Previously, we conducted a multi-center, double-blinded randomized controlled trial comparing arthroscopic Bankart repair with and without remplissage. The end point for the randomized controlled trial was two years post-operative, providing support for the benefits of remplissage in the short term in reducing recurrent instability. The aim of this study was to compare the medium term (3 to 9 years) outcomes of patients previously randomized to have undergone isolated Bankart repair (NO REMP) or Bankart repair with remplissage (REMP) for the management of recurrent anterior glenohumeral instability. The rate of recurrent instability and instances of re-operation were examined.

The original study was a double-blinded, randomized clinical trial with two 1:1 parallel groups with recruitment undertaken between 2011 and 2017. For this medium-term study, participants were reached for a telephone follow-up in 2020 and asked a series of standardized questions regarding ensuing instances of subluxation, dislocation or reoperation that had occurred on their shoulder for which they were randomized. Descriptive statistics were generated for all variables. “Failure” was defined as occurrence of a dislocation. “Recurrent instability” was defined as the participant reporting a dislocation or two or more occurences of subluxation greater than one year post-operative. All analyses were undertaken based on intention-to-treat whereby their data was analyzed based on the group to which they were originally allocated.

One-hundred and eight participants were randomized of which 50 in the NO REMP group and 52 in the REMP group were included in the analyses in the original study. The mean number of months from surgery to final follow-up was 49.3 for the NO REMP group and 53.8 for the REMP group. The rates of re-dislocation or failure were 8% (4/52) in the REMP group at an average of 23.8 months post-operative versus 22% (11/50) in the NO REMP at an average of 16.5 months post-operative. The rates of recurrent instability were 10% (5/52) in the REMP group at an average of 24 months post-operative versus 30% (15/50) in the NO REMP group at an average of 19.5 months post-operative. Survival curves were significantly different favouring REMP in both scenarios.

Arthroscopic Bankart repair combined with remplissage is an effective procedure in the treatment of patients with an engaging Hill-Sachs lesion and minimal glenoid bone loss (<15%). Patients can expect favourable rates of recurrent instability when compared with isolated Bankart repair at medium term follw-up.

Purpose of the study: When repairing rotator cuff tears, injury to the infraspinatus is generally a posterior extension of a supraspinatus tear. The description of isolated tears of the infraspinatus has not been to our knowledge reported in the literature. We report a series of 13 cases with more than one year follow-up.

Material and methods: Thirteen patients underwent surgery for an isolated tear of the infraspinatus between 1995 and 2004. There were ten men and three women. Mean age at surgery was 47 years (range 34–62). The right shoulder was involved in seven of the thirteen cases, and the dominant shoulder in eight. A progressive onset was observed in eleven patients and nine had a history of treated calcified tendinopathy. Clinically, pain was the predominant symptom. The Jobe test was deficient in all patients as was external rotation (except one patient). The preoperative Constant score was 70 (range 62–87). X-rays revealed type C posterior calcification in nine patients. A full-thickness tear was observed in seven cases, a partial deep tear in three, and a partial superficial tear in three. Isolated fatty degeneration of the infraspinatus noted Goutallier grade 2 or greater was observed in seven patients. Open surgical repair was preformed in all patients.

Results: Mean time to revision was 29 months (range 12–82). Subjectively, six patients were very satisfied, six were satisfied, and one was disappointed (failure by secondary tear). Two shoulder-hand syndromes were noted in the postoperative period. At last follow-up, the Constant score was 83.5 (range 64–97). All patients except one were satisfied with pain relief but the lack of force was significant.

Discussion and conclusion: Isolated tears of the infra-spinatus are rare, but there is a notable relationship with calcifying tendinopathy of the same tendon. Repair should be undertaken before the development of fatty degeneration in order to improve the chances of force recovery.

Purpose of the study: Four elements differentiate myotendinous tears of the infraspinatus from other rotator cuff tears: the tendon insertion on the trochiter and the joint capsule are spared; the onset in characterized by intense muscle oedema followed at 6 to 12 months by severe and definitive fatty degeneration.

