Anatomic Reduction and Next-Generation Fixation Constructs for Arthroscopic Repair of Crescent,L-Shaped,and U-Shaped Rotator Cuff Tears

Emerging techniques and instrumentation have allowed orthopaedic surgeons to achieve rotator cuff repair through an all-arthroscopic technique. The most critical steps in rotator cuff repair consist of proper identification of the cuff tear pattern and anatomic restoration of the torn tendon footprint. With anatomic reduction of the rotator cuff tendons, a sound fixation construct can help restore rotator cuff contact pressure and kinematics, allowing for decreased repair tension and optimal healing potential. We provide surgical methods to recognize tear patterns and present a repair construct that will restore the anatomic footprint of the torn rotator cuff tendon. The key, initial maneuver to restore the anatomic footprint of the cuff includes placement of a suture anchor at the anterolateral corner for L-shaped tears and at the posterolateral corner for reverse L–shaped and U-shaped tears. After insertion of the medial-row anchors, the tendon stitches should be planned by use of a grasper to hold the tendon in a reduced position and guide location of the stitch. The lateral row with suture bridge can be visualized, and the final repair construct should produce an anatomic restoration of the rotator cuff footprint.     

Peroneal tendon injuries: An evaluation of 49 tears in 41 patients

Forty-one patients sustaining 49 tears of the peroneal tendons were evaluated prospectively a minimum of 1 year after surgical treatment. Preoperative and postoperative function and activity were assessed by using the American Orthopedic Foot and Ankle (AOFAS) score. Mean age at the time of surgery was 44.0 +/- 11.7 years. Mean follow-up after the index surgery was 35.5 +/- 22.2 months. There were 17 women and 24 men. One woman had bilateral surgery 1 year apart. There were a total of 18 tears of the peroneus longus tendon; 11 of these were isolated, whereas 7 had a combined tear with peroneus brevis. There 31 peroneus brevis tears; 24 of these were isolated and 7 were combined. Using 3-way analysis of variance, there were no significant differences in return to activity or postoperative AOFAS scores among those with a longus, brevis, or combined tear. The mean return to activity for peroneus longus, peroneus brevis, and combined tears were 3.2, 3.6, and 3.7 months, respectively. The mean postoperative AOFAS scores were 90.6, 90.8, and 84.3 respectively. The mean preoperative AOFAS score was 52.0 +/- 16.8. The mean postoperative score was 89.7 +/- 10.3 (P <.00001). Using this scoring system, there were 24 excellent, 12 good, 4 fair, and 2 poor scores. Three patients underwent additional surgery. Fourteen of 16 athletes returned to full sporting level. The average return to activity for the entire group was 3.49 +/- 1.15 months.     

A new test of resistance in the diagnosis of postero-superior rotator cuff tears

The aim of this study was to assess the diagnostic accuracy of a new clinical test for the diagnosis of subacromial impingement and full thickness postero-superior rotator cuff tears. One hundred and twenty patients who underwent arthroscopic treatment for acromioplasty or cuff repair were previously submitted to a new test of resistance. The test is performed in the standing position with the involved arm in 90° abduction, 20°–30° anteposition and in external rotation (as for full-can test). Thus, the patient was invited to follow the way of a spiral drawn on a drawing sheet for 20 turns; 1 turn = from the centre to the end of the spiral and vice versa (spiral width = 20 cm). The test was considered positive when the patient was not able to conclude it due to strength decrease or to shoulder pain. Sensitivity, specificity, positive and negative predictive values as well as diagnostic accuracy were calculated for our test of resistance. The test resulted scarcely reliable as detector of subacromial impingement and not very reliable as detector of small tear. When the test is positive there is a high probability that a subacromial disease exists; instead, when it is negative there is a high probability that the patient has not a large or massive cuff tear. The resistance test (Gum-Turn test) adds to our armamentarium of physical examination signs in patients with painful shoulder and furnishes further information on possible dimensions of tendinous tear.     

