This study looks at the dynamic tendon-to-bone contact properties of rotator cuff (RC) repairs—comparing single row repairs (SRR) with double row transosseous- equivalent (TOE) repairs. It was postulated that relaxation during, and movement following, the repair would significantly compromise contact properties and therefore, the ability of the tendon healing.

Simulated tears were created in the supraspinatus tendon of six cadaveric human shoulders. A SRR was then performed using the OPUS System, creating two horizontal mattress sutures. An I-Scan electronic pressure-sensor (Tekscan, Boston, MA) was placed between the supraspinatus tendon and bone. The arm was then rested for 300secs (relaxation) before being passively moved twice through a range-of-motion (0-90 degrees abduction, 0-45 external and 0-45 internal rotation) and finally returned to neutral. The contact properties were recorded throughout each movement. The procedure was then repeated using two TOE techniques: parallel sutures (TOE-P) and a cross over suture pattern (TOE-C).

While peak pressures during the repair were higher in the two TOE repairs, all three methods demonstrated relaxation over 300s such that there was no significant diference in contact pressures at the end of this time. TOE parallel and cross-over repairs demonstrated no significant change in mean TTB contact pressure, force and area during abduction, external rotation and return to neutral, when compared to the 300sec relaxation state. TOE-C demonstrated a higher contact force on internal rotation (+53%). The SRR demonstrated a significant drop in contact force on abduction (−63%), and return to neutral (−43%) and a trend on external rotation (−34%). SRR exhibited no change on internal rotation.

There have been very few biomechanical studies with which observe RC repair contact properties dynamically. Relaxation of the repair can be partially reversed. Significant decrease in contact area with SRR during movement occurred, compared to the TOE repairs, which remains unaltered. This is an important consideration when determining postoperative rehabilitation.

Introduction

Anterior cruciate ligament (ACL) reconstructive surgery is one of the most commonly performed surgical procedures. Synthetic ACL repair surgery with the Lars ligament is designed to repair, rather than replace, the torn ACL. Once the ACL is repaired, the level of function, biomechanical attributes and proprioception should be similar to the pre-injury state.

All patients in this cohort have undergone surgical repair of the torn ACL with synthetic Lars ligament augmentation. The indications and surgical technique will be outlined.

Patients have been assessed at follow-up with KOOS and Marx scores, which reflect the surgical outcome. The preliminary results with a six-month minimum follow-up will be presented. The results reflect previous published studies that show that surgical repair of the torn ACL with Lars ligament augmentation, can reliably and reproducibly stabilise the knee and allow an early return to sport. Complications include one septic arthritis, superficial wound infections and improperly placed bone tunnels.

Synthetic ACL repair using the Lars ligament is a reprodicible technique that allows a rapid post-operative rehabilitation and avoids all complications relating to graft harvesting. The indications and the surgical technique are quite specific and must be adhered to in order to achieve the best results.

Rotator cuff repair failure may to some extent be attributed to tendon-bone gap formation at the repair sight caused by insufficient suture tightening. We measured the footprint contact properties over time of single row and trans-osseous equivalent repairs. We also investigated the effect of suture retightening on the repair.

Rotator cuff tears (RCT) were created in the supra-spinatus tendon of 6 cadaveric shoulders. An electronic pressure sensor (Tekscan) was placed between the tendon and bone to measure the footprint pressure. The OPUS AutoCuff System was used to consecutively repair the RCT using a single row repair (SR-R) and two trans-osseous equivalent repair (TOE-R) techniques;

two parallel sutures (TOE-P) and

Peak initial contact force, were recorded on suture tightening (peak force) and equilibrium contact properties after 300 seconds relaxation (equilibrium force). Data were analysed using pairwise ANOVA.

All techniques demonstrated a similar trend in the contact properties over the test period with an initial peak in contact force on tightening of the sutures, followed by a rapid drop in contact pressure immediately after suture tightening, and finally tending towards equilibrium contact force at 300 seconds.

The TOE-C group demonstrated the highest mean ‘peak force’ and the highest ‘equilibrium force’ after 300 seconds relaxation. The TOE-P ‘peak force’ and ‘equilibrium force’ were −15% and −3% that of TOE-C, while the SRR was −45% and −25% that of TOE-C.

Retightening the sutures a second time had little effect on the SSR contact properties, while retightening the TOE repairs increased the equilibrium contact force by 30% although this was not significant.

Significant relaxation occurs especially within the first 30s, compromising the contact properties.

TOE-R’s exhibit better contact properties than SRR. Retightening the TOE-R’s tended towards a higher final equilibrium contact force. SRR repair contact properties were unaffected by a second tightening.

TOE-R’s should be re-tightened before the suture is locked

Introduction Ultrasound is a readily available and widely used tool in the investigation of rotator cuff pathology in the shoulder. Reports in the literature as to the diagnostic accuracy of ultrasound in diagnosing cuff tears vary widely. Accuracy rates varying from 50% to 100% have been reported. Most reports reflect the accuracy rates from a single sub-specialized institution.

Method Sity-one consecutive patients with rotator cuff pathology diagnosed on ultrasound, underwent arthroscopy of the shoulder and rotator cuff repair, if a full thickness tear was found at surgery. Most patients had their ultrasound ordered by the referring doctor, prior to my initial review. The ultrasounds were performed at various suburban practices. Most were performed at branch practices of one of the three ‘corporate’ practices in Sydney. All full thickness tears were repaired arthroscopically.

Results Ultrasound correctly identified rotator cuff tears in 80.3%. Four of 61 patients (6.6%) were reported as having partial thickness tears and at surgery were found to have small full-thickness tears. Six of 61 patients (9.8%) had small full thickness tears diagnosed on ultrasound, but were found to have partial thickness tears at surgery. One patient (1.6%) had an ultrasound diagnosis of a tear but had an intact tendon at surgery. One patient (1.6%) was found to have a full thickness tear with an ultrasound that reported an intact tendon.

Conclusions Ultrasound is a valuable tool on the investigation of patients with rotator cuff pathology. It is not reliable in differentiating partial thickness from small full thickness cuff tears. This differentiation is not critical and should not significantly change the patient’s treatment. Reasons for false positive and false negative ultrasounds will be given. Ultrasound for the diagnosis of rotator cuff tendon tears, as performed in suburban practices, is accurate in up to 97% of cases.

Introduction: Acromioclavicular (AC) joint injuries are common in both the sporting and working populations. Most injuries are grade I in severity and settle with an appropriate non-operative treatment program.

Arthroscopic soft tissue debridement of the AC Joint without excising the distal clavicle, is a bone sparing procedure that, to our knowledge, has never been reported in the literature.

This paper is a retrospective review of patients with chronic recalcitrant AC joint injuries, who underwent arthroscopic soft tissue debridement of the AC joint.

Materials and Methods: Fourteen patients underwent arthroscopic AC joint soft tissue debridement. All patients had failed a non-operative treatment program including physiotherapy, anti-inflammatory tablets and corticosteroid injections. All patients had been symptomatic for a minimum of four months prior to surgery.

The surgery involves a glenohumeral joint arthroscopy, subacromial bursoscopy and AC joint arthroscopy. Excision of the torn AC joint meniscus, AC joint synovectomy and soft tissue clearance were performed in all cases. Surgery was performed as a day-only procedure.

Results: Ten out of fourteen patients obtained good pain relief and a corresponding increase in function. One patient was lost to follow-up. One patient subsequently underwent an open AC joint reconstruction for chronic instability.

Five patients had previously undiagnosed SLAP tears.

Conclusion

Arthroscopic soft tissue debridement for recalcitrant AC joint injuries gave good results in 77% of cases.