Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological augmentation when repairing rotator cuff tears. Cite this article:
Implantation of ultra-purified alginate (UPAL) gel is safe and effective in animal osteochondral defect models. This study aimed to examine the applicability of UPAL gel implantation to acellular therapy in humans with cartilage injury. A total of 12 patients (12 knees) with symptomatic, post-traumatic, full-thickness cartilage lesions (1.0 to 4.0 cm2) were included in this study. UPAL gel was implanted into chondral defects after performing bone marrow stimulation technique, and assessed for up to three years postoperatively. The primary outcomes were the feasibility and safety of the procedure. The secondary outcomes were self-assessed clinical scores, arthroscopic scores, tissue biopsies, and MRI-based estimations.Aims
Methods
Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR. A total of 40 patients were randomly assigned to either braided absorbable polyglactin suture or braided nonabsorbable polyethylene terephthalate suture groups. ATR was then repaired using the Krackow suture method. At three and six months after surgery, the isokinetic muscle strength of ankle plantar flexion was measured using a computer-based Cybex dynamometer. At six and 12 months after surgery, patient-reported outcomes were measured using the Achilles tendon Total Rupture Score (ATRS), visual analogue scale for pain (VAS pain), and EuroQoL five-dimension health questionnaire (EQ-5D).Aims
Methods
The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate ligament 360° tenodesis (SL 360) technique for treatment of scapholunate (SL) instability. We studied the results of nine patients (eight males and one female with a mean age of 44.7 years (26 to 55)) who underwent the SL 360 procedure for reducible SL instability between January 2016 and June 2019, and who were identified from retrospective review of electronic medical records. Final follow-up of any kind was a mean of 33.7 months (12.0 to 51.3). Clinical, radiological, and patient-reported outcome data included visual analogue scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Wrist Score (MWS), and Patient-Rated Wrist Examination (PRWE). Means were analyzed using paired Aims
Methods
The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Aims
Materials and Methods
The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair.Aims
Patients and Methods
Arthroscopically controlled fracture reduction in combination
with percutaneous screw fixation may be an alternative approach
to open surgery to treat talar neck fractures. The purpose of this
study was thus to present preliminary results on arthroscopically
reduced talar neck fractures. A total of seven consecutive patients (four women and three men,
mean age 39 years (19 to 61)) underwent attempted surgical treatment
of a closed Hawkins type II talar neck fracture using arthroscopically
assisted reduction and percutaneous screw fixation. Functional and
radiological outcome were assessed using plain radiographs, as well
as weight-bearing and non-weight-bearing CT scans as tolerated.
Patient satisfaction and pain sensation were also recorded.Aims
Patients and Methods
The number of patients undergoing arthroscopic surgery of the
hip has increased significantly during the past decade. It has now
become an established technique for the treatment of many intra-
and extra-articular conditions affecting the hip. However, it has
a steep learning curve and is not without the risk of complications.
The purpose of this systematic review was to determine the prevalence
of complications during and following this procedure. Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines were used in designing this study. Two reviewers systematically
searched the literature for complications related to arthroscopy
of the hip. The research question and eligibility criteria were
established Aims
Materials and Methods
Aims. Advances in arthroscopic techniques for rotator cuff repair have
made the
A trial-based comparison of the use of resources, costs and quality
of life outcomes of arthroscopic and open surgical management for
rotator cuff tears in the United Kingdom NHS was performed using
data from the United Kingdom Rotator Cuff Study (UKUFF) randomised
controlled trial. Using data from 273 patients, healthcare-related use of resources,
costs and quality-adjusted life years (QALYs) were estimated at
12 months and 24 months after surgery on an intention-to-treat basis
with adjustment for covariates. Uncertainty about the incremental
cost-effectiveness ratio for arthroscopic Aims
Patients and Methods
The aim of this study was to analyse human muscle tissue before
and after rotator cuff repair to look for evidence of regeneration,
and to characterise the changes seen in the type of muscle fibre. Patients were assessed pre-operatively and one year post-operatively
using the Oxford Shoulder Score (OSS) and MRI. The cross-sectional
area and distribution of the type of muscle fibre were assessed
on biopsies, which were taken at surgery and one year post-operatively.
