University Of California At Los Angeles Score Research Articles

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

Background: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. Methods: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. Results: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. Conclusions: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

An Anterosuperior Deltoid Splitting Approach for Plate Fixation of Proximal Humeral Fractures

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.

Arthroscopic Tenodesis Through Positioning Portals to Treat Proximal Lesions of the Biceps Tendon

Arthroscopic biceps tenodesis is a good choice for treating proximal lesions of the biceps tendon. However, there are few descriptions of the surgical approach. We introduce a technique for proximal biceps tenodesis using positioning portals and placing suture anchors. Our patients had a minimum of 12 months of follow-up. Between January 2010 and June 2012, a total of 49 patients (21 men, 28 women) underwent arthroscopic biceps tenodesis. The pathology was mainly associated with proximal lesions of the biceps tendon, with the diagnosis confirmed in all patients. Patients were evaluated preoperatively and then up to and including the final follow-up. Their pain and conditions were assessed using the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angeles (UCLA) scores for pain; range of active forward flexion; and active range of motion. All data were analyzed statistically. All patients were operated on successfully. They achieved good healing during the follow-up (mean 14 months; range 12–34 months). Before surgery the ASES, Constant, and UCLA scores were 17.0, 39.4, and 15.4, respectively. After surgery they were 33.6, 89.1, and 31.2, respectively. The scores had significantly improved: ASES scores from 17.0 to 33.6 (P < 0.05); Constant scores from 39.4 to 89.1 (P < 0.05); UCLA scores from 15.4 to 31.2 (P < 0.05). Arthroscopic tenodesis through positioning portals to treat proximal lesions of the biceps tendon produces satisfactory clinical outcomes. This technique is convenient and safe.Level of evidenceLevel IV, Case Series, Treatment Study.

General and Disease-Specific Use of Outcomes Scores for the Shoulder: A Survey of Aossm, Aana, and Isakos Members

Objective: To report on the knowledge and use of both general and disease-specific shoulder outcomes scores among orthopedic surgeons. Methods: A 22-question Internet survey was administered to members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North American, and the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine via voluntary e-mail participation. Questions targeted demographic information, preferred surgical management of shoulder conditions, and the preferred use of shoulder outcomes instruments in clinical practice. Results: Excluding defunct and duplicate e-mails among membership societies, a total of 3892 unique e-mails were sent, from which 1129 surveys were returned and were fully completed (29%). The largest number of respondents were in private practice (52%); 21% were in academia; and 26% were in a mix of settings. As for location, 74% practiced in the United States, 10% in Europe, 8% in Mexico/South America, and 6% in Asia. A total of 31% total respondents used scores all or most of the time, and 30% used scores at least some of the time. Respondents felt that the 3 most commonly utilized shoulder scores were the American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) score, and the Constant score. The majority of respondents (76%) performed all-arthroscopic instability repairs. The ASES and Western Ontario Shoulder Instability Index (WOSI) scores were the most preferred measures to monitor instability patients, whether or not the scores were actually implemented in their practice. Most perform between 10 and 25 superior labrum anterior-posterior repairs per year and preferred the ASES, UCLA, and Constant scores for these repairs; rotator cuff repair preferred outcomes instruments were similar. When asked to choose 1 score for all shoulder conditions, the ASES was the clear favorite. Conclusions: This study reports the knowledge and utilization of shoulder scores for both general and disease-specific conditions. Most respondents preferred the ASES score for most shoulder conditions; however, other scores, such as the WOSI, the Constant, and the Short-Form (SF)-36/12, were popular. This information offers insight into the current and future use of shoulder outcomes both for general and disease-specific use.

Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement.

There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction. In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction.

Platelet-Rich Plasma in Rotator Cuff Repair

Background: Although platelet-rich plasma (PRP) has been used in rotator cuff repair, most authors have been unable to report the advantages of this method in clinical trials. Hypothesis: The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective, randomized, double-blind study with 2 groups of 27 patients each (PRP group and control group). Complete supraspinatus tears with retraction of less than 3 cm were subjected to arthroscopic single-row repair; at the end of the surgical procedure, liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin. The outcomes were assessed by the University of California at Los Angeles (UCLA) and Constant scales, visual analog scale (VAS) for pain, and magnetic resonance imaging (MRI) before and 3, 6, 12, and 24 months after surgery. The significance level was 5%. Results: The 2 groups of patients exhibited significant clinical improvement (P < .001). Between the preoperative assessment and 24-month follow-up, the mean UCLA score increased from 13.63 ± 3.639 to 32.70 ± 3.635 and from 13.93 ± 4.649 to 32.44 ± 4.318 in the control and PRP groups, respectively (P = .916). The mean Constant score increased from 47.37 ± 11.088 to 85.15 ± 9.879 in the control group and from 46.96 ± 11.937 to 84.78 ± 14.048 in the PRP group (P = .498). The mean VAS score varied from 7.00 ± 1.939 and 6.67 ± 1.617 before surgery to 1.15 ± 1.916 and 0.96 ± 2.244 at the 24-month assessment in the control and PRP groups, respectively (P = .418). The only difference was in the mean UCLA score at 12 months, with 30.04 ± 4.528 in the control group and 32.30 ± 3.506 in the PRP group (P = .046). The control group exhibited 1 case of a complete retear and 4 partial retears, and the PRP group exhibited 2 cases of partial retears (P = .42). Conclusion: Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at 24-month follow-up. Given the numbers available for analysis, the retear rate also did not change.

Arthroscopic Treatment Versus open Reduction Technique for Fracture of Greater Tuberosity of Humerus

Purpose of study is to analyze clinical effectiveness by comparing results about arthroscopic treatment versus open reductiontechnique for fracture of greater tuberosity of Humerus. Methods is that from Oct. 2009 to Mar. 2013, 14 patients (group A)who got arthroscopic treatment and 9 patients (group O) who got open reduction technique for fracture of greater tuberosity ofHumerus, all 23 patients, were analyzed retrospectively. Clinical and functional evaluation were fulfilled by final range of motion,Constant score and The university of California at Los angeles(UCLA) score. Bone union was evaluated by radiologic finding. Of23 patients, female were 20 patients and male were 3 patients. Mean age was 62.6(39-81) years. From followed-up group A,Union period was mean 33.5(28-38) days, UCLA score was mean 30.8(28~33) points, forward flexion range was170.7°(150~180°), abduction range was 156.8°(110~180°), constant score was mean 61.0(43~73) points. From followed-upgroup O, Union period was mean 34.4(31~38) days, UCLA score was mean 30.8(28~33) points, forward flexion range was166.1°(150~180°), abduction range was 151.1°(130~180°), constant score was mean 64.7(56~74) points. There was nostatistical difference between the group A and group O.Conclusion is that arthroscopic treatment is effective treatment in aspects of bone union and clinical result comparing openreduction technique for fracture of greater tuberosity of Humerus, Besides, hospitalization period and pain could be reduced byarthroscopic treatment

Italian Version of University of California at Los Angeles (UCLA) Activity Score: Cross-Cultural Adaptation

Over the last 10years, patient-oriented evaluations using questionnaires have become an important aspect of clinical outcome studies. Any questionnaire must be translated and culturally adapted in order to be used with different language groups, and the translated version must then be evaluated for reliability, validity and responsiveness which are fundamental attributes of any measurement tool. The aim of this study is the validation, translation and cross-cultural adaptation of the Italian version of UCLA activity Score, following the Guillemin criteria. The results show that our Italian version of the UCLA score has the following: reproducibility expressed as ICC=0.994, an internal consistency calculated as Spearman–Brown coefficient=0.754 and finally the construct validity has demonstrated a significant Pearson's correlation coefficient with other validated hip questionnaires.

Short-term Low-dose Oral Corticosteroid Therapy of Impingement Syndrome of the Shoulder: A Comparison of the Clinical Outcomes to Intra-articular Corticosteroid Injection

BACKGROUND: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection.METHODS: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined.RESULTS: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p &lt; 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p &lt; 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p &lt; 0.05).CONCLUSIONS: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.

Analysis of Treatment Results of Unstable Distal Clavicle Fractures Using Hook Plate

Purpose: The purpose of this study is to analyze the treatment results and complications in unstable distal clavicle fractures which were treated with a Hook plate, and, in particular, to compare the functional results before and after removal of the Hook plate. Materials and Methods: We examined 20 cases in 20 patients who underwent removal of Hook plates after bony union was obtained in an unstable fracture of the distal clavicle (Neer type II) from March 2009 to December 2012. The average follow-up period after initial surgery was 12 months (8-20 months). Plates were removed at 18 weeks (ranged from 10-36 weeks) after initial fixation. University of California at Los Angeles (UCLA) and Korean Shoulder Scoring System (KSS) scores were used for clinical functional evaluation, and plain radiographs were used for radiological evaluation. Results: In radiological evaluation, bony union was obtained at an average of 11.4 weeks (ranged from 8-14 weeks) in all of the 20 patients. All of the 20 patients showed limited range of motion, mild pain, and discomfort of the shoulder before removal of the Hook plate, and all of the 20 patients showed better results in UCLA and KSS score after removal of the plate, when compared to before removal. Stress fracture as a major complication, was united completely with a ‘figure of 8’ bandage and deep wound infection was resolved after repeated debridement and antibiotic treatment with satisfactory functional results. Conclusion: Hook plate in treatment of unstable fracture of the distal clavicle is considered to be a useful method because rigid fixation can be obtained. However, there are some complications, such as limited range of motion, pain, and discomfort of the shoulder joint, before removal of the Hook plate. Therefore, we think that removal of the Hook plate as soon as possible if bony union is obtained would be desirable.

