Introduction: The rotator cuff is subject to constant pressure from the head of the humerus. This tends to ‘wring out’ the blood supply resulting in a functionally avascular critical zone, although microvessels can be identified. This zone is the site of degeneration and tears. Damage repair under these conditions would be difficult. Myofibroblasts are characteristic of the contractile phase of wound healing. We have examined their distribution in both healthy resected and torn, degenerating rotator cuff tissue and correlated their presence with vascularity and hypoxia in the surrounding tissue. Methods: Rotator cuff tissue was obtained from ten patients undergoing surgical repair. The size of tear was 1–4.5cm, Immunohistochemical staining with commercial monoclonal antibodies to HIF-1α (Hypoxia inducible factor), vimentin, smooth muscle actin (SMA), CD31 and VEGF was performed on formalin fixed paraffin embedded tissues. Visualisation used standard DAB chromagen technique. Results: Focal myofibroblast positivity (SMA+/VIM+) was detected, areas of positivity were found at the interface between torn and degenerating tissues adjacent to the tear. Myofibroblasts were absent in degenerating tissue. The areas of myofibroblast positivity were well vascularized, with strong VEGF positivity. Nuclear HIF-1α positivity was identified in the adjacent endothelial cell population and sporadically in fibroblast population, although not in the myofibroblasts. Conclusion: Evidence of an ongoing wound healing response was found in tissue from torn rotator cuffs. However, it was patchy and infrequent.

Introduction: Injury to the wrist may result in derangement of the distal radioulnar joint (DRUJ) and lead to deformity and degenerative changes. This often gives pain on ulnar side of the wrist and limits forearm rotation. We share our experience with the Sauve-Kapandji procedure for chronic posttraumatic derangement of the DRUJ.

Methods: Sixteen patients (seventeen wrists) with chronic posttraumatic derangement of the DRUJ were assessed before and after SauvŽ-Kapandji procedure using Cooneyñs score. There were six men and ten women and average follow up was 64 months.

Results: Mean supination improved from 43.9û to 78.5û and the mean pronation improved from 44.4û to 80.6û at the time of latest follow-up. Pain relief was satisfactory, and the mean grip strength improved from 30.6% of that on the unaffected side preoperatively to 72.1% at the time of follow-up. The ulnar stump was stable in þf-teen patients. Thirteen of the sixteen patients were able to return to work full-time without restrictions. At a mean of 64 months four patients had an excellent result; six a good result; þve a fair result; and one patient a poor result.

Conclusion: On the basis of our þndings, we believe that the index operation is a good salvage procedure for the treatment of chronic posttraumatic derangement of DRUJ, especially when non-operative treatment has been unsuccessful and rotation of the forearm is severely limited.

Background: Microvessels have been identified in the functionally avascular critical zone of the rotator cuff. Inadequate local sprouting of these capillaries might impair attempts at repair. We have identified widespread VEGF positivity in endothelial cells. However, this was accompanied by strong positivity for the cell cycle inhibitor p27 and little proliferation (Ki-67 positivity). Non-steroidal anti-inflammatory drugs (NSAID) can impair healing by inhibiting angiogenesis. The mechanisms include upregulation of p27 in endothelial cells. Objective: Does NSAIDs influence endothelial cell proliferation in torn rotator cuff? Methods: Pathological assessment of Rotator cuff tissue, obtained from 35 patients undergoing surgical repair, was performed on H& E sections. Ongoing vascular proliferation was identified by plump endothelial cells and budding of vessels. Preoperative drug prescription data was obtained from patient’s General practitioners. The drugs used were NSAIDs (including Ibuprofen and Diclofenac), COX2 inhibitors & Opiates. Results: Ongoing vascular proliferation was not identified in 20/35 patients. 25 patients were taking analgesics; vascular proliferation was absent in 15. 20 patients were taking NSAIDs of these 15 demonstrated no ongoing vascular proliferation, (p≤0.014). No significant effect of opiates or COX2inhibitors was found. Discussion: Patients taking NSAIDs showed a significant reduction in vascular proliferation. If endothelial cell proliferation is an important component of repair in rotator cuff tears, more work should be done to clarify this matter.