Clinical and MRI outcomes 10 years after repair of massive posterosuperior rotator cuff tears

BACKGROUND: Massive rotator cuff tears are challenging to treat, with few or no studies on long-term outcomes of repair. The purpose of this study was to report 10-year outcomes following repair of massive posterosuperior rotator cuff tears, with and without extension into the subscapularis, and to determine prognostic factors that could influence clinical scores and retear rates. METHODS: The records of 234 patients who underwent repair of a massive posterosuperior rotator cuff tear at a total of 15 centers were retrieved. Patients were asked to return for evaluation at 10 years; 78 patients could not be contacted, 7 had died, and 19 had undergone a reoperation. A total of 130 patients (68% men) with a mean age (and standard deviation) of 56.1 ± 7.7 years (range, 26 to 79 years) were evaluated clinically, and 102 of them were also evaluated using magnetic resonance imaging (MRI). The tear was confined to the supraspinatus and infraspinatus tendons in 94 shoulders and also involved the superior portion of the subscapularis in 36 shoulders. Univariable and multivariable regressions were performed to determine whether 10-year total Constant-Murley scores and repair integrity were associated with patient characteristics, tear patterns, or repair techniques. RESULTS: In the study cohort, complications were noted in 14 shoulders (11%) (stiffness in 10 and infection in 4). For the 130 shoulders evaluated clinically, the mean total Constant-Murley score improved from 53.1 ± 15.9 (range, 14 to 83) preoperatively to 78.5 ± 11.3 (range, 36 to 98) at 10 years. Of the 102 shoulders evaluated using MRI, 32 had a retear (Sugaya type IV or V). Of the 19 shoulders that underwent a reoperation (excluded from the study cohort), 9 had a retear. The overall prevalence of retears was 34%. Multivariable regression analysis revealed a significant association between the 10-year Constant-Murley score and preoperative retraction of the infraspinatus tendon, but no association between retears and any of the variables. Involvement of the subscapularis had no significant effect on preoperative or postoperative Constant-Murley scores or retear rates. CONCLUSIONS: Patients who had repair of a massive posterosuperior rotator cuff tear maintained considerable improvements in clinical and radiographic outcomes at 10 years. Partial concomitant tears of the subscapularis did not affect the total postoperative Constant-Murley scores or retear rates

Clinical and structural outcome twenty years after repair of isolated supraspinatus tendon tears

BACKGROUND: This study evaluated the clinical and structural outcome 20 years after repair of isolated supraspinatus tendon tears. We hypothesized that the results would deteriorate over time. MATERIALS AND METHODS: For this retrospective multicenter study, 137 patients were recalled for a clinical and imaging assessment. Six patients (4.3%) had died from unrelated causes, 52 (38.0%) were lost to follow-up, and 13 (9.5%) had undergone reoperations. This left 66 patients for clinical evaluation. Radiographs and magnetic resonance imaging were additionally performed for 45 patients, allowing assessment of osteoarthritis, tendon healing, fatty infiltration (FI), and muscle atrophy. RESULTS: The Constant Score (CS) improved from 51.5 ± 14.1 points preoperatively to 71 points (P < .05) with a mean Subjective Shoulder Value (SSV) of 77.2% ± 22%. Tendon discontinuity (Sugaya IV-V) was present in 19 of 45 patients (42 %), and there was advanced FI (Goutallier III-IV) of the supraspinatus in 12 (27%) and of the infraspinatus muscle in 16 (35%). Supraspinatus atrophy was present in 12 patients (28%), advanced arthritis in 6, and cuff tear arthropathy in 12 (30%). The CS and SSV were significantly inferior for shoulders with FI of stages III to IV (P < .05). The CS was lower in cuff tear arthropathy and correlated with infraspinatus FI. CONCLUSIONS: At 20 years after surgical repair of isolated supraspinatus tears, the clinical outcome remains significantly above the preoperative state. FI of the infraspinatus is the most influential factor on long-term clinical outcome

Revue clinique et radiologique de la prothèse totale d'épaule Aequalis® à plus de 3 ans de recul

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les Fractures fémorales autour des prothèses de hanche (hors fractures péri-opératoire)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validité du C-Test dans l'évaluation de la chirurgie de l'épaule

L'utilisation d'outils chiffrés validés pour l'évaluation des pratiques chirurgicales est indispensable. Le C-Test est un test fonctionnel décrit en 2006 par Marc qui n'a pas encore été validé. L'objectif de cette étude était d'évaluer dans le cadre de la chirurgie de l'épaule sa reproductibilité, ses corrélations avec les scores validés et sa sensibilité au changement. Cette étude prospective mono-centrique portant sur 24 patients opérés par un unique chirurgien a permit de retrouver une excellente reproductibilité inter-observateur (R=0.901; p<0.001), une corrélation significative avec le score de Constant pré- (R=0.72; p<0.001) et post-opératoire (R=0.44; p<0.05) avec un recul moyen de 12 mois mais non significative avec le DASH et le Quick-DASH, ainsi qu'une bonne sensibilité au changement (R=0.54; p<0.01). Les auteurs recommandent l'utilisation du C-Test dans la pratique quotidienne tout en conservant le score de Constant pour l'analyse fonctionnelle détaillée de l'épaule.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Les Fractures fémorales autour des prothèses de hanche (hors fractures péri-opératoire)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge de l'hyperlaxité dans l'instabilité antérieure chronique de l'épaule (à propos de 122 cas)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

RESULTATS D'UNE SERIE DE 41 RUPTURES IRREPARABLES DE LA COIFFE DES ROTATEURS TRAITEES PAR LAMBEAUX DELTOIDIENS

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anatomical evidence for a uniquely positioned suprascapular foramen

International audienceThe suprascapular foramen is a rare but not exceptional variation of the suprascapular notch. The suprascapular notch and suprascapular foramen could lead to pain and muscles atrophy because of nerve compression. In this study, we present a suprascapular foramen which does not correspond to a nerve's trajectory but rather corresponds to a specific bone formation that increases the surface area for muscle attachment. As a consequence, its presence cannot be taken as an indication for neurolysis, contrary to ossification of the foramen in its normal anatomical position. Moreover, this unique foramen is distinguishable from a classical suprascapular foramen on radiographs and, especially, on CT scan images

Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy

International audiencePurpose - There is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability. Methods - Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(-) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome. Results - Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P 4 (P 85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(-) groups did not show significant difference in the mean values of Rowe, Walch-Duplay and Constant-Murley scores. Conclusion - ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair. Level of evidence - Cases series, treatment study, Level IV