Surface Replacement Arthroplasty of the Humeral Head in Young, Active Patients: Midterm Results.

Background:The treatment of glenohumeral arthritis in young, active patients remains controversial. Standard total shoulder arthroplasty in this patient group has not obtained the same satisfaction rate as in older patients. One surgical option that has emerged is humeral resurfacing.Hypothesis:Humeral head surface replacement arthroplasty (SRA) would provide satisfactory clinical outcomes in active patients, allowing them to maintain their normal lifestyle without activity restrictions.Study Design:Case series; Level of evidence, 4.Methods:From 2004 to 2007, all consecutive surface replacement arthroplasties of the humerus performed at the authors’ institution were identified and retrospectively reviewed, and 118 patients who underwent SRA during this time were identified. This study included patients younger than 60 years who wished to maintain an active lifestyle; 52 of the 118 patients met the inclusion criteria. University of California at Los Angeles (UCLA) shoulder scores and subjective shoulder value (SSV) scores were used to measure clinical outcomes at an average follow-up of 6 years (range, 4-8 years). Of the 52 patients meeting the inclusion criteria, 48 were contacted and examined for the study, with 4 patients lost to follow-up.Results:The mean postoperative UCLA score was 28.03, with 1 patient requiring revision because of pain and glenoid wear. The mean SSV was 92% (range, 0%-100%), with 3 patients restricting their activity because of the shoulder. Forty-seven of the 48 contacted patients stated that, given the option, they would have the same surgery again. One patient required revision surgery because of pain.Conclusion:Surface replacement arthroplasty provided reasonable results in patients younger than 60 years with high activity demands with a low rate of revision at midterm follow-up.

Arthroscopic Repair of Massive Contracted Rotator Cuff Tears

Few studies of large-to-massive contracted rotator cuff tears have examined the arthroscopic complete repair obtained by a posterior interval slide and whether the clinical outcomes or structural integrity achieved are better than those after partial repair without the posterior interval slide. The study included forty-one patients with large-to-massive contracted rotator cuff tears, not amenable to complete repair with margin convergence alone. The patients underwent either arthroscopic complete repair with a posterior interval slide and side-to-side repair of the interval slide edge (twenty-two patients; Group P) or partial repair with margin convergence (nineteen patients; Group M). The patient assignment was not randomized. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and range of motion were used to compare the functional outcomes. Preoperative and six-month postoperative magnetic resonance arthrography (MRA) images were compared within or between groups. At the two-year follow-up evaluation, the SST, ASES score, UCLA score, and range of motion had significantly improved (p < 0.001 for all) in both groups. However, no significant differences were detected between groups. Even though the difference in preoperative tear size on MRA images was not significant, follow-up MRA images identified a retear in twenty patients (91%) in Group P and a significant difference in tear size between groups (p = 0.007). The complete repair group with an aggressive release had no better clinical or structural outcomes compared with the partial repair group with margin convergence alone for large-to-massive contracted rotator cuff tears. In addition, the complete repair group had a 91% retear rate and a greater defect on follow-up MRA images. Even though this study had a relatively short-term follow-up, a complete repair of large-to-massive contracted rotator cuff tears, with an aggressive release such as posterior interval slide, may not have an increased benefit compared with partial repair without posterior interval slide.

Arthroscopic repair of massive contracted rotator cuff tears using a “slide” technique