Material and method: Fifty-nine myotendinous tears of the infraspinatus were collected prospectively from 1993 to 2007. Female gender predominated (58%); trauma was noted at onset in 22% of the shoulders and the mean age of discovery was 48.9 years. Twenty-nine shoulders were seen at the acute phase with significant muscle oedema recognized on the MRI T2 Fat Sat sequence. A second group of 30 patients had grade 4 fatty infiltration of the infraspinatus without full thickness cuff tears. The EMG was available for 23 shoulders and was normal in all, ruling out a neurological cause. Associated lesions of the supraspinatus and infraspinatus tendons were: tendon calcification (61%) and partial tears at the acute phase (21%) and chronic phase (70%) suggesting a degenerative cause.

Results: Twenty-four patients underwent surgery and 35 had a medical treatment. At mean 46 months follow-up (range 12–125) the Constant score improved from 51.7 to 69.4 points (p< 0.0001). There was no different statistically between the operated and non-operated patients (p=0.325). All patients seen at the acute phase of the oedema progressed to complete grade 4 fatty degeneration of the muscle, irrespective of the treatment delivered.

Discussion: Early diagnosis of this lesion can be achieved with T2 Fat Sat MRI sequences. Arthroscopic repair to tighten the infraspinatus muscle could avoid the irremediable degeneration with total loss of muscle function.

We describe five patients, seen since 1984, with posterior shoulder pain and isolated wasting and weakness of the infraspinatus. In four of these a ganglion in the spinoglenoid notch was demonstrated by MRI and in one recent case ultrasound scans were positive. Three patients have been treated by operation, but there was recurrence in one after five years. In each confirmed case, the ganglion straddled the base of the spine of the scapula, extending into both supraspinatus and infraspinatus fossae. The nerve was either compressed against the spine or stretched over the posterior aspect of the ganglion. Adequate surgical exposure is essential to preserve the nerve to the infraspinatus and to allow complete removal of the ganglion. This is difficult because of the location and thin-walled nature of the cysts.

Introduction and purpose: The functional result of the functional repair of the rotator cuff is multifactorial. The purpose of this study was to assess the influence of supraspinatus and infraspinatus fatty degeneration prior to surgery on the functional result of open rotator cuff repair surgeries.

Materials and methods: The study comprised 32 patients (19 females and 13 males) operated on for a rotator cuff tear by means of open surgery. Mean age: 58.16. The right arm was involved in 20 cases, whereas the left one was involved in the remaining 12. The acromion was type II in 28 cases and type III in 4. In all cases a previous MRi was available. The analysis of fatty degeneration was made on the basis of Goutallier’s criteria. The assessment of the functional result was made according to Constant’s score. Minimum follow-up: 1 year.

Results: Mean Constant score: preop 51.41 (range: 30–69); postop (at the end of follow-up) 83 (range: 77–100). Fatty degeneration of the supraspinatus was deg. I in 32.25% of cases and deg. II in 45.16%. As regards the infraespinatus, 38,7% of cases had no fatty degeneration and 41.93% had deg. I. No significant differences were found regarding the post Constant score between patients with deg. 0-I supraspinatus fatty degeneration and patients with 0-I infraspinatus fatty degeneration (p 0.604) or between patients with deg. II-III-IV supraspinatus fatty degeneration and those with deg. 0-I infraspinatus fatty degeneration (p.654).

Conclusions: (1) Surgical repairs of rotator cuff tears lead to a satisfactory final functional result. (2) Considering the size of our sample, there do not seem to exist significant differences with respect to functional result between patients with supraspinatus (degrees 0–4) and patients with infraspinatus fatty degeneration (limited to deg. 0–1).

This paper aims to evaluate the Remplissage arthroscopic technique as described by Eugene Wolf used in patients with traumatic shoulder instability that present glenoid bone loss and Hill Sachs defects.

