The "Pull-Over" technique for all arthroscopic rotator cuff repair with extracellular matrix augmentation

Despite the vast improvement in techniques for arthroscopic rotator cuff surgery, repairs of massive and large tears remain an issue as they are associated with significantly high failure rates, particularly in the elderly population. As a result, there has been a focus of attention to improve rotator cuff repair healing rates. One of the strategies is augmentation of the repair with a patch. Arthroscopic augmentation is, however, technically demanding with challenges in introduction and stabilization of the patch. The purpose of this Technical Note is to describe a technique for arthroscopic rotator cuff repair with augmentation, which offers additional advantages over previous techniques because it facilitates the passage of the patch as well as providing a more robust medial stabilization of the augment and therefore possibly a stronger construct

Medium to long-term outcome of thoracoscapular arthrodesis with screw fixation for facioscapulohumeral muscular dystrophy

Background: Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique). Methods: All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically. Results: Thoracoscapular arthrodesis was performed in thirty-five shoulders in twenty-four patients; eleven patients underwent bilateral procedures. The principal study group consisted of thirty-two shoulders in twenty-one patients with a minimum follow-up of twenty-four months (Mean, eighty-eight months; range, twenty-four to 174 months). The mean Constant score increased from 30 (range, 17 to 41) preoperatively to 61 (range, 30 to 90) postoperatively. The mean satisfaction score increased from 1 (range, 0 to 4) to 8.4 (range, 4 to 10). Early complications consisted of one pneumothorax, one superficial wound infection, and four early failures, two of which were associated with noncompliance with the postoperative regimen. Late complications consisted of one posttraumatic fracture resulting in loosening and one painful nonunion; both were treated successfully with revision. Conclusions: Thoracoscapular arthrodesis with screw fixation prevented scapular winging and improved short-term and long-term shoulder function in patients with facioscapulohumeral dystrophy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Evaluation of the effect of Yoga and Pranayam on quality of ovulation in primary infertility by Color Doppler Ultrasonography

Evaluation of quality of ovulation is possible with the help of Trans Vaginal Color Doppler Sonography. In case of primary infertility if baseline sonography findings are normal, rest of the female factors for infertility and male factors of infertility are also normal, among this couple if female partner is subjected for daily based Yoga and Pranayam programme designed by qualified Yoga trainer at least for six month we can evaluate the quality of ovum and ovulation. During this programme, randomly selected female patients were subjected for Yoga and Pranayam (Group-I) and similar patients were not participated for Yoga and Pranayam (Group-II). The Trans Vaginal Color Doppler findings during ovulation were compared statistically between both the groups. Six months follow up result showed that pregnancy was positive for more number of patients performing Yoga without ovulation inducing drugs

The X-Pulley technique for subpectoral long head of the biceps tenodesis using all-suture anchors

Subpectoral long head of the biceps tenodesis is gaining popularity as a technique for treating patients with various pathologies of the tendon or its anchor to the superior labrum. It has the added advantage of addressing bicipital groove pathologies. Various techniques for performing it have been described, but none is without problems. We present a modification of the previously described techniques that involves 2 all-suture anchors and offers the added advantage of a reduced risk of fracture without sacrificing the biomechanical strength of the construct. We also believe that it may potentiate healing by providing an adequate surface contact area between the tendon and bone with a minimal risk of damage to the tendon and neurovascular structures

Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain : outcome after arthroscopic resection

Background: Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. Materials and Methods: Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years). All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients. Results: At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. Conclusion: Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury

Superior Capsule Reconstruction:What Do We Know?

The management of irreparable rotator cuff tears remains challenging. Since its introduction by Mihata in 2012, superior capsule reconstruction (SCR) has grown in popularity at an astonishingly rapid rate. The aim of this article is to provide a comprehensive review of the available literature, in order to highlight what has so far been published on SCR, covering all aspects including biomechanical, clinical and radiological studies as well as descriptions of the various techniques for performing the procedure. The short-term clinical results of SCR are promising, but there is need for further long-term studies, as well as randomised controlled trials comparing SCR to other treatment modalities for irreparable rotator cuff tears. Further imaging studies looking at graft healing rates are also required as the healing rates published so far are variable. Additionally, the mechanism of action by which SCR delivers good short-term functional outcomes needs further clarification, as does the importance of the choice of graft type and thickness

Distal triceps rupture repair: The triceps pulley-pullover technique

Distal triceps rupture is an uncommon but debilitating injury, and surgical fixation is almost invariably warranted. A number of techniques have been described in the literature in which combinations of transosseous tunnels and bone anchors have been used. We describe a modification to existing techniques-the triceps pulley-pullover technique with all-suture anchors. This technique minimizes bone loss, while maximizing the bone-tendon contact area and creating a double-row repair to optimize strength and healing

The 'Hoover' (vacuum cleaner) technique for calcifying tendonitis deposits excision and removal of the calcific debris

A new technical tip for the improvement of the arthroscopic treatment of symptomatic calcifying tendinitis is described. Arthroscopic excision of calcifying tendonitis may result with multiple minute calcific debris in the subacromial bursa, causing severe post operative pain due to chemical irritation of the bursa. We suggest the use of a bladeless shaver barrel as a "Hoover" (vacuum cleaner) for arthroscopic clearance of these miniature calcific debris from the subacromial space after resection of the major deposits. The use of this technique resulted in good clinical outcome with improved post operative pain

Degenerative rotator cuff tear, repair or not repair? A review of current evidence

INTRODUCTION We review the literature and highlight the important factors to consider when counselling patients with non-traumatic rotator cuff tears on which route to take. Factors include the clinical outcomes of surgical and non-surgical routes, tendon healing rates with surgery (radiological outcome) and natural history of the tears if treated non-operatively. METHODS A PRISMA-compliant search was carried out, including the online databases PubMed and Embase (TM) from 1960 to the end of June 2018. FINDINGS S A total of 49 of the 743 (579 PubMed and 164 Embase (TM)) results yielded by the preliminary search were included in the review. There is no doubt that the non-surgical route with an appropriate physiotherapy programme has a role in the management of degenerative rotator cuff tears. This is especially the case in patients with significant risk factors for surgery, those who do not wish to go through a surgical treatment and those with small, partial and irreparable tears. However, rotator cuff repair has a good clinical outcome with significant improvements in pain, range of motion, strength, quality of life and sleep patterns