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At least 469 records · Page 26Linked to original sources
PubMed2004

Rupture of the biceps tendon after arthroscopic thermal capsulorrhaphy.

The use of thermal energy in the shoulder to tighten capsular tissues through collagen denaturation is well established. Although reported complication rates are low, the natural history of thermal manipulation to both target and collateral tissue is poorly defined. We report two cases of biceps tendon rupture after arthroscopic capsular shrinkage. Both patients were young, athletic men with normal long head biceps tendons at the time of surgery. Each patient experienced a complete tear of the long head with distal muscle retraction, resulting in a "Popeye" deformity, at 3 months postoperatively. One patient elected further surgery with biceps tenodesis. Both patients have returned to their athletic activities with minimal functional deficits.

Adolescent↗
PubMed2004

How to use cuff suture instruments: the concept of "concave in and concave out".

Arthroscopic reconstructive surgery of the shoulder is extremely demanding. The advent of suture anchors and knot-tying instruments has greatly facilitated its development. Knowledge of the anatomy and surgical principles alone is not enough. Familiarity with specific instruments is also important. We describe our experience with the Elite Cuff Stitch Suture Relay (Smith & Nephew, London, U.K.). We describe a new concept on how to use this suture passer or similar instrument. We advocate this new concept of "concave in and concave out."

Arthroscopy↗
PubMed2004

Arthroscopic rotator interval repair: the three-step all-inside technique.

Many clinical reports have emphasized the importance of rotator interval lesions in patients with glenohumeral instability, and many investigators have described open repair techniques, either as a supplement to other capsule reconstruction or as an isolated procedure. In this article, an original arthroscopic technique for rotator interval closure is described. This technique allows the operator to accurately manage the degree of tightening of the rotator interval, the knot tying, and the suture cutting, under direct intra-articular arthroscopic vision.

Arthroscopy↗
PubMed2004

Arthroscopic humeral avulsion of the glenohumeral ligaments (HAGL) repair.

Humeral avulsion of the glenohumeral ligaments (HAGL lesion) is one of the pathologic lesions that occurs secondary to anterior glenohumeral instability. Although HAGL lesions occur less commonly than Bankart lesions in cases of anterior instability, it is necessary to understand this pathology and to make the necessary repair. An all-arthroscopic technique using suture anchors can be used to repair HAGL lesions, but it is a difficult and demanding technique. To facilitate this type of repair, the surgeon must be: (1) comfortable with both the 30 degrees and 70 degrees arthroscopes, (2) able to establish and use the 5-o'clock portal, (3) able to abduct and externally rotate the arm, and (4) able to ensure secure fixation of the glenohumeral ligaments to bone through adequate knot and loop security.

Acute Disease↗
PubMed2004

Arthroscopic removal of bullet fragments from the subacromial space of the shoulder.

This article describes a case of arthroscopic removal of a bullet fragment from the subacromial space. The bullet tore the rotator cuff and imbedded itself on the inferior surface of the acromion, producing pain and impingement. The bullet was removed, and the rotator cuff repaired arthroscopically. The patient noted complete relief of pain and improved range of motion.

Acromion↗
PubMed2004

An arthroscopic stitch for massive rotator cuff tears: the Mac stitch.

Arthroscopic repair of rotator cuff tears has become popular with the advancement in technology and arthroscopic technique. As we attempt to arthroscopically repair larger rotator cuff tears, we are relying more on tissue fixation. The tendon-suture interface has been recognized as the weak link in rotator cuff repair. In this article, we propose the use of the Mac stitch--a simple modification of suture placement, a combination of a horizontal and vertical loop at the site of repair--to increase the strength of tissue fixation. The Mac stitch is a simple arthroscopic stitch that can be used for small and massive rotator cuff repairs.

Arthroscopy↗
PubMed2004

Margin convergence of the posterior rotator cuff to the biceps tendon.

Massive rotator cuff tears can often be repaired arthroscopically with satisfactory results. Tear pattern recognition, knot security, and loop security are essential in the repair of large and massive rotator cuff tears. In the case of a massive U-shaped tear, with a contracted immobile supraspinatus and a deficient rotator interval, a type of margin convergence technique can be used. This technique allows for the partial closure of the rotator cuff defect along with the proximal advancement of the posterior cuff by securing the posterior leaf of the cuff tendon to the tendon of the long head of the biceps brachii. Because of the mechanical effect of strain reduction in margin convergence, this procedure decreases the strain at the margin of the posterior cuff, thereby protecting its repair to bone. Our goal with this procedure is not to obtain healing of the cuff to the biceps, but to optimize the conditions for healing of the rotator cuff to bone.

Arthroscopy↗
PubMed2004

The keeled acromion: an aggressive acromial variant--a series of 20 patients with associated rotator cuff tears.

