Arthroscopic repair of concomitant type II SLAP lesions in large to massive rotator cuff tears: comparison with biceps tenotomy

BACKGROUND: There are no studies examining superior labrum anterior and posterior (SLAP) repair combined with repair of large to massive rotator cuff tears, and it is unclear whether a combined SLAP repair would lead to better outcomes than biceps tenotomy. HYPOTHESIS: Tenotomy and rotator cuff repair would lead to better outcomes compared with those of combined SLAP and rotator cuff repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Our study population consisted of 36 patients who had undergone either combined SLAP and rotator cuff repair (when the biceps was too healthy to cut; group R = 16 patients) or tenotomy and rotator cuff repair (when any fraying or partial tear existed in the biceps tendon; group T = 20 patients) for concomitant type II SLAP lesions and large to massive rotator cuff tears. The cuff repair was performed in a single row for both groups. Outcomes were assessed by comparing range of motion as well as Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores between the 2 groups. RESULTS: At the 2-year follow-up, both groups demonstrated significant improvements in functional shoulder scores and range of motion. However, group T had better SST scores (group T, 9.3 ± 1.6; group R, 7.8 ± 1.9; P = .012), ASES scores (group T, 88.6 ± 8.9; group R, 80.4 ±8.9; P = .009), UCLA scores (group T, 29.6 ± 3.0; group R, 26.0 ± 4.2; P = .007), and forward flexion (group T, 145.9° ± 13.0°; group R, 132.5° ± 15.3°; P = .008). The mean tear size and the degree of preoperative muscle atrophy and fatty infiltration on magnetic resonance imaging were similar between the groups. CONCLUSION: For patients with concomitant type II SLAP lesions and large to massive rotator cuff tears, the outcomes of simultaneous arthroscopic SLAP and rotator cuff repair were inferior to those of arthroscopic biceps tenotomy and cuff repair in terms of functional shoulder scores and range of motion. Biceps tenotomy and rotator cuff repair may be a more reliable method to address concomitant type II SLAP lesions and large to massive rotator cuff tears in patients, although a randomized controlled trial is needed to confirm the results.ope

Apologie de Moliere-dans la querelle du Tartuffe

En vue de dégager le système de la signification chez Molière, nous analysons les textes qu'il a écrits pendant la querelle du Tartuffe: les trois placets présentés au roi et la préface du Tartuffe. Si la lecture se situe à la surface de ces textes, Molière semble plaider sa propre cause en s'appuyant sur l'idéologie dominante et les doctrines esthétiques de son temps. Mais si l'on procède à une lecture approfondie, un autre système de signification se dégage de ces écrits, système profond qui, contredisant les raisons superficiellement invoquées par l'auteur pour défendre son oeuvre, laisse voir les vrais avis de Molière sur le théâtre et sur l'homme. Ce système double de la signification nous paraît une des stratégies que Molière a adoptées pour se protéger et en même temps pour s'assumer la liberté en poursuivant ses activités théâtrales dans la situation politico-culturelle de son temps

Une etude sur l'immobilite beckettienne

L'action gcsticulairc et scenique Ptant l'une des proprietts th6gtraleu, lc thkitre de Bcckett nous invite h regarder des ncteurs qui ne bougent pas. c'est de ce phPnomCne paradoxal de leur imrnobilisation que notre ktudc s'efforce de degage* certaine signification dynamiquc. L'cspacc schique qui ne permet point l'acte d'en sortir, force les acteurs h prcndre conscence de la situation d'existence claustrke dans un lieu dklimitt. par ici. De lh resulte leur actc qui va en s'immobilisant. Unc analy~e psychique ne pourrait-elle pas lire par l i une sorte de nostalgic au retour ii la Mkre? En une sens si, pourtant ce dtsir intkrieur est kgalcment bloqui: par la censure conscicnte dc l'homme condamn6 i vivre non pas au-delk imaginaire, mais ici existentiel. Ainsi lui restc-t-il n'existcr que par el A travers la parole permettant la seule rnani&re de vivre. En voib un sens cache de l'immobilitk beckettienne

