Massive rotator cuff tear can cause functional disability due to instability and degenerative changes of the shoulder joint. In patients with massive irreparable rotator cuff tear, tendon transfer is often used as the salvage procedure. Latissimus dorsi and pectoris major transfer are technically demanding procedures and may incur complications. The biceps tendon transfer may provide a biologically superior tissue patch that improves the biomechanics of the shoulder joint in patients with irreparable rotator cuff tear. This study evaluated the functional outcomes of biceps tendon transfer for irreparable rotator cuff tear in 6 patients with two years and longer follow-up. Between September 2006 and October 2011, 50 patients with 50 shoulders underwent surgical repair for MRI confirmed rotator cuff tear. Among them, six patients with massive irreparable rotator cuff tear were identified intraoperatively, and underwent proximal biceps tendon transfer to reconstruct the rotator cuff tear. The biceps tendon was tenodesed at the bicipital groove, and the proximal intra-articular portion of the biceps tendon was transected. The biceps graft was fanned out and the distal end fixed to the cancellous trough around the greater tuberosity with suture anchor. The anterior edge was sutured to the subscapularis and the posterior edge to the infraspinatus tendon or supraspinatus if present. Postoperative managements included sling protection and avoidance of strenuous exercises for 6 weeks, and then progressive rehabilitation until recovery.Background:
Methods:
This study compared the functional outcomes of total hip arthroplasty (THA) in one hip and extracorporeal shockwave (ESWT) in the other hip in patients with bilateral hip necrosis. Seventeen patients with bilateral hip necrosis were treated with THA for late stage ONFH in one hip and ESWT for early lesion in the other hip. In THA, only one type of prosthesis was used and all components were cementless. In EWST, each hip received 6000 shocks at 28 Kv (equivalent to 0.62 mJ/mm2 energy flux density) in a single session. The evaluations included pain score, Harris hip score, radiographs and MR images at 6 and 12 months and then yearly. Significant improvements in pain score and Harris hip score were noted after treatment in both hips. However, the magnitudes of improvement showed significant differences between the two sides favoring the ESWT side. On subjective assessment, 13 patients rated ESWT better than THA; 4 patients reported comparable results of THA and ESWT, and none graded THA better than ESWT. In THA side, abnormal radiographs were noted in 47% (8 of 17) including component mal-position, nonprogressive radiolucency, and suspected component loosening. In ESWT side, significant reduction of bone marrow edema and a trend of decrease in the size of the lesion were observed after treatment. ESWT and THA are effective for early and late stages of ONFH respectively. However, better functional outcomes were observed in ESWT-treated hips than hips treated with THA in patients with bilateral hip disease in short-term.