Paired samples from eight patients were analysed. There were three
men and five women with a mean age of 63 years (50 to 73).Aims
Patients and Methods
This study compared the clinical outcomes following
mini-open rotator cuff repair (MORCR) between early mobilisation
and usual care, involving initial immobilisation. In total, 189
patients with radiologically-confirmed full-thickness rotator cuff
tears underwent MORCR and were randomised to either early mobilisation
(n = 97) or standard rehabilitation (n = 92) groups. Patients were
assessed at six weeks and three, six, 12 and 24 months post-operatively.
Six-week range of movement comparisons demonstrated significantly
increased abduction (p = 0.002) and scapular plane elevation (p
= 0.006) in the early mobilisation group, an effect which was not
detectable at three months (p >
0.51) or afterwards. At 24 months
post-operatively, patients who performed pain-free, early active mobilisation
for activities of daily living showed no difference in clinical
outcomes from patients immobilised for six weeks following MORCR.
We suggest that the choice of rehabilitation regime following MORCR
may be left to the discretion of the patient and the treating surgeon. Cite this article:
Children with congenital vertical talus (CVT)
have been treated with extensive soft-tissue releases, with a high
rate of complications. Recently, reverse Ponseti-type casting followed
by percutaneous reduction and fixation has been described, with
excellent results in separate cohorts of children with CVT, of either
idiopathic or teratological aetiology. There are currently no studies
that compare the outcome in these two types. We present a prospective cohort
of 13 children (21 feet) with CVT of both idiopathic and teratological
aetiology, in which this technique has been used. Clinical, radiological
and parent-reported outcomes were obtained at a mean follow-up of
36 months (8 to 57). Six children (nine feet) had associated neuromuscular
conditions or syndromes; the condition was idiopathic in seven children
(12 feet). Initial correction was achieved in all children, with significant
improvement in all radiological parameters. Recurrence was seen
in ten feet. Modification of the technique to include limited capsulotomy
at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial
correction of CVT of both idiopathic and teratological aetiology.
Recurrence is a problem in both these groups, with higher rates
than first reported in the original paper. However, these rates
are less than those reported after open surgical release. Cite this article:
We have reviewed the current literature to compare
the results of surgery aimed to repair or debride a damaged acetabular
labrum. We identified 28 studies to be included in the review containing
a total of 1631 hips in 1609 patients. Of these studies 12 reported
a mean rate of good results of 82% (from 67% to 100%) for labral debridement.
Of the 16 studies that reported a combination of debridement and
re-attachment, five reported a comparative outcome for the two methods,
four reported better results with re-attachment and one study did
not find any significant difference in outcomes. Due to the heterogeneity
of the studies it was not possible to perform a meta-analysis or
draw accurate conclusions. Confounding factors in the studies include
selection bias, use of historical controls and high rates of loss
of follow-up. It seems logical to repair an unstable tear in a good quality
labrum with good potential to heal in order potentially to preserve
its physiological function. A degenerative labrum on the other hand
may be the source of discomfort and its preservation may result
in persistent pain and the added risk of failure of re-attachment.
The results of the present study do not support routine refixation
for all labral tears. Cite this article:
We explored the trends over time and the geographical
variation in the use of subacromial decompression and rotator cuff
repair in 152 local health areas (Primary Care Trusts) across England.
The diagnostic and procedure codes of patients undergoing certain
elective shoulder operations between 2000/2001 and 2009/2010 were extracted
from the Hospital Episode Statistics database. They were grouped
as 1) subacromial decompression only, 2) subacromial decompression
with rotator cuff repair, and 3) rotator cuff repair only. The number of patients undergoing subacromial decompression alone
rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence
interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95%
CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked
in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably
in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)). Given the lack of evidence for the effectiveness of these operations
and the significant increase in the number of procedures being performed
in England and elsewhere, there is an urgent need for well-designed
clinical trials to determine evidence of clinical effectiveness. Cite this article: Bone Joint J 2014;96-B:70–4.