In our study 28 patients (5 women and 23 men) with mean age of 31 yrs underwent arthroscopic stabilization of the shoulder by the same surgeon during 2007–2008 period. All patients presented Hill Sachs lesion, 11 of them had medium or large glenoid bone loss, 10 had an “inverted pear” glenoid shape, 4 had been revised for stabilization in the same shoulder and 14 presented joint hypermobility. Mean age for the age of 1st dislocation was 20,1 yrs and our follow up ranged from 5–28 months (Mean=18). The recurrence of instability and the functional outcome were evaluated pre-op and postop with the Rowe Zarins Score. The post op rehabilitation was performed by a specialist.

None of the patients presented recurrent instability. The Rowe Zarins Score raised from a mean pre op score of 23,33 (15–60) to a mean post op score of 97,11 (75–100) (p< 0.05). All the patients that were into sports activities before the presentation of shoulder instability began training again and our post op evaluation of the shoulder’s ROM showed a decrease in the external rotation from 0°–15°.

The infraspinatus tenodesis and posterior capsulodesis in patients with humeral bone loss seems to offer so far excellent post op results despite the slight decrease in the external rotation of the shoulder.

Objective: The high incidence of retear following primary rotator cuff tendon (RCT) repair necessitates new strategies for tendon footprint augmentation. This study’s objective was to evaluate the SeriCuff™, a non-mammalian derived silk-based long-term bioresorbable implant, for RCT footprint reinforcement. The study aimed to characterize the device when overlaid on the infraspinatus tendon footprint of sheep in a RCT repair model. The technique was not targeted for the repair of massive RCT defects but advocated as a preventive measure to cuff reruptures in mid-to-large cuff tears, avoiding the need for surgical revision.

Methods: Bilateral surgeries were performed on each of 10 sheep during a single surgical session. The right shoulder of each animal was implanted with SeriCuff and the left shoulder was used as an operated control. The superficial layer of the infraspinatus tendon was removed and feathered for a distance of 1 cm. The remaining footprint was bluntly dissected from the humeral head with the exception of a thin band of the superior portion of the infraspinatus tendon. The footprint was approximated, 3 suture anchors placed equi-distantly along the edge of the full thickness region of the tendon and the tendon sutured to the anchors with a modified Mason-Allen stitch. Two additional anchors were placed along the lateral edge of the tendon in the right shoulder. The SeriCuff device was positioned over the 5 anchors and sutured in place using a single suture at each location (Fig 1B). In the left shoulder, no device was implanted and a second row of anchors was not used. Animals were allowed to ambulate immediately post-op with unrestrained motion for the duration of the study. All animals were necropsied at 3 mos and evaluated histologically (N=4) and mechanically (N=6). Samples designated for mechanical analysis were dissected leaving only the infraspinatus tendon and muscle attached to the humorous. The tendon was pulled to failure at a rate of 500 mm/min with the sample positioned such that the longitudinal axis of the tendon was collinear with the applied load.

Results: The animals were able to ambulate following surgery with return to normal gait at an average of 6 days post-operatively. Pain scores diminished with time throughout the first two weeks. Mechanical analysis indicated an average 42% increase in repair strength of the SeriCuff reinforced repair as compared to the contralateral control at 3 months. The SeriCuff device supported the formation of Sharpy’s fibers in the remodeling tendon tissue.

Conclusions: The addition of SeriCuff helped to reestablish the tendon footprint resulting in significantly increased repair strength 3 most post-op and therefore may have applications in reducing the high incidence of primary repair failure.

Purpose: Short-term results of surgical repair of subscapularis tears are well known. The purpose of this study was to assess long-term outcome after surgical repair of 21 full-thickness tears of the subscapularis.

