Purpose of the study: Irrespective of the technique used, the average rate of bone-tendon healing after rotator cuff repair is about 50% One of the reasons is the poor vitality of the tissues implicated in repair, particularly progressive destruction of the enthesis. Using the rat Achilles tendon, we destroyed the enthesis mechanically then repaired it with and without local injection of chondrocytes in order to study the effect of cell therapy on healing phenomena.

Material and method: Sixty 3-month-old Wistar rats were operated on under general anaesthesia to detach the Achilles tendon and destroy the enthesis. In the first group (RI), the tendon was reinserted via a transosseous tunnel using a 4/0 non absorbable knitted thread. In the second group (RIC), joint chondrocytes, harvested from 4-day-old rats were injected locally during the same repair procedure. Animals were sacrificed every 15 days (n=15 per group) for a biomechanical and histology study.

Results: In group RI, the non-healing rate was 50% versus 33% in group RIC; the difference was not significant (n=0.3). Tear resistance was increased significantly at 45 days in the RC group (p=0.04). The histology study showed a statistically significant development of a neoenthesis in the RIC group (p< 0.05), which was not observed in the RI group.

Discussion: This animal model is valid for exploring rotator cuff healing with a spontaneous rate of healing to the order of 50%. Addition of chondrocytes during the surgical repair induces the production of an enthesis and increases the healing rate 50% and the value of the different biomechanical parameters at 30 days, with a statistically significant difference at 45 days.

Purpose of the study: Treatment of irrepable massive rotator cuff tears remains a controversial issue. The purpose of this study was to assess clinical and radiological outcome in patients with a reversed shoulder prosthesis used for the treatment of irreparable massive rotator cuff tears with or without associated glenohumeral osteoarthritic degeneration.

Material and methods: Between 1996 and 2002, 55 reversed shoulder prostheses were implanted via a superolateral approach. Mean follow-up of the 15 men and 40 women (mean age 73 years, age range 57–86 years) was 34.8 months (range 24–84 months). The supraspinatus and infraspinatus tendons were retracted to the glenoid and ruptured in 100% of the patients: 27 shoulders (49%) also presented a infrascapularis tear. Glenohumeral osteoarthritis (Fukuda IV and V) was persent in 29 patients. Postoperatively, patients were assessed with the Constant score and radiographically on plain x-rays.

Results: Three patients were excluded from the analysis because of implant infection and removal before review. Subjectively, 90% of patients were satisfied or very satisfied. All items of the Constant score improved significantly (p< 0.0001). Active elevation improved from 65° to 123°. External rotation was not improved. Radiographically, there wre 41 shoulders with a grade 0, 1 or 2 notch (Nerot system), and 11 with a grade 3 or 4 notch. Thirteen patients (25%) presented heterotopic ossifications.

Discussion and conclusion: In this context, the clinical results obtained with this prosthesis are much better than with any other type of arthroplasty. Radiographically, heterotopic ossifications have a significant impact on the Constant score (p=0.015). Presence of ta glenoid notch is signifiantly associated with use of a medialized or retaining polyethylene cup (p< 0.0001). For us, loosening of the metaglenoidglenosphere bloc is related to the progression of the glenoid notch. For these reasons, it would be preferable to reserve this type of arthroplasty for patients aged over 70 years presenting an irreparable massive cuff tear with satisfactory glenoid bone stock sufficient for obtaining a good anchor for the metaglen. We recommend only using lateralized polyethylene cups.

Purpose: Endoscopy provides an attractive alternative to open surgery for diagnostic and therapeutic purposes in patients with ankle tendon disease. Early work was published by Van Dijk in 1994.

Material and methods: Twenty patients (mean age 34.7 years, range 20–59 years), 16 with posttraumatic lesions, underwent 22 tendinoscopy procedures using a slightly modified technique with a 4.5 optical. The procedures, conducted under general anaesthesia, were performed to explore fibular (n=15), posterior tibial (n=6), and anterior tibial (n=1) tendons. Prospective follow-up was at least six months (6 – 30). Preoperatively, all patients presented more or less localised pain with signs of tendon suffering. Fifteen had undergone prior explorations (ultrasound=4, MRI=7, CT scan=1, MRI+ultrasound=3) which had not revealed any anomaly in seven.

Results: Peritendinous adherences were observed intra-operatively in 18 cases with inflammatory reactions requiring resection in 13. A lesion of the tendon itself was found in seven cases-fissure (n=2), superficial dilaceration (n=2), induration (n=2), strangulation (n=1)-which required specific cure with forceps or motorised instrumentation. No explanation of the pain could be identified in one patient. Postoperatively, 17 patient achieved complete pain relief which persisted for at least six months. At last follow-up, one patient had not been reviewed, twelve were totally pain free and five had developed associated symptoms (cracking, swelling). Overall, four patients were very satisfied, eight were satisfied, four were disappointed, and three were dissatisfied (no improvement). There were no signs of worsening and no complications directly related to the method.

Conclusion: These results of early experience in France are less satisfactory than those reported by Van Dijk who had 80% good results for 85 tendinoscopic procedures in 70 patients. They do however confirm the usefulness of this technique for the management of patients with tenosynovitis, adherences, and partial ruptures of the ankle tendons which cannot always be identified with classical imaging techniques. Definitive evaluation will require analysis of a larger series of well selected patients.