Young adults with hip pain secondary to femoroacetabular
impingement (FAI) are rapidly being recognised as an important cohort
of orthopaedic patients. Interest in FAI has intensified over the
last decade since its recognition as a precursor to arthritis of
the hip and the number of publications related to the topic has
increased exponentially in the last decade. Although not all patients
with abnormal hip morphology develop osteoarthritis (OA), those
with FAI-related joint damage rapidly develop premature OA. There
are no explicit diagnostic criteria or definitive indications for
surgical intervention in FAI. Surgery for symptomatic FAI appears
to be most effective in younger individuals who have not yet developed
irreversible OA. The difficulty in predicting prognosis in FAI means
that avoiding unnecessary surgery in asymptomatic individuals, while
undertaking intervention in those that are likely to develop premature
OA poses a considerable dilemma. FAI treatment in the past has focused
on open procedures that carry a potential risk of complications. Recent developments in hip arthroscopy have facilitated a minimally
invasive approach to the management of FAI with few complications
in expert hands. Acetabular labral preservation and repair appears
to provide superior results when compared with debridement alone.
Arthroscopic correction of structural abnormalities is increasingly becoming
the standard treatment for FAI, however there is a paucity of high-level
evidence comparing open and arthroscopic techniques in patients
with similar FAI morphology and degree of associated articular cartilage damage.
Further research is needed to develop an understanding of the natural
course of FAI, the definitive indications for surgery and the long-term
outcomes. Cite this article:
There have been a few reports of patients with
a combination of lumbar and thoracic spinal stenosis. We describe six
patients who suffered unexpected acute neurological deterioration
at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery.
Five had progressive weakness and one had recurrent pain in the
lower limbs. There was incomplete recovery following subsequent
thoracic decompressive surgery. The neurological presentation can be confusing. Patients with
compressive myelopathy due to lower thoracic lesions, especially
epiconus lesions (T10 to T12/L1 disc level), present with similar
symptoms to those with lumbar radiculopathy or cauda equina lesions.
Despite the rarity of this condition we advise that patients who
undergo lumbar decompressive surgery for stenosis should have sagittal
whole spine MRI studies pre-operatively to exclude proximal neurological
compression. Cite this article:
Orthopaedic surgeons have accepted various radiological
signs to be representative of acetabular retroversion, which is
the main characteristic of focal over-coverage in patients with
femoroacetabular impingement (FAI). Using a validated method for
radiological analysis, we assessed the relevance of these signs
to predict intra-articular lesions in 93 patients undergoing surgery
for FAI. A logistic regression model to predict chondral damage
showed that an acetabular retroversion index (ARI) >
20%, a derivative
of the well-known cross-over sign, was an independent predictor
(p = 0.036). However, ARI was less significant than the Tönnis classification
(p = 0.019) and age (p = 0.031) in the same model. ARI was unable
to discriminate between grades of chondral lesions, while the type
of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other
widely recognised signs of acetabular retroversion, such as the
ischial spine sign, the posterior wall sign or the cross-over sign
were irrelevant according to our analysis. Regardless of its secondary
predictive role, an ARI >
20% appears to be the most clinically
relevant radiological sign of acetabular retroversion in symptomatic
patients with FAI. Cite this article:
Slipped capital femoral epiphysis (SCFE) is relatively
common in adolescents and results in a complex deformity of the
hip that can lead to femoroacetabular impingement (FAI). FAI may
be symptomatic and lead to the premature development of osteoarthritis
(OA) of the hip. Current techniques for managing the deformity include
arthroscopic femoral neck osteochondroplasty, an arthroscopically
assisted limited anterior approach to the hip, surgical dislocation,
and proximal femoral osteotomy. Although not a routine procedure
to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy
has been successfully used to treat FAI caused by acetabular over-coverage. These
procedures should be considered for patients with symptoms due to
a deformity of the hip secondary to SCFE. Cite this article: