Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: A prospective study of 46 patients

Background Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up. Patients and methods We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33-78) years were included in this 6-year evaluation. Results The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery. Interpretation Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery

Dynamic fixation of unstable trochanteric hip fractures. A clinical and radiographic evaluation of the Medoff sliding plate.

In stabilising extracapsular hip fractures, the Medoff sliding plate (MSP) differs from other screw-plates by its compression capacity along the femoral shaft (uniaxial dynamization). Additional compression along the neck of femur can be achieved by primary release of the lag screw (biaxial dynamization). 244 consecutive inter- and subtrochanteric fractures in 243 elderly patients were fixed with the MSP, and prospectively followed for a minimum of one year. 104 unstable intertrochanteric fractures were uniaxially dynamized and 108 similar fractures were biaxially dynamized. Postoperative weight-bearing was permitted in 95 % of the patients. At 1 year, there was a significant difference (p=0.03) in the fixation failure (7 vs 1) between the dynamization groups. 32 subtrochanteric fractures were also dynamized with the MSP, 17 uniaxially and 15 biaxially. In the uniaxial group staged biaxial dynamization, i.e. initial plate slide later followed by secondary release of the lag screw, was done in 3 fractures with a complete plate slide, and which successfully stopped further lag screw migration. The one failure was a nonunion in a biaxially dynamized fracture. We developed a practical method for establishing the real degree of sliding in screw-plate devices from standard a.p. radiographs, independently of the position of the hip. By analysis of the radiographs, we found that an unstable fracture configuration of the greater trochanter increased the degree of femoral medialisation and fracture compression in biaxially dynamized intertrochanteric fractures. We also performed a randomised multicenter trial in 107 elderly patients, in order to compare the efficacy of the load sharing concept of the MSP (n=55) with that of three more load bearing screw-plate devices (n=52) in fixation of subtrochanteric fractures. Significantly (p=0.04) more patients in the MSP group (78 % vs 60 %) were allowed immediate postoperative weight-bearing. Significantly (p=0.01) fewer failures (1 vs 8) were found in the MSP group than in the other group. We think that it is possible to reduce the rate of fixation failure by using the right dynamization mode of the MSP. We recommend uniaxial dynamization in the subtrochanteric fracture, staged biaxial dynamization in the combined inter/subtrochanteric fracture with a complete plate slide, and biaxial dynamization in the unstable intertrochanteric fracture

The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting

Abstract Background The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery. Methods Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14–56) months postoperatively with the non-operated leg used as reference. Results Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22–62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one. Conclusions Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed

Weighted or internal rotation radiographs are not useful in the classification of acromioclavicular joint dislocations

Background: Weighted radiographs are performed to classify acromioclavicular joint dislocations; however, the evidence regarding their usefulness is conflicting. Laboratory studies suggest that internal rotation views can replace weighted radiographs, but this has not been clinically evaluated. Purpose: To evaluate whether weighted or internal rotation radiographs uncovers more high-grade acromioclavicular joint dislocations than non-weighted radiographs. Material and Methods: A total of 162 patients with acromioclavicular joint dislocations were prospectively included. After applying exclusion criteria, 140 remained. Three panorama radiographs, including both coracoclavicular intervals, were completed of each participant: first, a weighted radiograph with 5-kg weights suspended from the wrists; second, a non-weighted radiograph; and third, an internal rotation radiograph. The coracoclavicular intervals were measured by two radiologists independently, and measurements were translated into Rockwood classifications. The classifications and measurements derived from the different radiographic views were compared. Results: Weighted radiographs caused no significant changes in classification. For the internal rotation views, there was a significant change in classification for radiologist 2; however, the reason was that more injuries were downgraded compared to the non-weighted views. Relative to the non-weighted radiographs, the mean increase of the coracoclavicular interval on the injured side in the weighted view was 0.5 mm (95% confidence interval [CI] 0.37–0.65) and in the internal rotation view 0.2 mm (95% CI 0.04–0.33). While these changes were statistically significant, they were small and not clinically important. Conclusion: This study does not support the use of weighted and internal rotation radiographs in the classification of acromioclavicular joint dislocations

Return to work after early repair of acute traumatic rotator cuff tears

Background: Lost workdays following rotator cuff repair is not well-studied in the literature. We aimed to define the time away from work following early arthroscopic repair of acute traumatic rotator cuff tears and compare it with the recommendations of the American Medical Disability Advisor (MD Guidelines) and The Swedish Social Insurance Agency. Methods: Thirty-two consecutive working patients with a median age of 58 (42–70) years suffering from acute traumatic rotator cuff tears who underwent arthroscopic repair were prospectively studied. The studied variables were age, gender, alcohol use, smoking, number of injured tendons, dominant side involvement, work-related injury, employment status, preoperative work level, alterations of work tasks at return to work, and time away from work. Results: 97% of the patients returned to full-duty work. The median time to return to full-duty work was 5.0 (1.1–10.5) months. Preoperative work level (p = 0.025) and dominant side (p = 0.02) significantly affected the time away from work on the univariate analysis, while GLM model showed a trend (p = 0.09) for shorter sick leave by dominant side involvement. The sick leave was longer in all three work level categories compared with the MD Guidelines and longer in the light and medium work categories compared with the recommendations by FK. Conclusions: According to the present study, acute traumatic rotator cuff tears cause a considerable loss of work days. However, almost all patients are expected to return to work after a median time of 5 months following arthroscopic repair. Current guidelines and recommendations regarding sick leave following repair of rotator cuff tears might have to be reviewed

No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears

Purpose Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. Methods In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42-75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25-37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. Results The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5-14.5) compared to 11 (5-12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5-8.9) vs. 0.1 (0-1.5), p = 0.003] and proliferation [4.0 (1.8-6.9) vs. 0.4 (0-2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). Conclusion This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears.Funding Agencies|Lund University; Stig og Ragna Gorthon Research Foundation; Thelma Zoegas Foundation, Helsingborg, Sweden</p

Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears : a prospective study

Background: Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT. Methods: Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II. Results: 79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT. Conclusion: Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT