Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears

The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign–directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion

Transtendon, Double-Row, Transosseous-Equivalent Arthroscopic Repair of Partial-Thickness, Articular-Surface Rotator Cuff Tears

Arthroscopic transtendinous techniques for the arthroscopic repair of partial-thickness, articular-surface rotator cuff tears offer the advantage of minimizing the disruption of the patient's remaining rotator cuff tendon fibers. In addition, double-row fixation of full-thickness rotator cuff tears has shown biomechanical advantages. We present a novel method combining these 2 techniques for transtendon, double-row, transosseous-equivalent arthroscopic repair of partial-thickness, articular-surface rotator cuff tears. Direct visualization of the reduction of the retracted articular tendon layer to its insertion on the greater tuberosity is the key to the procedure. Linking the medial-row anchors and using a double-row construct provide a stable repair that allows early shoulder motion to minimize the risk of postoperative stiffness

Long Head of the Biceps Tendon Allis Clamp Evaluation Technique

Disorders of the long head of the biceps brachii are a common finding in conjunction with other causes of shoulder pathology. Nonoperative means as first-line treatment are often successful; however, surgery can be indicated for refractory tendinopathy. There is debate as to the best surgical treatment of the long head of the biceps tendon (LHBT) with different types of arthroscopic and open techniques. The decision on what treatment option to perform is often made at the time of surgery after arthroscopic evaluation of the LHBT. Certain examples of tendon disease are easily visible intra-articularly; however, a large portion of the tendon is not intra-articular and not readily viewed during routine arthroscopy. This study describes a simple arthroscopic technique for evaluation of an increased portion of the LHBT using an Allis clamp. The clamp is inserted through the anterior portal, placed around the LHBT, and rotated such that the tendon is wrapped around itself, bringing the distal tendon into the joint for arthroscopic viewing. This procedure is a routine part of our assessment of the LHBT during arthroscopy

Flow cytometry analysis of TREM-1 and TREM-2 expression on CD16⁺ and CD14⁺ cells.

<p>(A) Representative images for the gating of the cells in Group-1 and Group-2 patients. (B) Comparison between Group-1 and Group-2 patients showing increased TREM-1 expression in the cells of Group-1 revealing the severity of inflammation. <i>n = 8 for both the groups</i>, <i>* p<0</i>.<i>05; NS–Not significant</i></p

Arthroscopic Tissue Culture for the Evaluation of Periprosthetic Shoulder Infection

Background: Periprosthetic shoulder infections can be difficult to diagnose. The purpose of this study was to investigat

Primers and their sequences used for RT-PCR analysis.

<p>Primers and their sequences used for RT-PCR analysis.</p

H&E staining of biceps tendons—Group-1 (Patient numbers—PT3, PT6, PT8 and PT10) and Group-2 (Patient numbers–PT2, PT4, PT13 and PT9).

<p>The green arrows show tendon cells; black arrows point inflammation; red arrows indicate angiogenesis; blue arrows show ECM disorganization; violet arrows point fatty infiltration; and yellow arrows indicate normal ECM with dense collagen deposition. The inflammation and fatty infiltration were not evident in Group-2 while ECM disorganization was less prominent compared to Group-1. The figures are shown in 400x magnification.</p

MicroRNAs Associated with Shoulder Tendon Matrisome Disorganization in Glenohumeral Arthritis

<div><p>The extracellular matrix (ECM) provides core support which is essential for the cell and tissue architectural development. The role of ECM in many pathological conditions has been well established and ECM-related abnormalities leading to serious consequences have been identified. Though much has been explored in regards to the role of ECM in soft tissue associated pathologies, very little is known about its role in inflammatory disorders in tendon. In this study, we performed microRNA (miRNA) expression analysis in the long head of the human shoulder biceps tendon to identify key genes whose expression was altered during inflammation in patients with glenohumeral arthritis. We identified differential regulation of matrix metalloproteinases (MMPs) that could be critical in collagen type replacement during tendinopathy. The miRNA profiling showed consistent results between the groups and revealed significant changes in the expression of seven different miRNAs in the inflamed tendons. Interestingly, all of these seven miRNAs were previously reported to have either a direct or indirect role in regulating the ECM organization in other pathological disorders. In addition, these miRNAs were also found to alter the expression levels of MMPs, which are the key matrix degrading enzymes associated with ECM-related abnormalities and pathologies. To our knowledge, this is the first report which identifies specific miRNAs associated with inflammation and the matrix reorganization in the tendons. Furthermore, the findings also support the potential role of these miRNAs in altering the collagen type ratio in the tendons during inflammation which is accompanied with differential expression of MMPs.</p></div