Material and methods: Inclusion criteria were subscapularis tear (n=21) which were isolated (n=9) or associated with a supraspinatus tear (n=11) without intraspinatus tears. The subscapularis was reinserted by transosseous fixation in fifteen cases and with a trapezeal flap in six. The supraspinatus was repaired by transosseous suture. Function (Constant score) was assessed preoperatively, at one and three years, and at last follow-up (nine years, range six to fifteen years). We also noted radiographic changes (subacromial height, osteoarthritis using the Samilson classification, anterior dislocation of the humeral head). Fatty degeneration (FD) of the cuff was assessed on pre-operative scans and at last follow-up. Arthroscan, performed at one year and ultrasonography performed at last follow-up were used to assess cuff continuity.

Results: The rough Constant score was 45.2 (12–93.5) preoperatively, 67.5 (20–95) at one and three years and 59.45 (20–95) at last follow-up. At last follow-up, the Constant score was significantly better than preoperatively (improved pain score). There was only one case of repeated tear (repaired supraspinatus). At last follow-up we noted six anterior dislocations. The subacromial space remained unchanged (9.5 mm). Glenohumeral osteoarthritis developed in fourteen cases (2 Samilson class 3) including eight de novo degenerations. FD of repaired subscapularis tendons was 0.8 (0–4) preoperatively and 1.64 (1–4) at last follow-up. FD of unrepaired subscapularis tendons treated with a trapezeal flap worsened (2.2 to 2.7). FD of the supraspinatus and infraspinatus (0.5 preoperatively) worsened one stage. At last follow-up, the Constant score was lower in the presence of anterior dislocation of the humeral head (p=0.013). Development of anterior dislocation of the humeral head was correlated with major preoperative FD of the subscapularis (cut-off between 1.5 and 2, p=0.01). There was a correlation between more FD of the infraspinatus and the presence of anterior dislocation of the humeral head. Among the trapezeal flaps, there were only two good results (Constant scores 74 and 75) in patients with FD of the subscapularis scored 1.5 preoperatively.

Conclusion: Functional and radiographic outcome after cuff repair or palliation with a trapezeal flap for subscapularis tears associated or not with supraspinatus tears is not satisfactory unless the fatty degeneration of the subscapularis is low preoperatively (δ 1.5).

Aims

We performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes.

Nowadays it is well known that both a clinical examination and an imaging investigation (MRI/CT scans) are useful in order to provide surgeons with complete informations about the proposed treatment for shoulder pain. The purpose of this study was to evaluate the diagnostic sensitivity of the Neer, Hawkins, Jobe, Lift-off and Infraspinatus tests in diagnosing rotator cuff tears and compare this with what was found during surgery. From 2001 to 2003, data from 430 patients who underwent shoulder open surgery, performed by a single surgeon, were documented. The results showed that the Jobe test has a sensitivity of 97.5% and positive prognostic value (PPV) of 80.3% and negative prognostic value (NPV) of 90.9% for the presence of a supraspinatus lesion; the Neer, Hawkins and Yokum tests have a sensitivity close to 95% for assessing subacromial bursitis; the Lift-off and Infraspinatus tests have a sensitivity close to 70% for assessing the degree of lesion and identify a severe lesion with a NPV over 83%. The Lift-off and Infraspinatus tests also provide information concerning muscular trophism and concerning retraction and degeneration of tendons. According to our results, clinical evaluation of shoulder pain should be supported by imaging investigations for diagnosis of rotator cuff tear