Objective To evaluate the “slide“ technique used in arthroscopic repair of massive contracted rotator cuff tears.Methods Between January 2007 and December 2010,21 patients (8 men and 13 women) underwent arthroscopic repair of massive contracted rotator cuff tears using the ” slide” technique.Their mean age was 60.5 years,ranging from 42 to 73 years.Seven cases had the tear on the left side and 14 on the right.All patients were followed up until the last time by X-ray and MRI evaluations.The postoperative range of motion (ROM) and functional recovery were evaluated by comparing the preoperative visual analog scale (VAS) pain score,University of California at Los Angeles (UCLA) and Constant-Murley scores with those at the last follow-up.Results All patients were followed up for an average of 23.2 months (range,12 to 36 months).Good healing was achieved in all cases.The last follow-ups showed good alignment of the shoulder joint and no upper advancement of the humeral head.The average postoperative VAS,UCLA and Constant-Murley scores were respectively 4.6 ± 1.3,8.7 ± 2.5 and 38.1 ± 7.7,significantly better than those at the last follow-up (9.0 ± 1.2,29.4 ±4.5 and 86.9 ± 10.0 respectively) (P ＜0.05).No infection,nonunion or paresthesia of the shoulder joint was observed.Conclusion Arthroscopic repair of massive contracted rotator cuff tears using the ”slide” technique can lead to satisfactory clinical outcomes with respect to pain,ROM,muscle strength and functional recovery. Key words: Shoulder joint; Arthroscopy; Shoulder impingement syndrome; Reoperation

AB0673 Comparison of the duration of ultrasound treatment in patients with subacromial impingement syndrome.

Background.ObjectivesA prospective, randomized and single-blind study has been performed in order to compare the efficiency of ultrasound treatment of various durations as applied to patients with subacromial impingement syndrome.MethodsForty patients,...

Curative effect of arthroscopic suture anchor fixation on shoulder bankart injury

To determine the curative effect of arthroscopic suture anchor fixation on shoulder bankart injury. Sixteen patients with shoulder recurrent dislocation and diagnosed bankart injury were treated with suture anchor fixed by shoulder arthroscopy. Both shoulders of the patients had X-ray, MRI, physical examination before the operation. Suture anchors were used to fix the lesion labrum by shoulder arthroscopy. University of California at Los Angeles (UCLA) score and visual analogue scale (VAS) score were adopted for the final evaluation at the latest follow-up. All patients were followed for a period of 25 (7-68) months. At the latest follow-up, no redislocation and instability occured. The pre- and post-operation UCLA score was (20.8 ± 0.8) vs (32.9 ± 1.5), excellent in 6, good in 10, with no poor score, while the pre- and post-operation VAS score was (3.3 ± 0.8) vs (0.6 ± 0.5). Suture anchor fixation guided by arthroscopy is good for bankart injury caused by recurrent shoulder dislocation, which has many advantages, such as mini-invasion, rapid recovery and a satisfactory outcome in function and motion.

Arthroscopic Transfer of the Long Head of the Biceps Tendon

Objectives:Evaluation of the mid-term clinical and functional outcome in a cohort of patients who underwent transfer of the long head of the biceps tendon (LHBT).Methods:Patients diagnosed with biceps instability or related pathology that underwent arthroscopic assisted or all arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon were considered. The procedure was performed either as an isolated procedure on in conjunction with another procedure by the senior author. Outcome surveys were collected for 157 patients with a subset of 43 patients available for clinical examination at 2-10 years postop time point. Outcome measures were based on American Society of Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA), and L’Insalata questionnaires. Ipsilateral and contralateral metrics were also evaluated.Results:157 patients (25 female, 132 male; average age 50 years; average postop 4.9 years) were evaluated with L’Insalata, UCLA, and ASES questionnaires, scoring 84.78, 29.77, and 83.4, respectively. In the 33 patients who had an isolated LHBT transfer, the L’Insalata, UCLA, and ASES scores were 79.52, 27.6, and 83.95, respectively. 43 shoulders (7 female, 36 male; average age 50 years; average postop 5.1 years) were available for clinical examination by a physician other than the treating surgeon. There was no statistically significant side-to- side strength difference using a 10-pound weight. All of the patients reported no arm pain at rest with regard to the biceps. 81% of patients reported no biceps tenderness upon palpation of the bicipital groove and 85.8% had a negative throwing test. 95.2% of patients had a negative active compression test. Speed’s and Yergason’s tests were negative in 90.5% and 95.2% of patients respectively. One patient (3%) complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. Five patients (12.0%) had a Popeye sign and one patient (3%) exhibited biceps subsidence. 86% of patients were self-rated as good to excellent, with the remaining 14% reporting fair or poor results.Conclusion:Arthroscopic subdeltoid transfer of the LHBT to the conjoint tendon is an appropriate and reliable intervention for active patients with chronic, refractory biceps pathology. There was no loss of strength for biceps curls. All patients reported no pain isolated to biceps muscle at rest. Ninety-seven percent of patients had resolution of their preoperative biceps symptoms.

Comparision of ultrasound therapy of various durations in the treatment of subacromial impingement syndrome.