关节镜下巨大肩袖撕裂边缘切除及肱骨结节成形术简

目的探讨无法缝合的高龄巨大肩袖撕裂在关节镜下行肩袖边缘切除及肱骨结节成形术后的疗效。方法查阅文献并整理相关巨大肩袖损伤关节镜下手术方法及疗效,特别是检索国内外针对高龄患者且无法缝合的巨大肩袖撕裂,整理发表的关节镜下行肩袖边缘切除及肱骨结节成形术后疗效方面的论文资料。同时,结合笔者几年来肩关节镜手术中遇到的几乎不能进行肩袖缝合,而行切除退缩撕裂边缘及肱骨结节成形术的32例高龄肩关节镜病例为对象,实施临床及放射线随访分析其预后及影响因素。结果平均随访29个月（13～52个月）,结果表明,具有统计学意义的疼痛缓解、增加活动范围等功能得到改善。而术前肩峰下间隙小于2mm组,其预后不良。结论关节镜下处理巨大肩袖撕裂,首先游离松解撕裂退缩的组织后尝试缝合修补,而对于无法缝合的巨大肩袖撕裂,不必勉强缝合。如果术前虽有疼痛,但上臂能上举90°以上。放射线检查肩峰下间隙大于2mm时,考虑行包括肩峰下成形、肩袖撕裂边缘切除及肱骨结节成形术,也可以获得满意的效果。     

Current concepts on meniscal repairs

The specific meniscus injury pattern were divided into many patterns. Nowadays, the meniscus root injury, radial tear meniscus, bucket handle tear meniscus and Ramp lesion were particularly focused on many way to manage and still controversial a lot of issues. Meniscus root tears (MRTs) and Ramp lesion are the most ignored, or misdiagnosed causes of chronic knee pain. Most patients delayed seeking treatment, consequently resulting in cartilage loss, and leading to the condition progressing to osteoarthritis knee. This has resulted in the rate of MR and Ramp repair increase significantly. The bucket handle meniscus tear trend to strong saving the anatomical meniscus and avoid to menisectomy. This article, on the other hand, will reveal you how to save and secure a nearly native meniscus fixation. In case of the radial meniscus, the partial meniscectomy is still used to treat this type of injury today, but it does not prevent degenerative changes from occurring, which can lead to unfavorable outcomes. Meniscal repair is a popular procedure for treating radial tears as an alternative to surgery. However, this pattern of meniscus tear can be difficult to repair and has a high failure rate, the arthroscopic meniscus repair techniques are published.     

Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears

Traditional open repair of traumatic triangular fibrocartilage complex (TFCC) tears requires a relatively extensive exposure, and arthroscopic repair, though conceptually simple, can be technically demanding. We describe a mini-open suture anchor technique that, while minimally invasive, is easier to perform than previously described open or arthroscopic techniques. Results achieved using this technique in eight cases compare favourably with those reported for other techniques.     

Strain distribution due to propagation of tears in the anterior supraspinatus tendon

Rotator cuff tears are a significant clinical problem. Tears in the anterior supraspinatus might behave differently compared to central tears due to differences in regional structural properties. The objective of this study was to determine strain distributions for anterior supraspinatus tendon tears and the relationship to tear propagation during cyclic loading. It was hypothesized that highest maximum principal strain would be posterior to the tear, and tears would propagate in the direction of the maximum principal strain. Eight human cadaveric supraspinatus tendons with surgically created small tears in the anterior third were tested with increasing levels of cyclic loads. The position of strain markers was recorded on the bursal surface of the tendon to calculate strain. Tendons reached a 2 cm critical tendon retraction at 580 ± 181 N. Largest strains were found medial and posterior to the tear (26.1 ± 9.4%). In five tendons, the strain direction for the initial (114 ± 28°) and final loading sets (86 ± 20°) indicated the strain direction shifted from an anterior to posterior orientation (p < 0.01), corresponding to the direction of tear propagation. Based on the results, anterior supraspinatus tears would remain isolated to the supraspinatus tendon during activities of daily living. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1283–1289, 2014.