This study describes our experience with an unusual type of acromial spur. In the last 7 years, we have treated 20 patients with a previously undescribed "keeled" acromion. The keel refers to a central, longitudinal, downward sloping spur on the acromial undersurface. Patients with a keeled acromion are at significant risk of bursal-sided as well as full-thickness rotator cuff tears. All patients in this series had significant bursal-sided tears, and 12 of 20 patients (60%) had full-thickness rotator cuff tears associated with an acromial "keel." In addition, patients with a keeled acromion are younger (average age, 52.7 years) than would be expected for patients with rotator cuff disease. Often these patients are misdiagnosed, and effective treatment is delayed. Diagnosis of a keeled acromion relies on a high level of suspicion, as well as knowledge of clinical and radiographic signs consistent with an acromial keel. We discuss the clinical presentation, radiographic findings, associated rotator cuff pathology, as well as methods to avoid intraoperative technical errors when treating patients with an acromial keel. The goal is to raise awareness of this relatively uncommon but clinically important entity and to help guide the treating surgeon's therapeutic measures.

Acromion↗
PubMed2004

Preliminary experience of fully arthroscopic repair of triangular fibrocartilage complex lesions.

Triangular fibrocartilage complex (TFCC) lesions are commonly repaired arthroscopically. Most of the interest in repairing TFCC lesions is focused on the development of an internal technique to avoid an extra incision of the skin. The most common techniques in use today are the inside-out or the outside-in, both of which have the disadvantage of requiring an additional opening to tie the suture. We suggest a personal method that allows an all-inside repair for type 1B lesions with a technique similar to the one used for rotator cuff repair in the shoulder.

Adult↗
PubMed2004

Identification of essential anatomic landmarks in performing arthroscopic single- and double-interval slides.

Contracted and immobile massive rotator cuff tears, which represent a small percentage of all massive tears, are believed by many to be irreparable. The development of arthroscopic single- and double-interval slides has allowed for the successful anatomic and tension-free repair of the majority of contracted and immobile massive rotator cuff tears. However, the safe and effective performance of interval slides requires clear and precise identification of certain anatomic landmarks, specifically the scapular spine and the base of the coracoid. This report describes how to arthroscopically identify and expose these anatomic landmarks.

Arthroscopy↗
PubMed2004

Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique.

In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.

Arthroscopy↗
PubMed2004

Bursoscopic evaluation for degree of rotator cuff tear using an air-infusion method.

This article presents a method of bursoscopic examination with use of a glenohumeral air-infusion technique for the detection of full-thickness tears hidden by bursal tissue. We inflated the glenohumeral joint with 50 to 60 mL of air while simultaneously observing the joint with bursoscopy for the detection of air bubble leakage. The air-infusion technique is valuable in detecting full-thickness tears and useful for evaluating the patency of repair.

Air↗
PubMed2005

Salvage rotator cuff repair using a biotenodesis screw.

Rotator cuff tear fixation can be difficult when humeral head bone stock is poor as a result of osteopenia or osteoporosis. This technical note describes biotenodesis screw use to achieve effective fixation after 2 previous attempts at implanting suture anchors failed.

Bone Screws↗
PubMed2005

Arthroscopic rotator cuff repair in patients older than 60 years.

PURPOSE: The purpose of this study was to analyze results by age, tear size, and type of suture repair (margin convergence by side-to-side suture, direct tendon-to-bone repair with suture anchor, or side-to-side plus suture anchor) of arthroscopic rotator cuff repair in patients older than 60 years (average, 67.7 years). TYPE OF STUDY: Retrospective case series. METHODS: From January 1999 to January 2001, 64 patients (64 shoulders) older than 60 years had an arthroscopic rotator cuff repair performed by the same surgical team. Fifty-four patients (84.3%) were available for follow-up (average, 27 months); 54 shoulders were evaluated using the UCLA rating scale (0-35 points). Tears were categorized according to size. The pattern of tears determined the repair technique: crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears by margin convergence with or without suture anchor. RESULTS: The mean of postoperative UCLA score improved from 10.4 (range, 8.2-20 points) to 30.5 (range, 21-35 points) (P < .0001). Sixteen patients (29.6%) had excellent results (34-35 points), 28 (51.8%) had good results (28-33 points), 10 (18.5%) had fair results (21-27 points), and none had poor results. There were no statistical differences between postoperative UCLA score and groups by age (P = .53), suture technique (P = .06), and tear size (P = .5). The correlation between technique of repair, age, and postoperative score has not shown statistical differences between margin convergence with or without suture anchor and direct tendon-to-bone repair with suture anchor in the 61- to 65-year-old patients. Patients older than 65 years achieved the best results with margin convergence by side-to-side suture. CONCLUSIONS: Arthroscopic rotator cuff repair in the elderly achieves satisfactory results in a large percentage of cases regardless of the patient's age, tear size, and type of suture repair. These results are comparable to those of traditional open repair. We believe that arthroscopic evaluation allows an accurate assessment of rotator cuff tear configuration resulting in a more precise repair. LEVEL OF EVIDENCE: Level IV, case series (no, or historical, control group).

