Purpose: Massive rotator cuff defects are often associated with incapacitating pain and severe functional impairment and pose a difficult management problem.

Introduction: Tears of the rotator cuff are a common orthopaedic condition. The surgical treatment for such defects is varied and include simple debridement, “balanced” repair, local musculotendinous transfers, and autograft or allograft tendon grafts. This study was designed to evaluate the mid-term results of porcine dermal xenograft tendon grafts in the treatment of chronic, massive rotator cuff defects.

Method: Ten patients with a mean age of 64.9 years (46 – 80), 5 male, 5 female, with mean cuff defects of 4.5 cm, were selected from the waiting list to undergo an open subacromial decompression and grafting of the rotator cuff defect with a PDX patch. The patients were then subjected to the standard post-operative rehabilitation regime. All patients were assessed pre-operatively and at six weeks, three months, six months, and one year using the Constant score and Mini-DASH questionnaire. The study had the approval of the regional ethics committee.

Results: All ten patients were followed up and demonstrated excellent pain relief from the procedure. Pain scores improved from 6.7 pre-operatively to 13.9 at 12 months. At the same time intervals function score improved from 12.1 to 15.7, range of movement from 13.6 to 21.4, power from 5.1 to 10.9, Constant score from 39.6 to 56.9 and finally the DASH score from 26 to 17.9. There were no major post-op complications and the graft did not cause any adverse reaction. Subjective and functional results improved to six months from pre-op values, but at one year, with the exception of pain, the results were slightly less good but still improved.

Conclusion: This procedure offers an alternative method of managing massive rotator cuff tears. It simplifies the surgery with no tension on the repair and may reduce the requirement for prolonged splintage. Pain relief is excellent and there have been no reported adverse effects to the graft.

We have reviewed 106 patients after treatment for spontaneous rupture of the calcaneal tendon, and assessed the clinical results including the power of plantarflexion. In patients treated within 48 hours of injury the result was very similar in conservatively and in operatively treated patients. The incidence of major complications was higher after operation (17%) than in those treated conservatively (4%). Patients who were treated more than one week after injury, however, had an inferior result with respect to power of plantarflexion after conservative management. It is therefore recommended that calcaneal tendon rupture is treated conservatively with a plaster in full equinus when it is diagnosed within 48 hours of injury, and by operation when diagnosis has been delayed for more than one week.

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed.