Resultado do tratamento cirúrgico artroscópico das rerrupturas do manguito rotador do ombro

ResumoObjetivosavaliar a função de pacientes operados por via artroscópica de recidiva pós‐cirúrgica de lesão do manguito rotador (série de casos) e compará‐los com aqueles sem recidiva (grupo controle). Comparar a função de pacientes com recidiva de lesões do manguito rotador (MR) maiores e menores do que 3cm.Métodosavaliação retrospectiva de pacientes submetidos a revisão artroscópica das lesões do manguito rotador com o uso dos escores de ASES, Constant e Murley, UCLA e escala analógica de dor e comparação com pacientes do grupo controle submetidos a reparo primário do MR.Resultadoso tamanho da lesão do manguito rotador na recidiva apresentou influência no resultado do tratamento cirúrgico artroscópico com significância estatística. Os escores funcionais mostraram piores resultados quando comparados àqueles do primeiro procedimento.Conclusãoo tratamento cirúrgico artroscópico das rerrupturas de lesões do manguito rotador mostrou piores escores funcionais quando comparado ao reparo primário da lesão.AbstractObjectivesto evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series) and compare this with function in patients without recurrence (control group); and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3cm.Methodsthis was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analogue pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair.Resultsthe size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure.Conclusionarthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury

Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair

AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were righthand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 years hand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears (33.7) compared with those with non-traumatic tears (32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group (P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the nontraumatic group and 0.729 in the traumatic group (P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory.Univ Fed São Paulo, Orthoped & Traumatol Dept, Shoulder & Elbow Surg Sector Hand & Upper Limb Su, BR-04038030 São Paulo, SP, BrazilShoulder Surg Sector Hosp Ortoped Belo Horizon, BR-30210300 Belo Horizonte, MG, BrazilUniv Fed São Paulo, Orthoped & Traumatol Dept, Shoulder & Elbow Surg Sector Hand & Upper Limb Su, BR-04038030 São Paulo, SP, BrazilWeb of Scienc

Arthroscopy repair of the rotator cuff lesions of the shoulder: functional evaluation of the results of 87 patients

Objetivo: Avaliar o resultado funcional obtido, atraves da reparacao por via artroscopica de lesoes do manguito rotador. Material: Foram avaliados 87 ombros de 87 pacientes, operados no periodo de 23/01/96 a 28/03/00, com tempo medio de seguimento de 43,3 meses (24 a 72 meses). Metodo: Os 87 pacientes operados foram selecionados, segundo os criterios: lesao do manguito rotador em apenas um ombro e ausencia de patologias associadas que possam interferir na evolucao e resultado final. A dor persistente e a limitacao funcional foram os indicadores para a cirurgia. Os pacientes foram avaliados no pre-operatorio segundo criterios clinicos e de imagens. A avaliacao final considerou os criterios de pontuacao de resultados sugeridos pela University of California at Los Angeles e a avaliacao da forca medida atraves de um dinamometro simples constituido por uma balanca de uso domestico. Resultados: Noventa e dois por cento dos pacientes tiveram resultados Excelentes e Bons, 3,4 por cento Regulares e 4,6 por cento Ruins. A pontuacao media foi de 33,1 por cento. O percentual de recuperacao de forca do lado operado, em relacao ao lado nao-operado, foi de 76,7 por cento. O lado operado recuperou 90 por cento ou mais da forca equivalente do lado nao-operado, em 40,7 por cento dos pacientes. Conclusoes: A reparacao artroscopica das lesoes do manguito rotador permite um indice de 92 por cento de Excelentes e Bons resultados. Existe relacao inversa entre a extensao da lesao e a pontuacao de resultados. Nao existe correlacao significativa entre a idade dos pacientes por ocasiao da cirurgia e a pontuacao de resultados. O lado operado recupera 90 por cento ou mais da forca equivalente do lado nao-operado em 40,7 por cento dos pacientes. A recuperacao media de forca do lado operado e de 76,7 por cento em relacao a forca do lado nao-operado. Ha uma relacao inversa entre a recuperacao da forca no lado operado e a extensao da lesaoBV UNIFESP: Teses e dissertaçõe

