Laurent Nové-Josserand | PubMed Health

PubMed2006

Glenoid bone grafting with a reverse design prosthesis.

The purpose of this study was to evaluate the outcome of patients who underwent glenoid bone grafting and implantation of a reverse design prosthesis in 1 or 2 stages for the treatment of glenoid bone loss and rotator cuff insufficiency. Indications for the reverse prosthesis in this series included cuff tear arthropathy and revision arthroplasty. Nine patients were reviewed clinically and radiographically with a minimum 2-year follow-up (range, 24-41 months). Despite a low postoperative functional score (mean Constant score, 53 points [range, 22-79 points]), most patients were satisfied with their results primarily because of pain relief. (The mean pain score increased from 3 points preoperatively to 12.5 points postoperatively.) Radiographic evaluation did not demonstrate component loosening or evidence of graft failure. Six patients had radiographic evidence of an inferior scapular notch, which may be of concern in the future. Early results of this procedure are encouraging, but further clinical and radiologic assessment is necessary.

Aged↗

PubMed2006

Arthroscopic debridement in the treatment of patients with isolated tears of the subscapularis.

PURPOSE: To evaluate the treatment of properly selected patients with isolated subscapularis tears by arthroscopic debridement and release of the long head of the biceps. METHODS: Eleven shoulders that had undergone arthroscopic debridement in the treatment of subscapularis tears were reviewed. In all patients, 3 months of appropriate nonoperative management had been unsuccessful. Patients were selected for arthroscopic debridement if the tear was thought to be irreparable, or if the patient was older and unwilling to participate in the rehabilitation required after repair had been completed. Mean age at surgery was 64 years. The mean time interval from onset of symptoms to surgery was 11 months. Seven tears were traumatic, and 4 were degenerative. Four tears involved the superior third of the subscapularis tendon, 2 involved the superior two thirds of the subscapularis tendon, and 5 were complete tears. Nine shoulders also had dislocation or subluxation of the long head of the biceps tendon; these patients underwent concomitant biceps tenotomy. Patients were evaluated clinically and radiographically at a mean 34-month follow-up (range, 24 to 48 months). RESULTS: The mean Constant score increased from 49 points preoperatively to 80 points postoperatively (P < .0001). Nine patients were satisfied or very satisfied with the results. Preoperatively, 2 patients had mild glenohumeral arthritis. Postoperatively, radiographs demonstrated no progression of arthritis and no new-onset arthritis in these 2 patients. CONCLUSIONS: The combination of arthroscopic debridement and biceps tenotomy in the treatment of subscapularis tears with biceps disease in selected patients yields good objective improvement and a high degree of patient satisfaction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Female↗

PubMed2006

Repair of tears of the subscapularis. Surgical technique.

BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively. RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon. CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.

Humans↗

PubMed2005

The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration.

UNLABELLED: We sought to determine how various types of full-thickness rotator cuff tears, fatty degeneration of the rotator cuff muscles, duration of symptoms, and mechanism of injury affect the sizes of the acromiohumeral and coracohumeral intervals. We studied 206 shoulders with rotator cuff tears that had surgical treatment. The acromiohumeral interval (anteroposterior radiograph) and the coracohumeral interval (computed tomogram) were measured on preoperative imaging studies. An abnormal acromiohumeral interval was associated with multiple-tendon rotator cuff tears involving the infraspinatus, fatty degeneration of the supraspinatus or infraspinatus, and duration of symptoms longer than 5 years. An abnormal coracohumeral interval was associated with a combined tear of the supraspinatus and subscapularis and fatty degeneration of the infraspinatus or subscapularis. Fatty degeneration of the infraspinatus therefore was associated with an abnormal acromiohumeral interval and an abnormal coracohumeral interval. Evaluation of a patient who has a diminished acromiohumeral or coracohumeral interval should involve examination with computed tomography or magnetic resonance imaging of the rotator cuff tendons to determine the type of tear and of the rotator cuff muscles to determine the degree of fatty degeneration. LEVEL OF EVIDENCE: Diagnostic study, Level II-1 (development of diagnostic criteria on basis of consecutive patients--with universally applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.

Acromioclavicular Joint↗

PubMed2005

Repair of tears of the subscapularis.

BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively. RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon. CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.

Adult↗

PubMedDate not supplied

Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases.

