INTRODUCTION: Full thickness rotator cuff tears have been associated with changes of the anterior acromion. In a previous study we also documented differences in lateral extension of the acromion in rotator cuff tears compared with shoulders with intact cuffs. It was the purpose of this study to verify in a prospective examination, whether presence or absence of rotator cuff tearing in a precisely defined population is quantitatively related to the degree of lateral extension of the acromion.

MATERIAL AND METHODS: 59 consecutive patients between 60 and 70 years and hospitalized for reasons other than shoulder pathologies were entered into a prospective study. All 110 shoulders without previous operations, major trauma or rheumatoid arthritis were examined radiographically and with ultrasonography by two independent examiners.

RESULTS: 67 cuffs were intact, 28 showed a cuff tendinopathy, 17 a full thickness tearing. The acromion index for shoulder with rotator cuff tear was 0.75, for tendinopathy 0.68 and for normal cuffs 0.65. The differences between rotator cuff tears and the other two groups was significant (p< 0.05). The acromion index was not related to gender or osteoarthritis. An acromion index of < 0.77 had a positive predictive value of > 70%. An acromion index of < 0.7 predicted an absence of rotator cuff tearing with an accuracy of 97%. Interobserver agreement of the assessment was excellent with 88%.

CONCLUSION: The relationship between rotator cuff tears and a large extension of the acromion can be used to predict the presence of rotator cuff tears in shoulders between ages 60 and 70. A cause-effect relation is probable and will be studied further.

Large osteochondral defects are difficult to treat, but several treatment options are available. The posterior condyle transfer salvage technique described by Wagner in 1964 and Imhoff in 1990 has been developed further and is now used for coverage of large osteochondral defects in the load-bearing zone. The new technique is called MEGA-OATS.

From July 1999, 25 patients of mean age 33.3 years (17 to 60) were treated with MEGA-OATS. Thirteen patients additionally underwent high tibial osteotomy and two bone grafting, using bone harvested from the proximal tibia. The mean follow up was 17.8 months. The technique calls for excision of the posterior femoral condyle which is placed in a specially designed work station. A MEGA-OATS cylinder of diameter 20 mm to 35 mm is prepared and, using the press-fit technique, grafted into the prepared defect zone. The Lysholm score increased postoperatively from 66.33 (49 to 71) to 87.8 (72 to 97). Three months postoperatively control MRI showed incorporation of all cylinders. Between six and 12 weeks postoperatively patients attained a full range of motion and became fully weight-bearing. To date one superficial infection resolving on oral antibiotics and two cases of arthrofibrosis four months postoperatively that required arthroscopic release were seen. No postoperative meniscal lesions of the posterior horn have been observed.

MEGA-OATS achieves a congruent reconstruction of the articular surface in the load-bearing zone of the femoral condyle. We consider it a good alternative in the treatment of large osteochondral defects of the femoral condyle in young patients.

Large osteochondral defects are difficult to treat, but several treatment options are available. The posterior condyle transfer salvage technique described by Wagner in 1964 and Imhoff in 1990 has been developed further, and is now used for coverage of large osteochondral defects in the load-bearing zone. The new technique is called MEGA-OATS.

From July 1999, 17 patients of mean age 39 years (16 to 6) were treated by MEGA-OATS. Two patients additionally underwent high tibial osteotomy and two bone grafting, using bone harvested from the proximal tibia. The mean follow-up was 12 months. The technique calls for excision of the posterior femoral condyle, which is placed in a specially designed work station. A MEGA-OATS cylinder of diameter 20 mm to 35 mm is prepared and, using the press-fit technique, grafted into the prepared defect zone.

The Lysholm score increased postoperatively from 63 (49 to 71) to 81 (72 to 85). Three months postoperatively control MRI showed incorporation of all cylinders. Between six and 12 weeks postoperatively, patients attained a full range of motion and became fully weight-bearing. To date no postoperative complications or meniscal lesions of the posterior horn have been observed.

MEGA-OATS achieves a congruent reconstruction of the articular surface in the load-bearing zone of the femoral condyle. We consider it a good alternative in the treatment of large osteochondral defects of the femoral condyle in young patients.