Arthroscopic repair of subscapularis tear: Surgical technique and results

SummaryIntroductionArthroscopic management of extensive subscapularis tendon lesions was reported more recently than for the supra- and infra-spinatus tendons. Extensive tears create technical problems requiring an extra-articular approach. The few results so far reported have been encouraging.Study designSurgical techniques adapted to each type of tear according to our subscapularis lesion classification are described, with the preliminary results from our cohort.Patients and methodsBetween January 2006 and December 2008, 74 patients were operated on for extensive subscapularis tear. Twenty-three were assessed over a minimum 2 years’ follow-up (mean, 32 months) on UCLA, ASES and Constant scores, comparative dynamometric Bear-Hug test, visual analog pain scale and self-assessed shoulder function.ResultsPostoperative clinical results for the 23 patients followed up showed an improvement in shoulder function from 58 to 86%, in UCLA score from 16.4 to 30.9 points and in weighted Constant score from 48.6 to 75.2%.DiscussionIn case of severe tear, we recommend visualizing the subscapularis tendon along its main axis from above, on a lateral approach allowing the intra- and extra-articular parts to be controlled, so as to check the reduction achieved by traction wire and anatomic fixation by anchors and sutures via an anterior access of varying height but systematically kept under tension. Biceps tenodesis is often required. Results show a clear improvement on all scores: pain, strength and function. The failure rate was 9% (two cases). There were no complications.Level of evidenceIV (retrospective study)

Comparison between 2D and 3D computed tomography evaluation of glenoid bone defect in unilateral anterior gleno-humeral instability

Obiettivo. Scopo del nostro lavoro \ue8 stato valutare la concordanza tra misurazioni bidimensionali (2D) e tridimensionali (3D) con tomografi a computerizzata (TC) nella identifi cazione delle dimensioni e del tipo di difetto osseo di glena nell\u2019instabilit\ue0 gleno-omerale anteriore. Materiali e metodi. Cento pazienti con instabilit\ue0 glenoomerale anteriore monolaterale hanno eseguito esame TC delle spalle. Le immagini sono state riformate sia con il metodo 2D (multi-planar reconstruction, MPR) che 3D (volume rendering technique, VRT). L\u2019area del difetto di glena \ue8 stata calcolata in confronto con la glena sana ed \ue8 stata espressa in percentuale. La concordanza tra le due misurazioni \ue8 stata valutata con il metodo Bland- Altman; una differenza media del 5% \ue8 stata considerata clinicamente signifi cativa. Risultati. L\u2019analisi della concordanza tra le misurazioni MPR e VRT della percentuale di glena mancante ha mostrato una differenza media di 0,62%\ub11,96%. La concordanza percentuale tra le due misurazioni nel valutare la grandezza del difetto osseo \ue8 stata del 97% (p<0,0001). La concordanza percentuale nel discriminare il tipo di difetto osseo \ue8 stata del 97% (p<0,0001). Conclusioni. La concordanza tra misurazioni TC 2D (MPR) e 3D (VRT) nell\u2019identifi care le dimensioni ed il tipo di difetto osseo di glena nell\u2019instabilit\ue0 glenoomerale anteriore \ue8 stata cos\uec alta da poterle considerare intercambiabili.Purpose. This study evaluated the agreement between 2D and 3D computed tomography (CT) measurements in identifying the size and type of glenoid-bone defect in anterior glenohumeral instability. Materials and methods. One hundred patients affected by unilateral anterior glenohumeral instability underwent a CT of both shoulders. Images were processed with both 2D [multiplanar reconstruction (MPR)] and 3D [volumerendering (VR)] methods. The area of the missing glenoid was calculated in comparison with the healthy glenoid and expressed as a percentage. Agreement between the two measurements was assessed according to the Bland-Altman method; a 5% mean difference was considered as clinically relevant. Results. Analysis of agreement between MPR and VR measurements of the percentage of missing glenoid showed a mean difference equal to 0.62%\ub11.96%. Percent agreement between the two measurements in detecting the presence of bone defect was 97% (p<0.0001). Percent agreement between the two measurements in discriminating the type of bone defect was 97% (p<0.0001). Conclusions. Agreement between 2D (MPR) and 3D (VR) CT measurements to identify the size and type of glenoid-bone defect in anterior glenohumeral instability was so high that the two measurements can be considered interchangeable