[Purpose] A prospective, randomized, single-blind study was performed in order to compare the efficacy of ultrasound treatments of various durations for patients with subacromial impingement syndrome. [Subjects and Methods] One hundred patients who had been diagnosed with subacromial impingement syndrome by clinical examination and magnetic resonance imaging were included in this study. Patients were randomly divided into two groups of fifty patients per group. The first group received 15 sessions of therapeutic ultrasound (4 minutes), superficial heat and transcutaneous electrical stimulation therapy combined with exercise. The second group received the same treatment except that each of the 15 ultrasound sessions were eight minutes in length. The patients were evaluated before and after the treatment. A visual analog scale (VAS) was used to assess pain, the University of California at Los Angeles (UCLA) and Constant Scale were used to assess shoulder function and the Beck Depression Inventory (BDI) was used to quantify depressive symptoms. [Results] There were no statistically significant differences between the groups in age, time since the onset of pain, sex, education and depression levels prior to the treatment. The post-treatment evaluation of patients VAS, UCLA, Constant, and BDI scores showed statistically significant within group improvements. When the two groups were compared, we found no statistically significant differences in the Constant activities of daily living, Constant external rotation, Constant force and BDI scores. However, the second group scored better than the first group in all the remaining parameters. [Conclusion] Ultrasound therapy was found to have beneficial effects on pain and functional status in the treatment of subacromial impingement syndrome. Eight minutes of ultrasound treatment was shown to be more effective than 4 minutes of ultrasound treatment.

Groin Pain after Metal on Metal Hip Resurfacing: Mid-Term Follow-Up of a Prospective Cohort of Patients

Groin pain after metal on metal hip resurfacing has been previously reported. The purpose of this study was to determine the natural history of a cohort of patients with groin pain after hip resurfacing previously reported on and incidence of revision surgery. Our group previously reported an 18% incidence of groin pain at a mean of 18months post hip resurfacing. This cohort of groin pain patients was prospectively followed. Patients were evaluated using a visual analog pain rating score, the University of California at Los Angeles (UCLA) Physical Activity Index, and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Functional outcome scores were compared from initial to latest follow up using the paired Student's t test. Further diagnostic evaluation and/or intervention or other complication was also recorded. The latest mean follow up from surgery was 63 ± 15months. The mean pain rating, UCLA, and WOMAC scores all improved at latest follow up, although WOMAC score improvement was not statistically significant. Mean pain rating score improved from 5.2 ± 2.0 to 2.5 ± 1.4 (p = 0.0001). UCLA activity score improved from 6.4 ± 2.0 to 6.9 ± 1.6 (p = 0.03). Total WOMAC score improved from 75.6 ± 20.5 to 84.5 ± 14.8 (p = 0.15). Only one patient was revised for an adverse local tissue reaction. Groin pain post hip resurfacing has a multifactorial etiology, and in the vast majority of cases improves over time with no significant functional limitations. However, the surgeon should be aware of the many potential causes, and help minimize the possibility with proper patient selection and surgical technique.

Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up (P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points (P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B (P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) (P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.

Arthroscopic Treatment of Rotator Cuff Tears With Shoulder Stiffness

Background: In a single arthroscopic surgery for rotator cuff tears with a stiff shoulder, closed manipulation with or without arthroscopic capsular release has been combined with the repair. Few studies have reported functional results after this surgery, and a clinical comparison has not been reported. Purpose: To compare functional outcomes with and without capsular release in arthroscopic treatment of rotator cuff tears with a stiff shoulder. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients who underwent arthroscopic rotator cuff repairs with a concomitant stiff shoulder, 34 patients were treated with either manipulation and arthroscopic capsular release (group A; n = 18) or manipulation without capsular release (group B; n = 16). Preoperative mean passive forward flexion was 118° in group A and 117° in group B, whereas external rotation at the side was 28° and 29°, respectively. All patients were evaluated at a minimum 2-year follow-up in terms of visual analog scale for pain, muscle power, range of motion, Constant score, modified American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, and modified University of California at Los Angeles (UCLA) scores. Results: The mean modified ASES score was 90.3 for group A and 87.7 for group B (P = .086). The mean UCLA scores were 34.3 and 33.0, respectively (P = .247). The 2 groups showed a significant difference in forward flexion and external rotation post operatively, as group B recovered more slowly. There was no difference in the mean visual analog scale for pain at the last follow-up, but a 13° difference in forward flexion (P < .001) and a 10° difference in external rotation (P =.001) were seen. Conclusion: Overall satisfactory results could be achieved by either method, whereas rapid recovery and improvement of range of motion could be achieved by using a single arthroscopic repair and concomitant release for patients with rotator cuff tears with stiff shoulder.