Etude sur le Canada francophone

본 연구의 목적은 카나다·불어권 지역, 즉 퀘벡의 분화에 대한 포괄적이고 기초적인 지식을 확립하는 데 있다. 퀘벡은 주변 영어문화권으로부터 받는 끊임없는 동화의 위협에도 불구하고 자신들 고유의 불어권 문화를 형성, 발전시킴으로써 세게 문화 구도 속에서 독특한 위치를 차지하고 있으며, 퀘벡의 역사는 문화적, 사회적, 정치적 변화 속에서 자신들만의 독특한 정체성을 형성하기 위한 퀘벡인들의 노력이 어떠한 것이었던가를 잘 보여준다. 따라서 본 연구는 카나다 불어권을 역사, 정치, 경제, 예술, 언어의 다섯 분야로 나누어 탐구함으로써 이 지역이 갖는 특수성을 보다 잘 이해하고자 하였다. 특히 다음의 사항이 주된 연구 대상이 되었다. 주요 연구대상은 카나다 불어의 역사, 문화 생활에 불어의 사용이 끼친 영향, 이중언어주의, 현재의 퀘벡의 경제상황, 다원문화주의, 문화의식과 정치의식과의 상관성, 카나다의 미래 등이었다. 이러한 연구를 통해 우리는 퀘벡이 다른 문화권들과의 관계 속에서 자신의 독자성을 잃지 않으려는 끊임없는 노력을 보여주는 동시에 '다양성 속의 통일성'이라는 자신의 궁극적 목표에 다가서려는 노력도 잃지 않는 독자적인 문화권임을 알 수 있었다

Arthroscopic partial repair of irreparable large to massive rotator cuff tears

PURPOSE: The aim of this study was to evaluate the outcome of arthroscopic partial repair and margin convergence of irreparable large to massive rotator cuff tears. METHODS: Between January 2003 and July 2008, 27 patients who met the inclusion criteria underwent arthroscopic partial repair and margin convergence of irreparable large to massive rotator cuff tears. An irreparable tear was defined as a tear with a minimum anterior-to-posterior width of 3 cm or larger, where it was not feasible to completely cover the humeral head with the cuff at the time of surgery. RESULTS: The mean preoperative tear size was 42.1 ± 6.2 mm. The mean size of the postoperative residual defect in the repaired tendon along the medial margin of the greater tuberosity was 12.0 ± 5.5 mm. All shoulder scores showed improvement. The Simple Shoulder Test improved from 5.1 ± 1.2 to 8.8 ± 2.1 (P < .001), the Constant score from 43.6 ± 7.9 to 74.1 ± 10.6 (P < .001), and the University of California, Los Angeles score from 10.5 ± 3.0 to 25.9 ± 5.0 (P < .001). Both Constant and University of California, Los Angeles shoulder scores also showed an inverse correlation with defect size. We compared muscle strength between the affected and contralateral sides and found that the strength of the affected side was not restored to the same level as the contralateral side (P < .001). CONCLUSIONS: Arthroscopic partial repair and margin convergence showed satisfactory short-term outcomes in irreparable large to massive rotator cuff tears. Thus it is suggested that, even in a large to massive tear that appears irreparable, attempting to repair it as much as possible to possibly convert it into a functional rotator cuff tear by re-creating a balanced forced couple can be helpful in reducing pain, as well as improving functional outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.ope

Effect of Physiological Posterolateral Rotatory Laxity on Early Results of Posterior Cruciate Ligament Reconstruction with Posterolateral Corner Reconstruction

BACKGROUND: The purpose of this study was to evaluate the influence of physiological posterolateral rotatory laxity on posterior cruciate ligament (PCL) reconstruction in terms of posterior stability and clinical outcomes. METHODS: We retrospectively reviewed the records of sixty-five patients who had undergone arthroscopic PCL reconstruction with simultaneous reconstruction of the posterolateral corner from March 2004 to April 2009. Patients were categorized into three groups according to the amount of tibial external rotation at 90° of knee flexion on the uninjured side: Group 1 (50°; n = 18). Knee instability was assessed with posterior and varus stress radiographs as well as with the dial test at 30° and 90° of knee flexion. Functional scores were assessed with use of the Lysholm score and the International Knee Documentation Committee (IKDC) score preoperatively and at the time of final follow-up. RESULTS: At the time of follow-up, there was no significant difference among the three groups with regard to the mean side-to-side difference in posterior translation as measured with Telos stress radiography (Group 1: 3.6 ± 1.3 mm, Group 2: 3.3 ± 1.6 mm, and Group 3: 4.3 ± 1.6 mm; p = 0.098). There was also no significant difference among the groups with respect to knee stability as assessed on the varus stress radiographs or with the dial test at 30° and 90° of flexion. Finally, there was no significant difference among the groups with respect to the Lysholm or IKDC functional scores. CONCLUSIONS: This study suggests that the instability of knees that have PCL and posterolateral corner injuries with physiological posterolateral rotatory laxity can be controlled successfully with PCL reconstruction and simultaneous reconstruction of the posterolateral corner. Physiological posterolateral rotatory laxity should not be considered a risk factor for abnormal knee laxity after PCL reconstruction with simultaneous reconstruction of the posterolateral corner.ope