Age Factors↗
PubMed2005

Biomechanical comparison of bioabsorbable sutureless screw anchor versus suture anchor fixation for rotator cuff repair.

PURPOSE: Anchors that directly fix the rotator cuff to bone without using sutures may simplify the challenges associated with arthroscopic rotator cuff repair. This study compared a bioabsorbable screw fixation device to a standard suture anchor fixation method. TYPE OF STUDY: Randomized trial. METHODS: A poly-L-lactide acid (PLLA), bioabsorbable screw anchor was compared with a metallic suture anchor loaded with No. 2 braided polyester suture in 12-week-old fresh-frozen bovine shoulders. Twelve specimens were randomly assigned to the 2 repair groups (6 per group). A 1 x 2-cm defect was created at the insertion site of the infraspinatus tendon. Two anchors were implanted 1 cm apart in the anatomic insertional area of the infraspinatus tendon. After preconditioning to 10 N, each construct was cycled between 10 and 180 N for up to a maximum of 2,500 cycles at a rate of 33 mm/second using a materials testing machine. The number of cycles to 5- and 10-mm gap formation at the repair site and mode of failure were recorded. Clinically, 10-mm gap formation defines complete fixation failure. Data were evaluated using an analysis of variance with significance set at P < .05. RESULTS: Mattress suture fixation had significantly higher number of cycles to 10-mm failure compared with the PLLA device (P = .015). Failure occurred by tissue pullout in half the specimens and by device failure in the other half, without differences in failure modalities between groups. CONCLUSIONS: This anchor provides low-profile fixation of the rotator cuff and eliminates suture placement and knot tying during arthroscopic and mini-open cuff repair. However, these data suggest that this anchor may not perform adequately under cyclic loading conditions in patients during postoperative rehabilitation. CLINICAL RELEVANCE: This bioabsorbable anchor may not provide sufficient fixation for rotator cuff repair in humans.

Absorbable Implants↗
PubMed2005

Panacryl synovitis: fact or fiction?

PURPOSE: It has been suggested from anecdotal experience that Panacryl suture (Ethicon, Johnson & Johnson, Westwood, MA) may be responsible for an exaggerated inflammatory response. Our goal was to test the null hypothesis that Panacryl causes aseptic synovitis when used on anchors in the case of arthroscopic Bankart and rotator cuff repair. TYPE OF STUDY: Retrospective review of the postoperative outcome, specifically looking for clinical criteria that are associated with aseptic synovitis. METHODS: Eighty-three arthroscopic Bankart and 33 arthroscopic rotator cuff repairs were performed using anchors loaded with Panacryl. The clinical factors associated with synovitis that we assessed were motion, pain, hyperthermia, and swelling. RESULTS: There was no hyperthermia. Two patients had transient swelling and 10 patients had initial transient postoperative pain. One patient had chronic pain and a second arthroscopy was performed 5 months after the initial procedure, which revealed obvious synovitis. Biopsy examinations were performed and these showed typical foreign-body reaction. Two anterior redislocations occurred after new traumas, 2 failed rotator cuff repairs were observed, due to early active motion, and 2 underwent an open revision repair; synovitis was not observed in any of these cases. After 6 months, the loss of external rotation was a mean of 6.7 degrees (Bankart) and 3.3 degrees (rotator cuff repair). The loss of forward elevation was a mean of 5.8 degrees (Bankart) and of 3.3 degrees (rotator cuff repair). CONCLUSIONS: In only 1 of 116 cases of arthroscopic repair was there direct evidence of synovitis. Even in the cases undergoing revision surgery, there was no indication that Panacryl caused aseptic synovitis. Clinical course after these repairs appeared to be similar to historical experience using nonabsorbable braided suture material. Failure rates in each series appeared to be more related to new trauma and use of other implants than to Panacryl suture. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed2005

Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions.

Chronic painful shoulder is a common complaint, yet its initial pathogenesis may have multiple etiologies as well as multiple and perhaps distinct primary or secondary etiologies responsible for its final clinical presentation. While the clinical presentation of pain and limitation of motion is easily defined, there are no standardized criteria for the differential diagnosis of various chronic shoulder pain syndromes, much less a consensus on their treatment. At present, there are limited nonsurgical options and medications approved for the treatment of chronic painful shoulder, and, with limited exceptions, there are no definitive conclusions about the efficacy of these therapies based on controlled clinical studies reported in the literature. There is a clear clinical need for local nonsurgical treatments that are safe and effective for chronic painful conditions. In this article, an attempt is made to review the diagnoses associated with chronic shoulder pain and some of the limited data that exist so as to suggest a therapeutic algorithm.

Algorithms↗