TB technique with minimum 5-year follow-up was carried out. Outcomes of interest included: range of motion (ROM) on examination under anaesthesia (EUA), visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores, Oxford Shoulder Score (OSS) and Short-Form (SF-12). From 243 consecutive ARCR procedures, 82 patients with a mean age of 55 ± 9.5 years met the inclusion criteria at 6.7 ± 1.5 years follow-up. There were significant improvements in VAS (5.5 ± 2.2 vs. 0.7 ± 1.5), ASES (47.6 ± 16.8 vs. 92.8 ± 13.0), OSS (31.3 ± 7.2 vs. 45.3 ± 3.5) and SF-12 (37.6 ± 7.6 vs. 50.3 ± 7.7) post-operatively (all p < 0.001). The single anchor TB ARCR technique has excellent patient reported outcomes at a minimum of 5 years and is suitable for supraspinatus tears smaller than 20 mm in the sagittal plane. Level IV; Consecutive Case Series.

Total resection of the symphysis pubis in a patient with postpartum symphysitis: clinical case

BACKGROUND: Complete rupture of the symphysis during childbirth is a rare but serious complication, with a frequency of 0.03%3%. Small partial tears with minor discrepancies are an indication of conservative therapy, which only requires the use of a pelvic brace. Larger symphyseal tears should be treated with surgery and fixation.&#x0D; CLINICAL CASE DESCRIPTION: This report presents a clinical case of successful orthopedic correction of symphysitis after delivery by cesarean section. A 25-year-old patient underwent total resection of the symphysis pubis with supra-acetabular fixation and external fixation device of a rod arrangement for 12 weeks.&#x0D; CONCLUSION: Several surgical techniques in combination with defect plasty with biocomposite material KollapAn-С made it possible to achieve a long-term positive result.

“Triple Package” Modified SpeedBridge Rotator Cuff Repair Technique

Treatment of full-thickness rotator cuff repairs vary in surgical technique depending on many factors including tear geometry, delamination of soft tissue, tissue quality, and rotator cuff retraction. The described technique presents a reproducible method of addressing tear patterns where the tear may be larger laterally, but the medial footprint exposure is small. This can be addressed with a single medial anchor combined with a knotless lateral-row technique to provide compression for small tears or two medial row anchors for moderate to large tears. In this modification of the standard knotless double row (SpeedBridge) technique, 2 medial row anchors are used, with 1 augmented with additional fiber tape and an additional lateral row anchor to create a triangular repair construct, increasing the size and stability of the footprint of the lateral row.

Development of a laparoscopic technique for inguinal hernioplasty in standing horses.

Most previously described techniques for laparoscopic inguinal hernioplasty (IH) in horses require advanced laparoscopic skills. Our objective was to describe a new laparoscopic IH technique using a surgical anchoring system. Standing laparoscopic IH was performed unilaterally in eight experimental stallions, using the contralateral inguinal canal (IC) as a control. A polyether ether ketone harpoon was anchored in the craniolateral aspect of the vaginal ring, and an extracorporeal knot was used to fix the device. Clinical evaluation, including testicular palpation and lameness examination, was conducted before and for 4 weeks after surgery. Repeat laparoscopy was performed 28 days later. Standing laparoscopic IH was performed in all horses with a surgical time of 38 ± 12.85minutes. In two animals, a small peritoneal tear occurred that did not require repair. No other complications were recorded. On repeat laparoscopy, all devices were in place, and the IC remained partially closed in all horses. The procedure was performed on normal experimental horses and has not been employed on horses that have had an inguinal hernia. This new standing laparoscopic hernioplasty technique provides another potential method for simple partial closure of the IC in stallions at risk of or with history of inguinal herniation.

Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease

Rotator cuff disease is extremely common, affecting between 6.8% and 22.4% of the population over age 40. Tear prevalence, size, likelihood of progression, and retear rates after surgical repair are all related to increasing age. These data suggest that asymptomatic rotator cuff tears are a process related to aging, and the description of this as a “tear” may be inaccurate. In addition to age, other nonmodifiable variables related to the presence and progression of rotator cuff tears include male sex, family history, and hand dominance. Smoking and certain disease states (diabetes, hypertension, serum lipid disorders) are potentially modifiable influences on rotator cuff disease. The relationship between symptoms and the presence of a rotator cuff tear and the progression of a rotator cuff tear are not robust. As fewer than 95% of people with rotator cuff tears come to surgery, the majority of rotator cuff tears are either asymptomatic or mildly symptomatic. Approximately half of existing rotator cuff tears progress over time. Those that progress more rapidly are more likely to have symptoms as the ability to compensate through teres minor hypertrophy and other adaptive mechanisms are exceeded. Both surgery and nonoperative treatments are effective at treating symptoms in patients with rotator cuff disease, but at this time it is not known which treatment is better for which patients. While some authors recommend repair for younger patients with smaller tears, the data on whether this approach can modify the natural history of rotator cuff disease is lacking.