Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. Standardized response means were used to determine responsiveness. The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). These results suggest that the DASH may be preferable to either a disease specific scale or a shoulder scale for detecting clinical progress following cuff repair.

A number of self-report scales exist for shoulder problems, including regional, joint-specific and disease specific scales. Determining the most responsive scale is essential for outcome evaluation and clinical trials.

Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. An independent research assistant administered scales. Standardized response means were used to determine responsiveness.

The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). The subscale of the WORC that showed the most change was lifestyle. Physical subscales of the SF-36 showed improvement; whereas, minimal impact on mental health was observed.

The DASH can be used for a variety of upper extremity conditions, whereas the WORC was designed specifically for rotator cuff disease. Unless a disease specific scale is more responsive, there is little reason to adopt a scale than can only be used for one condition. This data supports the ability of the DASH to indicate upper extremity function and the important role of the rotator cuff in function.

The implications of these findings are that the DASH may be preferable to either a disease specific scale for rotator cuff disease or a shoulder scale for detecting clinical progress.

The reliability and accuracy of plain radiographs, MRI and CT Arthrography to detect the presence of loose bodies was evaluated in twenty-six patients with mechanical elbow symptoms. The location of loose bodies found by the imaging studies was compared to arthroscopic findings. Overall sensitivity for the detection of loose bodies was 88 – 100% and specificity was 20 – 70%. Plain radiographs had a similar sensitivity and specificity of 84% and 71% respectively. MRI and CT Arthrography were similar to plain radiography, suggesting that routine use of these modalities is not indicated.

The purpose of this study was to determine the clinical utility of MRI and CT Arthrography (CTA) to reliably and accurately predict the presence of loose bodies in the elbow.

Twenty-six patients with mechanical elbow symptoms underwent plain radiography, MRI and CTA, followed by standard elbow arthroscopy. Three musculoskeletal radiologists reviewed the ‘blinded’ plain radiographs with both the MRI and CTA at separate sittings. The location and number of loose bodies on the MRI and CTA were recorded. The preoperative plain radiographs, MRI and CTA were compared to the arthroscopic findings.

Agreement between radiologists was higher for the number of loose bodies identified in the posterior compartment (ICC=0.72 for both MRI and CTA) than in the anterior compartment (ICC=0.41 and 0.52 for MRI and CTA respectively). The correlation between the number of lose bodies observed on MRI and CTA compared to those found arthroscopically was also higher in the posterior compartment (r=0.54–0.85) than in the anterior compartment (r=0.01–0.45). Both MRI and CTA had excellent sensitivity (92–100%) but moderate to low specificity (15–77%) in identifying posteriorly located loose bodies. Neither MRI nor CTA were consistently sensitive (46–91%) or specific (13–73%) in predicting anterior loose bodies. Overall sensitivity for the detection of loose bodies in either compartment was 88–100% and specificity was 20–70%. The preoperative radiographs had a similar sensitivity and specificity of 84% and 71% respectively.

MRI and CTA were similar to plain radiography in the prediction of elbow loose bodies.

Introduction and Aims: Suture anchors allow consistent reattachment of tendons and ligaments to bone. Many options are available. The purpose of this study was to compare the initial strength of two rotator cuff repair techniques. The hypothesis was that rotator cuff repair strength with anchors would be inferior to transosseous sutures.

Method: Eight paired shoulders with a standardised supraspinatus defect were randomised to bioabsorbable nonsuture-based anchor or transosseous suture repair. Each specimen was then subjected to a stepwise cyclic loading protocol, utilising a custom-designed loading apparatus. Repair site migration was measured using an optical measurement system, consisting of a digital camera and custom software. Mode of failure, number of cycles and load to failure were measured for 50% (5 mm) and 100% (10 mm) loss of repair. These results were correlated with bone mineral density, age and gender. Statistical analysis utilised paired t-tests and Pearson correlations.

Results: The anchors failed at the anchor-tendon interface, whereas the sutures failed through the sutures. Mean values for 50 percent loss of repair were 206 ± 88 cycles and 44 ± 15 N for the sutures, and 1193 ± 252 cycles and 156 ± 20 N for the anchors (p< 0.05). The corresponding values for 100 percent loss of repair were 2458 ± 379 cycles and 294 ± 27 N for the sutures, and 2292 ± 333 cycles and 263 ± 28 N for the anchors (p> 0.05). These results may be due to the relative less deformability of the anchors. This may be relevant clinically, as in the early post-operative period, while tendon healing to bone is occurring, anchors may offer improved strength, allowing improved initial healing. Strength was unaffected by bone quality. This may be attributed to each repair failing primarily through the repair construct or at the anchor-tendon interface, and not through bone. Strengths of this study include the use of paired specimens, the stepwise cyclic loading protocol, as well as increased accuracy of our measurement system. Limitations include the use of an in vitro model, as well as a simulated, standardised rotator cuff tear.

Conclusion: Repair strength with anchors was superior to sutures. Strength was unaffected by bone quality. Anchors facilitate an arthroscopic procedure, decrease operative time, and may allow a faster post-operative recovery. This study has described a new high-resolution method of measuring tendon repair failure and may be useful in future studies.

Introduction and Aims: Ganglia are commonly seen during investigation of patients with wrist pain. Our aim was to determine the prevalence of ganglia in an asymptomatic population.

Method: Following Institutional Ethical approval, Magnetic Resonance Imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. There were 67 males and 37 females, with an average age of 36, range 19–67 years. There were 52 right wrists and 51 left wrists.

Using a 1.89 Tesla surface coil Magnetic Resonance Imager the following sequences were obtained: Coronal T 1, Proton Density, T 2 and Inversion Recovery sequences; Sagittal Inversion Recovery sequences; Axial T 1 and Inversion Recovery Sequences. The images were then evaluated independently by two Muskuloskeletal Radiologists and one Orthopaedic Surgeon.

Results: Wrist Ganglia were identified in 53 out of 103 wrists. Wrist Ganglia were more prevalent in females than males, 58% compared to 48% respectively. The average long axis measurement was 7.5 mm (range 2.7–22.2), the average short axis measurement was 3.2 mm (range 1.6–10.1). Seventy percent of the Ganglia were found to originate from the volar capsule in the region of the interval between the Radio-Scapho-Capitate Ligament and the Long Radio-Lunate Ligament. Fourteen percent of the ganglia were dorsal and originated from the dorsal, distal fibres of the Scapho-Lunate Ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intra-osseous component.

Conclusion: The prevalence of asymptomatic wrist ganglia is high – 51%. Unlike previous surgical and pathological series, our study showed volar wrist ganglia are more common than dorsal wrist ganglia in the asymptomatic population. The vast majority of these asymptomatic ganglia do not show associated ligamentous disruption, soft tissue oedema or intra-osseous communication.