The pathogenesis of Calcifying Tendinitis (CT) is still not well established. Prognostic factors for outcome could not yet be identified. The purpose of this study was to evaluate the histologic features of calcific deposits (CD) and their correlation with radiologic and clinical findings.

122 patients with a radiologically confirmed CD were prospectively scheduled for arthroscopic shoulder surgery. According to their radiologic appearance (RA) the CD were graded as fluffy or sharply demarcated. Arthroscopic removal of the deposit was performed and biopsies were taken and embedded in methylmethacry-late. Sections were stained and also immunohistology was performed. Shoulder function was assessed with the Constant score (CS) and the SST.

Three distinct histologic stages (HS) of the CDs could be divided: calcification (I), fibrotic organisation (II) and ossification (III). Biopsies revealed 42x (34%) HS I, 18x (15%) HS II and 62x (51%) HS III deposits. 90% of the CD were located in the SSP tendon. 12 months after the operation the CS and the SST showed a significant improvement (p< 0.01). Forty percent of the patients with ossification (III) of the CD underwent unsuccessful shock wave therapy before. The preoperative RA as well as the HS of the CD did not predispose to postoperative outcome.

In this study three definite histologic stages of Calcifying Tendinitis were identified that have not been described previously. We underline the hypothesis that CT is an active cell mediated tissue process which can lead to production of primitive bone.

We describe the outcome at a mean follow-up of 8.75 years (7.6 to 9.8) of seven patients who had undergone osteochondral autologous transplantation for full-thickness cartilage defects of the shoulder between 1998 and 2000. These patients have been described previously at a mean of 32.6 months when eight were included. One patient has been lost to follow-up. The outcome was assessed by the Constant shoulder score and the Lysholm knee score to assess any donor-site morbidity. Standard radiographs and MR scores were obtained and compared with the pre-operative findings and the results from the previous review.

No patient required any further surgery on the shoulder. The mean Constant score improved significantly until the final follow-up (p = 0.018). The Lysholm score remained excellent throughout. There was a significant progression of osteoarthritic changes from the initial surgery to the first and final follow-up but this did not appear to be related to the size of the defect, the number of cylinders required or the Constant score (p = 0.016). MRI showed that all except one patient had a congruent joint surface at the defect with full bony integration of all osteochondral cylinders.

The results have remained satisfactory over a longer period with very good objective and subjective findings.

We describe 14 patients who underwent transfer of latissimus dorsi using a new technique through a single-incision. Their mean age was 61 years (47 to 76) and the mean follow-up was 32 months (19 to 42).

The mean Constant score improved from 46.5 to 74.6 points. The mean active flexion increased from 119° to 170°, mean abduction from 118° to 169° and mean external rotation from 19° to 33°. The Hornblower sign remained positive in three patients (23%) as did the external rotation lag sign also in three patients (23%). No patient had a positive drop-arm sign at follow-up. No significant difference was noted between the mean pre- and postoperative acromiohumeral distance as seen on radiographs. An increased grade of osteoarthritis was found in three patients (23%). Electromyographic analysis showed activity of the transferred muscle in all patients.

We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm². All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface.

Osteochondral autologous transplantation in the shoulder appears to offer good clinical results for treating full-thickness osteochondral lesions of the glenohumeral joint. However, our study suggests that the development of osteoarthritis and the progression of pre-existing osteoarthritic changes cannot be altered by this technique.