The Rotator Cuff Registry is a unique initiative of the New Zealand Shoulder & Elbow Society. The aim of the study was to enrol nationwide all patients undergoing rotator cuff repair over a 22 month period to provide best practice guidelines for management of rotator cuff tears.

To qualify for the Registry patients have to undergo surgical repair of either a partial or full thickness rotator cuff tear. Prior to surgery patients fill out a registration document as well as a pain score and Flex-SF function score. The Surgeon completes an operating day questionnaire detailing operative findings and repair methods. Follow-up is by pain and Flex-SF function scores returned at six, twelve and twenty-four months from surgery.

By the 31st December 2010 3000 patients had been recruited. Analysis of the first 2684 patients for the purpose of this abstract showed 70% Male and 30% female. The dominant arm was involved in 65%. 19% of patients were in high demand occupations, 27% in medium demand and 33% low demand occupations. 16% of patients were treated with all arthroscopic repair, 40% were mini-open and 44% open. Comparing pre-op and one year post-op activity scores by surgical approach the Flex-SF improved by 12.97 points in the arthroscopic group, 13.3 in the mini-open and 12.72 in the open (NSS). Pre-op, 6 mth and 12mth pain scores were arthroscopic 4.60, 1.81 and 1.57, mini-open 4.34, 2.15 and 1.52 and open 4.82, 2.27 and 1.86. Preoperatively, the open approach had statistically more pain than the mini-open. At 6 months the arthroscopic group had statistically less pain than the open and at twelve months the mini-open had statistically less pain than the open group. For all tear sizes significant improvements in Fex-SF were seen both from preoperative levels to 6 month follow-up and from 6–12 month follow-up. A labral tear was present in 12% and repaired in 25% of these. No difference was seen in outcome between these groups Biceps tenolysis was undertaken in 27% and tenodesis in 23%. A single row repair was selected in 44% and a double row in 56%. Double row repair resulted in better Flex-SF scores in the large tears

Six, twelve and some twenty-four month data will be presented. Outcome was unaffected by the surgical approach with arthroscopic, mini-open and open results essentially identical.

The New Zealand Nationwide Rotator Cuff Registry is a first worldwide. An initiative of The NZ Shoulder and Elbow Society, work commenced on the project in July, 2005, and the Pilot Study involving four surgeons and 200 patients commenced in September 2007 and finished in February, 2009. The Nationwide Registry commenced in March, 2009, and by 30th June 520 patients had been recruited. This presentation will focus on the data for the first six months of the study.

Analysis of data for the first four months showed that 71% of patients were male and 29% female. 62% involved the right shoulder. 88% of patients considered their shoulder problem accident-related. The rotator cuff repair was undertaken all-arthroscopic in 71 (13.8%), mini-open in 256 (49.6%), and open in 189 (36.6%). 95% were primary operations and acromioplasty was undertaken in 90%.

Using Cofield’s classification, tear size was small (< 1cm in AP length) in 10%, 1–3cm in 62% and large in 28%. Average pain score did not correlate with AP tear size but the Flex-SF activity score deteriorated with tear size. The supraspinatus was normal in 6% and had a full thickness tear of all of the tendon in 39%, part of the tendon in 38% and had a partial thickness tear in 17%. The subscapularis was involved in 33% and infraspinatus in 28%. A labral tear was present in 8.4% and was repaired in 2.1%. Distal clavicle excision was undertaken in 9% of which 62% were open and 38% arthroscopic. The long head of biceps was normally located in 82%, subluxed in 11% and dislocated in 7%. In 47% of cases it was normal, in 42% damaged and in 11% ruptured. Tenodesis was undertaken in 24%, tenotomy in 19% and in 57% the tendon was left in situ. Double row repair was utilised in 60% and single row in 40%. Suture anchors were used in 78% of repairs, bone tunnels in 7% and a combination in 15%. The tendon quality was rated very well in 26%, good in 54% thin in 13% and poor in 7%.

Postoperatively 42% were immobilised for 6 weeks, 24% for 4 weeks and 11% were not immobilised. A polysling was used in 56% and abduction pillow in 21%, and an ultrasling in 10%. Smoking and NSAID use will be compared in patient-derived outcome data at 6 months, one year and two years from surgery.