Purpose: To determine if administration of recombinant bFGF in an alginate gel would increase early healing mechanical parameters in acutely injured rat rotator cuff tendon at specific time points. Method: Sprague Dawley rats were randomly divided into 2 groups and had surgically created 1mm (half tendon width) full thickness injuries at exactly 2mm from insertion site of Infraspinatus on the humerus. 200ng of bFGF or vehicle control was administered to randomly chosen rats. Tendons were harvested at 1 week, 2 weeks and 4 weeks. In both groups, the Infraspinatus tendon was dissected, and left attached to the humerus. At the time of testing, the intact portion of the injured tendon was divided sharply across tendon fibers at the level of the injury leaving only the healing tissue callus in continuity with the remaining proximal and distal portions of the tendon and loaded to failure. Results: At 1 week the injury group’s average load to failure was 0.60N versus 0.61N in the bFGF injury group P = 1.000. At 2 weeks the injury group’s average load to failure increased to 1.03N versus 2.08N in the bFGF injury group P = 0.440 At 4 weeks the injury group’s average load to failure increased to 3.93N versus 5.56N in the bFGF injury group P = 0.008 representing a 41% increase in ultimate load. At 4 weeks, callus size of the injury group was 0.4mm2 versus 2.7mm2 in the bFGF injury group P < 0.001. Stiffness at 4 weeks for the injury tendons was 2.15 N/mm versus 3.54 N/mm in the bFGF group P = 0.008. Conclusion: At 4 weeks healing tissue of acutely injured rotator cuff exposed to bFGF has an increase in ultimate load to failure (41% compared to control), increase in tendon callus size and stiffness. Our findings suggest a role of bFGF or similar growth factors in accelerating the healing of injured rotator cuff tendon

Introduction. Shoulder arthoplasty has increased in the last years and its main goal is to relieve pain and restore function. Shoulder prosthesis enters in the market without any type of pre-clinical tests. Within this paper we present study experimental and computational tests as pre-clinical testing to evaluate total shoulder arthoplasty performance. Materials and methods. An in vitro experimental simulator was designed to characterize experimentally the intact and implanted shoulder glenoid articulation. Fourth generation Sawbones® composite left humerus and scapula were used and the cartilage was replicated with silicone for the intact articulation (figure 1). In the intact experimental articulation we considered the inferior glenohumeral ligament as an elastic band with equivalent mechanical properties. For the implanted shoulder, the Comprehensive® Total Shoulder System (Biomet®) with a modular Hybrid® glenoid base and Regenerex® central post was considered (figure 2). The prostheses were implanted by an experienced surgeon and clinical results from orthopedic registers were collected. The system structures were placed to simulate 90º in abduction, including the following muscle forces: Deltoideus 300N, Infraspinatus 120N, Supraspinatus 90N and Subscapularis 225N. The finite element model was created with tetrahedral linear elements with linear elastic and isotropic material for the humerus in figure 3, (Young's modulus for cortical bone − 16.5 GPa; trabecular bone − 124 MPa). Anisotropic behavior was considered for the scapula model (E11 = 342.1 MPa, E22 = 212.8 MPa, E33 = 194.4 MPa). The shoulder prosthesis was of polyethylene with 1GPa and titanium with 110 GPa. The Poisson's ratio was 0.3 in all material, except for polyethylene where we assumed a value of 0.4. A long-term post-operative condition was simulated. Results. The experimental results were compared with numerical ones for model validation. The strains measured evidence the effect of the implant presence, manly in the scapula. In the anterior region presents an increase of strains (+26%) was observed for the anterior region and decrease (−52%) in the posterior region, suggesting strain shielding in figure 4. At the glenoid cavity, the numerical principal strains present safety values of strains (200 to 2500) µε in both axial and coronal planes. This indicates that on the long-term the glenoid prosthesis is well fixed to the surrounding bone tissue and bone integrity is maintained despite the presence of the implant. However there are some peak values (2500, 25 000 µε) that were observed in some small areas in the posterior and distal regions. Results were compared with clinical ones. Discussion and Conclusions. The proposed pre-clinical test with the articulation at 90º in abduction can predict bone behavior when total shoulder prosthesis is implanted and in the long term post-operative condition. The results obtained evidence some critical regions around the glenoid component. This pre-clinical test can be implemented to improve the concepts before market