The purpose of this study is to evaluate the objective, subjective, and radiographic results of arthroscopic biceps tenotomy in selected patients with rotator cuff tears. Three hundred seven arthroscopic biceps tenotomies were performed in patients with full- thickness rotator cuff tears. Patients were selected for arthroscopic tenotomy if the tear was thought to be irreparable or if the patient was older and not willing to participate in the rehabilitation required after rotator cuff repair. Patients were evaluated clinically and radiographically at a mean of 57 months' follow-up (range, 24-168 months). The mean Constant score increased from 48.4 points preoperatively to 67.6 points postoperatively ( P < .0001). Eighty-seven percent of patients were satisfied or very satisfied with the result. The acromiohumeral interval decreased by a mean of 1.3 mm during the follow-up period and was associated with a longer duration of follow-up ( P < .0001). Preoperatively, 38% of patients had glenohumeral arthritis; postoperatively, 67% of patients had glenohumeral arthritis. Concomitant acromioplasty was statistically associated with better subjective and objective results only in patients with an acromiohumeral distance greater than 6 mm. Fatty infiltration of the rotator cuff musculature had a negative influence on both the functional and radiographic results ( P < .0001). Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long-standing rotator cuff tears.

Acromion↗

PubMedDate not supplied

Glenoid corticocancellous bone grafting after glenoid component removal in the treatment of glenoid loosening.

Nine patients underwent removal of a loose glenoid component and corticocancellous iliac crest autografting of the bony defect. No revision glenoid components were inserted. Eight bony defects were large, central, and cavitary, and one had an additional peripheral component. Patients were evaluated with a subjective assessment, Constant score, and radiographs at a mean follow-up of 30 months (range, 24-39 months). By use of Neer criteria, the result was considered satisfactory in 5 patients and unsatisfactory in 4. Functional improvement was modest, with the mean Constant score increasing from 46.3 to 49.9 points. Radiographs revealed a mean 4.1 mm of medialization of the humeral head within the glenoid (range, 1-11 mm). Two cases showed wear of the bone graft, thought to be induced by eccentric glenoid loading due to rotator cuff insufficiency. No other case demonstrated wear or graft resorption. One patient required reoperation for a massive rotator cuff tear; at the time of surgery, excellent glenoid bone continuity was observed, allowing implantation of a reverse prosthesis. Corticocancellous autografting appears to be a reliable procedure for restoration of glenoid bone stock after removal of a loose glenoid component. Although functional gains were modest, restoration of the glenoid bone component allows implantation if deemed necessary.

Aged↗

PubMedDate not supplied

Prosthetic replacement in the treatment of osteoarthritis of the shoulder: early results of 268 cases.

Two hundred sixty-eight anatomically designed shoulder arthroplasties for primary osteoarthritis were reviewed at a mean follow-up of 30 months. The Constant score adjusted for age and sex was 38% preoperatively and 97% at follow-up. Good or excellent results were observed in 77% of patients, and 94% were satisfied or very satisfied. Mean active forward elevation was 145 degree postoperatively, and all clinical parameters improved. Glenoid radiolucent lines were present in 58% of cases and were associated with a less satisfactory objective result. Postoperative active forward elevation, strength, and Constant score were inversely related to a tear of the supraspinatus or fatty degeneration of the infraspinatus. Patients who underwent biceps tenodesis had better pain relief. Complications occurred in 8.6% of cases, and 4.9% of shoulders required reoperation. Good early results can be obtained with nonconstrained shoulder arthroplasty in primary osteoarthritis.

Adult↗

PubMedDate not supplied

Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult.

Thirteen men with a mean age of 40 years had glenohumeral arthritis and symptoms of stiffness, pain, and locking of the joint at presentation. Provocative test results for anterior or posterior instability were negative. Computed tomography detected posterior humeral head subluxation relative to the glenoid and posterior cartilage wear. All patients demonstrated this posterior subluxation in the absence of posterior glenoid erosion. The mean glenoid retroversion was increased (14.5 degrees ). Increased glenoid retroversion was observed in the contralateral shoulder in 4 cases, and marked static posterior subluxation was noted in the contralateral shoulder in 3 cases. Various surgical procedures were performed in 5 patients to correct this arthrogenic posterior subluxation. Patients who underwent surgery were reviewed at a mean follow-up of 46 months with physical examination and computed tomography. The patients with the longer follow-up showed a progression of arthritis, and all cases showed persistent or recurrent posterior humeral subluxation. Glenohumeral arthritis with static posterior subluxation of the humeral head in the young adult could be the first stage of primary glenohumeral arthritis, predating signs of posterior glenoid erosion. Our attempts to correct this static posterior subluxation failed.

Adult↗