Large Footprint Bone Cyst: Arthroscopic Autologous Cylinder Press-Fit with Buddy Anchor Interference-Fit for Rotator Cuff Repair

BACKGROUND: About 20–25% of all rotator cuff tears are associated with footprint bone cysts. Large cysts (>10 mm2) are rare but can be problematic for anchor fixation and rotator cuff repair. So far treatment of footprint bone cysts was described using large or several anchors, cement, or compaction grafting mostly with allograft bone being biologically inferior to restore bone stock compared to autologous grafts. METHODS/RESULTS: We report about a 57-year-old manual laborer with persistent pain and loss of shoulder function (subjective shoulder value [SSV] 50%). Magnetic resonance imaging showed a high-grade partial supraspinatus tendon tear (>50%) associated with a large supraspinatus footprint bone cyst (10 mm × 11 mm × 17 mm). An efficient setup in lateral position for arthroscopic autologous press-fit grafting from the iliac crest is described for single-stage arthroscopic rotator cuff repair. Improved fixation was achieved using a buddy anchor interference-fit technique. CONCLUSION: The clinical follow-up after 12 months showed an excellent outcome (SSV >90%, DASH-Score 14 points, and Constant-Score 87 points) with dynamic ultrasound and radiographs confirming tendon and bone stock restoration

Image‐guided percutaneous cryoablation of unresectable sacrococcygeal chordoma: Feasibility and outcome in a selected group of patients with long term follow‐up

Chordoma is a rare malignant tumor of the axial skeleton. Percutaneous cryoablation (PCA) is a minimally invasive technique that allows freezing of tumors under imaging control. The purpose of our retrospective study was to investigate the outcome of PCA in a selected cohort of patients with sacrococcygeal chordoma, with a minimum of 5 years follow-up. Four patients were treated in 10 sessions. The mean follow-up was 57.3 months. We evaluated the feasibility, the procedure-related complications, the impact on pain control and oncological outcomes. Freezing of 100% of the tumor volume was possible in 60%. Pain control was not reliably evaluable. Local recurrence occurred in 90% of the treated lesions; the mean time to progression was 8.1 months (range 1.5-16). At last follow-up, one patient had died of the disease, one of another cause and one was receiving the best supportive care. The only patient alive without the disease had received additional carbon-ion radiotherapy. The 5-year survival rate after index PCA was 50%. Complete freezing of the tumor was technically challenging, mainly due to the complex local anatomy. Recurrence occurred in 90% of the lesions treated. PCA should be considered with caution in the curative management of sacrococcygeal chordoma

Image-guided percutaneous cryoablation of unresectable sacrococcygeal chordoma: Feasibility and outcome in a selected group of patients with long term follow-up

Background: Chordoma is a rare malignant tumor of the axial skeleton. Percuta- neous cryoablation (PCA) is a minimally invasive technique that allows freezing of tumors under imaging control. The purpose of our retrospective study was to in- vestigate the outcome of PCA in a selected cohort of patients with sacrococcygeal chordoma, with a minimum of 5 years follow‐up. Materials and Methods: Four patients were treated in 10 sessions. The mean follow-up was 57.3 months. We evaluated the feasibility, the procedure‐related complica- tions, the impact on pain control and oncological outcomes. Results: Freezing of 100% of the tumor volume was possible in 60%. Pain control was not reliably evaluable. Local recurrence occurred in 90% of the treated lesions; the mean time to progression was 8.1 months (range 1.5–16). At last follow‐up, one patient had died of the disease, one of another cause and one was receiving the best supportive care. The only patient alive without the disease had received additional carbon‐ion radiotherapy. The 5‐year survival rate after index PCA was 50%. Conclusion: Complete freezing of the tumor was technically challenging, mainly due to the complex local anatomy. Recurrence occurred in 90% of the lesions treated. PCA should be considered with caution in the curative management of sacro- coccygeal chordoma