Purpose of the study: Completely arthroscopic repair of rotator cuff tears is widely considered as the standard treatment. We reviewed a multicentric retrospective series of patients.

Material and methods: This series of arthroscopic repairs of full-thickness tears of the supraspinatus and infraspinatus were assess with the Constant score together with arthroMRI or arthroscan at one year follow-up at least. Data were analyzed with SPSS10. The series included 576 patients who underwent surgery from January 2001 to June 2003. Mean age was 57.7 years, 52% males and 60% manual laborers. Mean preoperative Constant score was 46.4/100 (r13.4). The tear was limited to the supraspinatus in 69% of patients with extension to the upper third of the infraspinagus for 23.5% and to all tendons for 7.5%. The supraspinatus tear was distal in 41.7% of patients, intermediary for 44%, and retracted for 14.3%. Arthroscopic repair was performed in all cases, with locoregional anesthesia for 60.9%. Implants were resorbable for 33% and metallic for 62.1%. Acromioplasty was performed for 92.7% and capsulotomy for 14.9%.

Results: The mean subjective outcome was scored 8.89/10. The Constant score improved from 46.3±13.4 to 82.7±10.3 with 62% of patients being strictly pain free. The force score improved from 8.5±3.7 to 13.6±5.4. Outcome was excellent or very good for 94% of the shoulders at 18.5 mean follow-up. The rate of complications was 6.2% with 3.1% of patients presenting prolonged joint stiffness, 2.7% reflex dystrophy, 0.2% infection and 0.2% implant migration. The cuff was considered normal in 55.7% of the shoulders with an intratendon addition image for 19%, i.e. 74.7% non-torn cuffs. A point leakage was noted in 9.5% with pronounced leakage in 15.7%, i.e. 25.2% recurrent tears.

Discussion and conclusion: The functional outcome obtained after arthroscopic repair of rotator cuff tears is good. Arthroscopy has the advantage of a low rate of complications yet provides good clinical and anatomic results. Age is correlated with functional outcome and healing, but should not be considered as a contraindication.

Purpose of the study: A statistical analysis of correlations between clinical outcome and anatomic results after arthroscopic repair of rotator cuff tears.

Material and methods: This multicentric series of rotator cuff tears was limited to the supraspinatus and infraspinatus. The statistical analysis searched for correlations between the clinical outcome (Constant score) and anatomic results (arthroscan and arthroMRI). The series included 576 patients, mean age 57.7 years, 52%μ males and 60% manual laborers. The tear was limited to the suprapsinatus in 69% of patients, with extension to the upper third of the infraspinatus in 23.5% and all tendons in 7.5%. The supraspinatus tear was distal in 41.7% of patients, intermediary in 44% and retracted in 14.3%. Fatty degeneration of the supraspinatus was noted grade 0 in 59.7%, 1 in 27.1%, 2 in 10.8% and 3 in 2.4%.

Results: The Constant score (46.3 preoperatively and 82.7 postoperatively) was strongly correlated with successful repair. The correlation was found for force, motion, and activity, but not for pain. The clinical outcome was correlated with extension, retraction, cleavage, and degeneration of the preoperative injury. The anatomic result was statistically less favorable for older, more extended, retracted, and cleaved tears or tears associated with fatty degeneration. Age was correlated with the extent of the initial tear and also with less favorable clinical and anatomic results. Work accidents were correlated with less favorable clinical outcome.

Discussion: The large number of anatomic controls with contrast injection facilitated demonstration of several statistically significant correlations. This enabled disclosure in a single series of evidence confirming earlier reports in the literature: repair of cuff tears improves the overall functional outcome for massive tears; the anatomic result depends on the size of the initial tear; pre-operative fatty degeneration is an important prognostic criteria; cuff healing is age-dependent.

Conclusion: Study of anatamoclinical correlations helps guide therapeutic decision making and enables the establishment of reliable prognostic criteria after arthroscopic repair of rotator cuff tears.

Purpose: Treatment of non-infected nonunion of the leg is a difficult challenge. Several technical solutions have been proposed. The purpose of this work was to assess the results achieved in patients treated with the Kuntscher technique and to detail indications.

Material and methods: Twenty-two patients who underwent surgery between 1987 and 1997 using the Kuntscher technique (reaming, renailing) for tibial nonunion were reviewed. There were 19 men and three women, mean age 36 years (range 16–58). Minimal follow-up was two years. The initial treatment consisted in non-locked cen-tromedular nailing the cruropedious (n=21) and screw-plate fixation (n=1). There were ten open fractures: Gustilo I (n=3), II (n=7). We noted: time to revision, time to healing, preoperative and last follow-up alignment, size and type of bone loss (fragment or segment), complementary procedures, complications.

Results: We had one infectious failure (Kuntschner nine months after screw-plate fixation, infection diagnosed at two months, bone healing after removal of the nail, reaming, external fixation and fibular strut with cancellous graft). There were no other complications. One patient was lost to follow-up at three months; this patient had a medial fragmental gap measuring 1 cm with a radiologically solid fracture at last follow-up. All other patients healed within a mean 3.44 months (2.5–10). Mean time before revision was six months (2.5–12). Segmental loss was 3–8 cm in six patients. There was not defective alignment at healing. A fibular osteotomy was performed in five cases. Complete weight bearing was initiated early in 15 patients (with crutches in seven).

Discussion: In our experience, the Kuntscher technique is a simple and effective method for the treatment of non-infected tibial nonunions. It is indicated for small gaps or small-sized segmental losses. The rapidity of the healing and the generally uneventful healing period suggest this method should be proposed early after diagnosis of nonunion.