Total shoulder arthroplasty is a well-tested procedure that offers pain relief and restores the joint function. However, failure rate is still high, and glenoid loosening is pointed as the main reason in orthopedic registers. In order to understand the principles of failure, the principal strain distributions after implantation with Comprehensive® Total Shoulder System of Biomet® were experimental and numerically studied to predict bone behavior. Fourth generation composite left humerus and scapula from Sawbones® were used. These were implanted with Comprehensive® Total Shoulder System (Biomet®) with a modular Hybrid® glenoid base and Regenerex® glenoid and placed in situ by an experienced surgeon. The structures were placed in order to simulate 90º abduction, including principal muscular actions. Muscle forces used were as follows: Deltoideus 300N, Infraspinatus 120N, Supraspinatus 90N, Subscapularis 225N. All bone structures were modeled considering cortical and the trabecular bone of the scapula. The components of prosthesis were placed in the same positions than those in the in vitro models. Geometries were meshed with tetrahedral linear elements, with material properties as follows: Elastic modulus of cortical bone equal to 16 GPa, elastic modulus of trabecular bone equal to 0.155 GPa, polyethylene equal to 1GPa and titanium equal to 110 GPa. The assumed Poisson's ratio was 0.3 in all except for polyethylene where we assumed a value of 0.4. The prosthesis was considered as glued to the adjacent bone. The finite element model was composed of 336 024 elements. At the glenoid cavity, the major influence of the strain distributions was observed at the posterior-superior region, in both cortical and trabecular bone structures. The system presents critical region around holes of fixation in glenoid component. At the trabecular bone, the maximum principal strains at the posterior-superior region ranged from 2250 µε to 3000 µε. While at the cortical bone, the maximum principal strains were 300 µε to 400 µε. The results observed evidence some critical regions of concern and the effect of implant in the bone strains mainly at the posterior-superior region of the glenoid cavity is pronounced. This indicates that this region is more affected by the implant if bone remodeling is a concern and it is due to the strain-shielding effect, which has been connected with loosening of the glenoid component

Aims

The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries and examined the effect of a range of demographic- and injury-related variables on these outcomes.

Purpose of the study: The appropriate treatment for massive irreparable rotator cuff tears is a subject of debate. The purpose of this work was to analyze at mean five years follow-up a series of 16 shoulders treated with a latissimus dorsi flap. Material and methods: These 16 patients (seven women) were aged 56 years on average. The procedure was a revision for four shoulders. The tears were all posterosuperior tears and caused invalidating pain in all patients. Mean anterior elevation was 93°. External rotation was 12°. The Constant score, assessed in eleven patients, was 27 points on average. The subacromial space measured 8 mm on average. Supraspinatus fatty degeneration was grade 2 in 45% and grade 3 in 55%. Infraspinatus degeneration was grade 3 in 80% and grade 4 in 20%. The latissimus dorsi flap was associated with a teres major flap in four shoulders and with a deltoid flap in seven. The semi-sitting position was used for 15 of the 16 patients. Discussion: Treatment of massive irreparable rotator cuff tears is a controversial issue. When the subacromial space is preserved, the presence of muscle atrophy and tendon retraction despite forced mobilization it is logical to use several muscle transfers. This small series demonstrated that a significant improvement can be obtained. Nevertheless the postoperative period is long and indications must remain limited. We discuss our results in comparison with other reported series

The aim of this study is to assess the clinical outcome following latissiumus dorsi transfer for massive irreparable tears of the rotator cuff. Between 1996 and 2002 seven patients with massive irreparable rotator cuff tears were treated by transfer of the latissimus dorsi by a single surgeon. Their mean age at time of surgery was 65 years. Five patients were female, five were primary procedures and two were revisions. Patients were assessed with MRI pre-operatively; the decision to plan a transfer was made clinically. At time of operation all were found to massive irreparable tears of the cuff including Supraspinatus and Infraspinatus, Subscapularis was intact in all cases. Five of the transfers were implanted to a bone trough, one was sutured to a tendon stump, and one was augmented with a Teflon patch. Mean time to follow up was 21 months. All patients were assessed by the lead author or by his Specialist Registrar. Six patients had a good result, one had a poor result this was a revision procedure resulting in deltoid origin detachment. Functional outcome significantly improved post-transfer. Constant score 62.1% vs 36.1% (p< 0.0005, Paired t-test), Pain was also significantly reduced post-transfer, both when active 7.1 vs. 2.2 p (< 0.005) and when at rest 3.7 vs. 1.2 (p< 0.005). Conclusion: These results are compatible with those published for Latissimus Dorsi Transfer. Latissimus Dorsi Transfer can be effective in restoring shoulder function and reducing pain following massive irreparable tears of the rotator cuff

