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

Result from surgical treatment on the terrible triad of the elbow

AbstractObjectiveTo evaluate the results from surgical treatment of the terrible triad of the elbow, with a minimum of six months of follow-up, taking elbow function into consideration.MethodsThe analyzed aspects of 20 patients, who underwent surgical treatment of the terrible triad of the elbow, were given as follows: Dash score (Disabilities of the Arm, Shoulder and Hand), Meps (Mayo Elbow Performance Score), pain according to VAS (visual analog scale), ROM (range of motion), patient satisfaction, degree of energy of the trauma, complications and radiographs.ResultsThe mean length of follow-up among the patients was 38 months. There were statistically significant relationships between the following set of parameters: trauma mechanism and patient satisfaction; radiological outcome of “heterotopic ossification” and satisfaction; functional flexion–extension ROM and satisfaction; and between type of radial head fracture and presence of a radiological outcome.ConclusionThe surgical treatment for the terrible triad of the elbow generally provided satisfactory results, when the functioning of this joint upon the return to activities was taken into consideration

Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review

Background: The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures. Objective: The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged. Methods: A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciencias da Saude, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed. Results: Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded by a government-based noncommercial agency, Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP). Conclusions: This study may provide surgical treatment effects evidence for SHFC. The results will assist clinical practice by demonstrating the effectiveness and potential complications of these interventions and might serve as a reference for future clinical trials on the topic.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Univ Fed Sao Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Rua Borges Lagoa 783-5o, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Rua Borges Lagoa 783-5o, Sao Paulo, BrazilWeb of Scienc

Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol

Background There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illnesshowever, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. Hypothesis Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. Design Double blind, placebo-controlled, parallel groups, randomised clinical trial. Materials and methods 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the (2) test and the analysis of variance for statistical analyses. Discussion This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. Ethics and dissemination The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). Trial registration number 8094833648737701 (NCT02757664)Pre-results.Univ Fed Sao Paulo, Dept Orthopaed, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP EPM, Orthoped & Traumatol Div Hand Surg & Upper Limb, Sao Paulo, SP, BrazilDepartment of Orthopaedics, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, BrazilOrthopedics and Traumatology—Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilWeb of Scienc