Tenodese bicipital "a rocambole": técnica e resultados

OBJETIVO: Apresentar nova técnica de tenodese bicipital e seus resultados, realizada parcialmente por via artroscópica e fundamentada em conceitos da anatomia normal e patológica do tendão da cabeça longa do bíceps. O fundamento é a predisposição deste tendão em fixar-se, após rotura ou tenotomia, no sulco intertubercular (autotenodese). MÉTODO: Avaliados, 63 pacientes (63 ombros); idade, 32 a 77 anos (média 55); femininos, 32 (51%); e masculinos, 31 (49%). Com idade acima de 60 anos, 35 pacientes (55,6%); abaixo de 60 anos, 28 pacientes (44,4%); desportistas, 18 (28,6%); com lesão associada do subescapular, 14 pacientes (22,2%). O seguimento mínimo foi de 12 meses, máximo de 74 e médio de 43 meses. O ombro direito correspondeu a 48 casos (76,2%), um dos quais era sinistro e 47 destros. O ombro esquerdo representou 15 (23,8%), com dois sinistros e 13 destros. Não houve ocorrência bilateral. Análise estatística de acordo com o programa SPSS, versão 18. Teste do Qui-quadrado de Pearson, correção de continuidade, adotado para testar a significância estatística da associação entre as variáveis. Consideradas associações estatisticamente significativas quando p inferior a 0,05. RESULTADOS: A deformidade residual de Popeye foi observada por sete pacientes (11,1%), observada apenas pelo examinador em 15 (23,8%) e não observada pelo examinador ou pelo paciente em 41 casos (65%). Não houve influência estatisticamente válida entre idade, prática de esportes de contato ou arremesso, lesão associada do tendão subescapular e a ocorrência de deformidade de Popeye. Satisfeitos, 58 (92,06%) pacientes; insatisfeitos, dois (3,17%); e indiferentes, três (4,76%). CONCLUSÕES: A técnica apresenta altos percentuais de satisfação por parte dos pacientes (92,06%); deformidade residual é percebida por 11,1% dos pacientes. Seu aparecimento não tem correlação estatisticamente válida com a faixa etária acima ou abaixo de 60 anos (p = 0,883), com a prática esportiva (p = 0,195) ou com a lesão associada do subescapular (p = 0,958)

Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation

Result from arthroscopic surgical treatment of renewed tearing of the rotator cuff of the shoulder

OBJECTIVES: To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series) and compare this with function in patients without recurrence (control group); and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm.METHODS: This was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair.RESULTS: The size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure.CONCLUSION: Arthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury

Functional outcome after arthroscopic repair of triple shoulder instability

ABSTRACT OBJECTIVE: To evaluate the functional outcomes of patients submitted to arthroscopic repair of triple labral lesion. METHODS: This was an analytical retrospective study of patients who underwent arthroscopic treatment of triple labral lesion from March 2005 to December 2014. Patients with at least one year of postoperative follow-up were included. A total of nine patients were evaluated. The mean age was 32.3 years and the dominant side was affected in five patients. Patients were functionally assessed regarding the range of motion (ROM) in elevation, external rotation with the arm close to the body the arm in abduction of 90°, and internal rotation, and by the Carter-Rowe score. The degree of satisfaction was assessed at the end of the follow-up period. RESULTS: Three patients had less than five episodes of instability, four patients had between five and ten episodes, and two patients had more than ten episodes. Seven patients had positive O'Brien test for SLAP lesions and positive apprehension test in abduction and external rotation, and only one patient had apprehension in adduction and internal rotation. Three patients persisted with positive O'Brien test and one with apprehension in abduction and external rotation at the end of follow-up. The range of motion was complete in all cases. The median Carter-Rowe score increased from 40 preoperatively to 90 (p = 0.008). CONCLUSION: The arthroscopic repair of triple labral lesions allows for the restoration of the stability of the glenohumeral joint, achieving excellent functional results

Preliminary results from osteosynthesis using Ender nails by means of a percutaneous technique, in humeral diaphysis fractures in adults

ABSTRACTOBJECTIVE: To demonstrate the clinical and functional results from treatment of humeral diaphysis fractures using Ender nails. METHODS: Eighteen patients who underwent osteosynthesis of humeral diaphysis fractures using Ender nails were evaluated. In addition to the clinical and radiographic evaluations, patients with a minimum of one year of follow-up were assessed by means of the Constant, American Shoulder and Elbow Surgeons (ASES), Mayo Clinic and Simple Shoulder Value (SSV) functional scores, and in relation to the degree of satisfaction with the final result. The fixation technique used was by means of an anterograde percutaneous route. RESULTS: All the patients achieved fracture consolidation, after a mean of 2.9 months (ranging from 2 to 4 months). The mean Constant score was 85.7 (ranging from 54 to 100) and the mean ASES score was 95.9 (ranging from 76 to 100). All the patients achieved the maximum score on the Mayo Clinic scale. CONCLUSION: Fixation of humeral diaphysis fractures using Ender nails by means of a percutaneous technique was shown to be a method with promising preliminary results

Videoarthroscopic treatment of glenohumeral osteoarthritis

OBJECTIVE: To evaluate possible benefits obtained through the use of surgical videoarthroscopy in the management of glenohumeral osteoarthritis. METHODS: We evaluated 37 patients (38 shoulders) who underwent through surgical videoarthroscopy in the period between November 1999 and May 2009 (minimum follow-up of two years). Twenty five patients attend for revaluation and thirteen were interviewed by telephonic contact. Functional assessments were performed (UCLA, Constant, and measurement of range of motion -ROM-), as well as pre and post surgical radiographics. We evaluated the influence of the following factors in the final results: the presence of chondral lesions, joint space narrowing, osteophyte presence, associated injuries (rotator cuff torn or instability), and follow-up. Among those patients interviewed by phone we evaluated the satisfaction level and if they would submit themselves again to the surgical procedure. RESULTS: It was observed significant gain towards to the function (UCLA) and the internal rotation, as well as the association between dissatisfaction and pre surgical joint space reduced. Among the operated patients, 84% were satisfied with the results and 86.6% would repeat the procedure. CONCLUSION: Surgical videoarthroscopy presents a relevant role in management of the glenohumeral osteoarthritis, providing improvement of functional results and high levels of satisfaction