Sub-Acromial Decompression (SAD) for impingement has a failure rate of 5–20%. We used MRI to see whether SAD failure is associated with muscle wasting or fatty degeneration in the rotator cuff. Fifty one patients with impingement were assessed using MRI pre- and post-op. Following arthroscopic SAD, seven patients with cuff tears were excluded. This study reviews the pre-op and 6 month post-op MRIs of the remaining 44 patients (25 males; 19 females) and also 17 additional MRIs obtained at three years post-op. MRI assessment was performed by an experienced radiologist using Zanetti’s muscle bulk assessment with values expressed as standard deviations from an age matched mean and Goutallier’s fatty degeneration assessment graded 0 to 4. There was a wide range of pre-op muscle bulk values (SupraSpinatus minus;2.4 to +3.4; SubScapularis minus;2.1 to +4.8; and InfraSpinatus/ Teres Minor minus;1.1 to +5.7). Comparing post-op with pre-op there was a gradual trend towards a reduced muscle bulk for each muscle after surgery but to a limited extent only (< 0.5SD). Pre-op fatty degeneration of SS and IS was grade 2 in about a half with a mild increase with time post-op (SS pre=50%, 6/12 and 3 years=59%; IS pre=45%, 6/12=43% and 3 years=59%). There was a similar age distribution for grades 1 and 2. Only three of the patients were a clinical failure at 6 months but this increased to five of the 17 patients scanned at 3 years. Predicting these failures was not possible based on the pre-op MRI data. The high initial success of SAD was not accompanied by an overall increase in muscle bulk or quality of the muscle at 6 months. The progressive loss of muscle bulk and quality over 3 years was accompanied by an increased clinical failure rate

This pilot study assesses level of agreement between surface and fine wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder. 18 subjects (11 female, mean 36 years) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained. Triple stud self adhesive surface electrodes (“Triode” – Thermo Scientific) were placed over Pectoralis Major (PM), Latissimus Dorsi (LD), Anterior Deltoid (AD) and Infraspinatus (IS) at standardised locations. A ‘Medi-Link’ dual channel surface EMG (Electro Medical Supplies) displayed a rectified smoothed signal. Patients performed five identical uniplanar standard movements (flexion, abduction, external rotation, extension and cross body adduction). After a rest period, a dual needle technique for fine wire insertion was used displaying a raw EMG signal on a ‘Sapphire II’ four channel EMG unit. An experienced examiner in each technique reported if muscle activation patterns differed from agreed normal during any movement and were blinded to the other test results. Sensitivity, specificity and kappa values for level of agreement between methods were calculated for each muscle according to the method of Altman. 15 patients were successfully tested. Sensitivity, specificity and kappa values between techniques for each muscles were PM (57%, 50%, 0.07), LD (38%, 85%, 0.22), AD (0%, 76%, −0.19) and IS (85%, 75%, 0.6). Only IS demonstrated high sensitivity and specificity and a moderate level of agreement between the two techniques. There was no correlation between skinfold size and agreement levels. Surface did not agree with wire analysis for PM, LD and AD, although IS did show moderate agreement. Subcutaneous fat did not appear to affect correlation

Aims

There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery.

Aims

The aim of this study was to investigate the outcomes of arthroscopic decompression of calcific tendinitis performed without repairing the rotator cuff defect.