Aim

The purpose of this study was to evaluate the results after arthroscopic reconstruction of isolated SSP lesions. Does double row repair in smaller lesions lead to better results and a lower retear rate?

Aim: The purpose of this study was to evaluate the results after arthroscopic cuff repair using suture anchors with associated lesions of the long head of the biceps. Does biceps tenodesis lead to better results?

Method: 80 patients (age 41 to 74) with one or two tendon lesons of the rotator cuff and associated lesions of the biceps (instability, partial tear) were treated with arthroscopic ruff repair using suture anchors. Preop examination included MRI and ultrasound. The fatty degeneration and infiltration of the tendon was noted according to Goutallier and Thomazeau. Patients were devided into 2 groups. 40 patients were treated with a biceps tenodesis and 40 cases with a tenotomy. Tenodesis was performed using suture anchors. Patients in both groups were comparable in age, sex, tear size and fatty degeneration. Rehanilitation protocol was equal in both groups. Prospective follow up was done at 3, 6, 12, 24 and 36 months using the Constant score. Ultrasound was documented at all follow-ups, MRI at last follow up.

Results: 73 Patients could be completely evaluated, 37 in the tenodesis and 36 in the tenotomy group. The constant score gained 42,3 points from 44,3 to 87,6 overall. There were 4 complete re-tears of the cuff in the tenodesis and 5 in the tenotomy group during follow up, requiring 2 revisions in each group. There was one revision due to stiffness in the tenodesis group, no infections were noted. 29 patients in tenotomy group had a visuable deformity compared to 3 cases in tenodesis group, whereas Ultrasound examination revealed 5 not healed tenodesis.

32 patients in the tenodesis group were satisfied with the result and would do surgery again compared to 25 in the tenotomy group, complaining about the visual deformity. There was no statistical difference in score result between the tenodesis or tenotomy group.

Discussion: The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months. The way a lesion of the biceps tendon is treated does not seem to have an effect on the postoperative score result. Cosmetic appearance was better in tenodesis group, leading to better patient acceptance.

Aim: The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic AC joint dislocation using a Bosworth screw.

Method: 18 Patients with acute AC Joint dislocation type Rockwood 3 were arthroscopically treated with temporary transfixation using a 7.0mm cannulated titanium screw of the clavicle to the coracoid process. The coracoid process is arthroscopically visualized and a drill guide for tibial anterior cruciate ligament positioning is used to exactly place the screw into the coracoid process. The screws were removed after 8 weeks. Patients were followed using a prospective study using the Constant Score after 3, 6, 12 and 24 months.

Results: 17 Patients were completely evaluated. One screw slipped out of the coracoid process 3 days after surgery requiring revision surgery. No screw breakage was observed. There were no other operation conditioned complications. Constant score showed a mean of 94,7 at last follow up. At follow up, no patient hat a redislocation without weight bearing. With 10kg weight a mean clavicular elevation of 1,8mm was observed. All remaining patients were satisfied with the functional and cosmetic result.

Discussion: There is some controversy about the surgical treatment of acute traumatic AC joint dislocation type Rockwood 3. Most open surgery techniques have the disadvantage of a poor cosmetic result or a difficult and dangerous hardware removal, because the scar of the AC joint capsule that is supposed to stabilize the clavicle has to be opened. The Bosworth screw technique does not touch the AC joint at all, but the open procedure has poor cosmetic outcome. It is also important to use a large screw to ensure proper hardware stability to avoid hardware failure. Our technique might be an alternative for the operative treatment of acute AC joint instability, because it is safe and all anatomical structures remain intact in case revision surgery with i.e. arthroscopic AC joint resection and ligamentoplasty is necessary.

Aims: In this prospective study, we examined the value of capsular shrinkage in the arthroscopic stabilization of the posttraumatic antero-inferior instability of the shoulder.

Methods: We treated 58 patients (38 men and 20 women) at the age of 29.7 (19–43) with the diagnosis posttraumatic antero-inferior shoulder instability with an arthroscopic stabilization.

The patients were divided in two groups: In the first group with 31 patients we performed a capsule-labrum refixation with Fastak-anchors. In the second group (27 patients), we performed additionally a capsular shrinkage of the antero-inferior capsule with the Hol-Yag-laser.

The re-examination was done in a postoperative time of 6, 12 and 24 months.

Results: 50 patients (35 men and 15 women, 27 patients of the group 1 and 23 patients of the group 2) could be re-examined.

Operation-conditioned complications did not occur. 3 postoperativ reluxations were seen in each group. 22 patients of the group 1 and 19 patients of the group 2 indicated to be content with the postoperative result. The Constant Score rose in the group 1 from 46 (37–59) praeoperativ to 88 (67–100) postOP. In the group 2 the Constant Score of 42 (33–61) rose to 86 (64–100) postOP.

Conclusions: There was no significant improvement regarding the re-dislocation rate, the subjective patient satisfaction and the obtained Constant Score by additionally performing capsular shrinkage of the antero-inferior joint capsule, as by the exclusive capsule-labrum refixation.

The anatomical reconstruction of the capsule-labrum-complex seems to be the crucial component in the arthroscopic stabilisation regarding to the postoperative results.