The aim of this study is to prepare for the introduction of the world’s first nationwide registry of all rotator cuff tears proceeding to operative management.

Patient’s are scored pre-operatively and again at six and 12 months post-op using the Flex SF functional scale, pain scales and work and activity levels. A questionnaire is filled out by the operating surgeon on the day of surgery detailing pathology and the operative methods used.

This study is a New Zealand Shoulder and Elbow Society initiative begun in 2007. New Zealand is ideally suited with a small, cohesive group of orthopaedic surgeons. Rotator cuff surgery is advancing rapidly with changes in surgical approach from open to arthroscopic, and repair methods from bone tunnels to various choices of anchors. A wide range of surgical methods are used within New Zealand, presenting an opportunity to use the large numbers generated by a registry to give valuable information guiding future treatment.

The operation day questionnaire includes information on tear size, surgical approach, repair methods, biceps and AC joint pathology and rehabilitation.

More than 100 patients have already been registered in the pilot study and a number have completed the six month questionnaire. These early results will be presented, along with important information for the large number of surgeons who will become involved when the nationwide registry commences.

At the New Zealand Shoulder and Elbow Society Meeting in 2005, it was decided to set up a national registry to look at the outcomes of rotator cuff repair in New Zealand. National Joint Registries have produced very powerful information on the performance of joint replacements, not just in the hands of the designer but for all surgeons. The patient numbers in these Registries have allowed powerful information to be derived which has had a significant impact on local practice.

A nationwide registry on rotator cuff repair in New Zealand has the potential to provide similar powerful information. This is an area in which there has been rapid change over the last five years particularly with regard to surgical approach whether it be open, mini-open or arthroscopic and uncertainty remains as to what is best ‘best practice’. Surgeons are unwilling to invest time and effort into mastering sometimes difficult new procedures unless significant benefit can be demonstrated. Aspects addressed include anchors v. traditional drill holes in bone, anchor type, suture type and configuration, length of immobilisation, post-operative regime, effects of smoking and NSAIDs, on outcome and outcome versus size of tear.

A pilot study is being undertaken to ensure the questionnaires are workable and the system will run smoothly. Early results of the pilot study will be presented.

Anterior cruciate ligament reconstruction is a common procedure performed by orthopaedic surgeons. The procedure continues to evolve, with a trend towards more accurate reconstruction of the pre-existing anatomy. Single bundle reconstruction has been the gold standard, with good to excellent results returning many athletes to their chosen sports. Persisting functional instability and late degenerative changes are well described, encouraging several centres to attempt to improve upon the single bundle technique.

This is a technical paper examining the first 15 cases in a single surgeon series. Technical challenges unique to double bundle reconstruction will be discussed with suggestions on how to minimise problems. Tourniquet time, early complications and KT1000 measures will be presented.

The technical requirements of anatomic double bundle ACL reconstruction fall within the skill set of a competent arthroscopist. The transition can be simplified with a clear knowledge of the problems unique to this procedure.

Surgeons are becoming increasingly aware of the importance of matching a patient’s native offset during hip arthroplasty. During the course of a previous study investigating proximal femoral geometry in New Zea-landers it was noted that accurately measuring the femoral offset of a hip arthroplasty patient by traditional methods is difficult and inaccurate. The relationship of various surface parameters were studied to find a simple and reliable method for the surgeon.

Eighteen cadaver femora were skeletalised and the offset was measured using a standardised radiological technique. The femoral neck was then sectioned from a point 1–2 cm above the lesser trochanter to the base of the trochanteric fossa. The femoral head was sectioned in the coronal plane and the centre of the head located with concentric circles. The distance from the centre of the head to the most lateral spike of bone was measured. This measure was compared to the radiological offset.

Offset correlated closely with the measurement from the centre of rotation to the most lateral spike of bone provided the neck cut extends to the base of the tro-chanteric fossa. Eleven of eighteen measurements were within 2mm of true offset and fifteen were within 3mm. A simple intra-operative technique taking no longer than one or two minutes and requiring no special equipment has been devised to allow the surgeon to accurately estimate the patients femoral offset.