An analysis of outcome of arthroscopic versus mini-open rotator cuff repair using subjective and objective scoring tools

The purpose is to perform a comparative analysis of mini-open and arthroscopic rotator cuff repairs through the use of subjective and objective scoring tools. We conducted a prospective comparative cohort study that evaluated 123 consecutive patients who underwent rotator cuff repairs (arthroscopic and 31 mini-open repair). Subjective and objective functional assessment was performed preoperatively and postoperatively at 3, 6, 12, 18 and 24 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Oxford Shoulder Score (OSS) and the Constant–Murley score. Statistical analysis was performed on the datasets assessing the Pearson correlation coefficients and any significant differences present at each respective time point. At every time point the arthroscopic group scored better than the mini-open group, regardless of the assessment tool employed. The percentage recovery from the baseline measured at 1 year was similar with either treatment option. A significant difference was found between the arthroscopic and mini-open groups for the Constant–Murley, DASH and OSS scoring systems preoperatively (P < 0.05), reflecting a difference in tear severity. Arthroscopic rotator cuff repair is comparable with the mini-open technique with well correlated postoperative rates recovery. Subjective scoring provides an accurate and potentially easier method of postoperative assessment for long-term follow-up of rotator cuff repairs.     

5-year results of the 1.5 cm incision Achilles tendon repair

BackgroundTo study a hypothesis that the cost-effective 1.5 cm medial incision Achilles tendon repair technique will provide good functional outcomes which are maintained for over 5 years.MethodProspective study of 12 consecutive cases with a minimal 5-year follow-up were recruited from April 2008 to November 2010. Cases whom were mentally incompetent or those which required concomitant procedures were excluded. Outcomes measures included the numeric pain rating scale, motor power strength, range of motion, functional scoring using the AOFAS hindfoot score and patient’s self-assessment using the Foot and Ankle Outcome Score (FAOS).ResultNo re-ruptures or sural nerve injured were identified after a minimal 5-year follow-up. Pain was minimal at 0.5/10, calf power was 5/5 and ankle range was good (plantarflexion: 38°/dorsiflexion: 21°). The AOFAS hindfoot score was 97.4 and all 5 sub-categories of the Foot and Ankle Outcome Score (FAOS) were good.ConclusionThe 1.5 cm medial incision repair of the Achilles tendon is an economically sound surgical technique, with minimal complications, which gives good medium length functional outcomes.Level of evidenceIV.     

微创减压联合经皮固定与传统开放手术治疗伴神经损害胸腰椎骨折的疗效比较

目的 :比较后路微创小切口减压联合经皮椎弓根螺钉复位内固定术与传统开放减压复位内固定术治疗伴神经功能损伤胸腰椎骨折的疗效。方法:我院自2011年12月~2014年6月收治56例伴神经功能损伤的胸腰椎骨折患者,分别采用后路小切口微创减压联合经皮椎弓根螺钉复位内固定术(26例,微创组)和传统开放后路减压椎弓根螺钉复位内固定术(30例,开放组),回顾性分析两组患者围手术期相关指标、影像学指标、术后神经功能恢复情况及并发症发生率并进行比较。结果:微创组手术切口肌肉剥离长度为7.46±2.67cm,术中出血量为271.54±125.53ml,术后引流量为74.50±73.58ml,输血比例为9/26,术后住院时间为19.19±10.66d,术后1周伤口疼痛视觉模拟评分(visual analogue scale VAS)为2.54±0.65分,术后止痛药使用比例为11/26;开放组分别为12.17±4.38cm,536.67±453.52ml,310.97±209.65ml,19/30,31.17±26.92d,3.60±0.77分和21/30,两组间比较有显著性差异(P0.05);微创组手术时间(222.88±64.41min)与开放组(190.83±83.19min)无显著性差异(P0.05)。微创组手术前、后矢状面Cobb角为10.51°±16.12°、0.70°±12.97°,伤椎椎体前缘高度百分比为(52.27±8.34)%、(86.64±12.80)%,矢状面指数为14.63°±10.29°、7.43°±6.79°,伤椎楔变角为13.45°±7.40°、4.07°±4.81°;开放组分别为15.04°±9.84°、2.96°±9.84°,(48.58±11.48)%、(86.63±9.76)%,20.67°±17.58°、7.38°±5.63°,14.16°±6.77°、4.26°±4.39°,两组术后影像学指标均较术前明显改善(P0.05),两组影像学指标改善程度(术后-术前)相当(P0.05)。后期随访两组神经功能恢复情况和并发症发生率均无显著性差异(P0.05)。结论:后路微创小切口减压联合经皮椎弓根螺钉内固定术治疗伴神经功能损伤的胸腰椎骨折具有与传统开放手术同样的效果,且具有切口小、出血少、住院时间短、伤口疼痛轻等优点。     

Clinical and radiological outcome after mini-open Latarjet technique with fixation of coracoid with Arthrex wedge mini-plate

BackgroundTechnical faults leading to coracoid fractures during screw insertion and coracoid graft osteolysis are concerns with standard screw fixation techniques in Latarjet procedure. The purpose of this study is to share our experience using Arthrex wedge profile plate with mini-open technique for graft fixation, that ensures better load distribution between coracoid graft and glenoid.MethodsWe did retrospective analysis of 24 patients with recurrent anterior shoulder instability after failed arthroscopic Bankart's repair. Arthroscopic examination of affected shoulder was done in lateral position before making patient supine for open Latarjet. A low profile wedge plate (Arthrex) with two screws was used for the procedure. CT analysis was performed post-operatively at 6 months to see graft union and results were evaluated using the Rowe and Walch Duplay score.ResultsMean follow-up time was 26 months. Postoperatively, mean forward elevation was 170.6 + 4.6° (loss of average 5.9°) and mean external rotation was 42.5 + 5.3° (loss of average 3.1°). All patients returned to their previous occupation. None reported to be having any recurrent subluxation. Functional assessment done using Rowe score and Walch Duplay score showed statistically significant improvement (p value 0.034). There were no implant-related complications and no case of coracoid graft osteolysis.ConclusionsMini-open Latarjet with graft fixation with Arthrex mini-plate provides satisfactory outcome in patients who require reoperation due to dramatic bone loss and failed soft tissue reconstruction. The modified incision improves exposure enabling plate fixation and the secure fixation accelerates rehabilitation.     

微创前路钢板内固定技术治疗不稳定性骨盆骨折

目的探讨应用微创前路钢板固定技术在治疗不稳定骨盆骨折中的应用,并评价其疗效。方法 2009年2月~2016年8月收治20例骨盆骨折的患者,其中男性9例,女性11例,平均年龄38.5岁,按照Tile分型,B型11例,C型9例;骨盆前环损伤类型,单侧耻骨支损伤11例,双侧耻骨支损伤9例;后环损伤类型,骶骨骨折6例,骶髂关节分离8例。骨盆前环骨折采用前路微创双切口髂腰肌下入路钢板固定,合并后环骨折的患者采用骶髂螺钉或钢板固定骶髂关节骨折脱位,并记录术中出血量和手术时间,术后应用Matta标准和Majeed评分系统对骨盆复位和功能恢复进行评价。结果20例患者均获得随访,平均26个月,手术切口一期愈合,前环骨折平均手术时间1h,出血215 m L,没有出现切口感染和神经血管损伤的手术并发症,骨折愈合时间在11周~14.5周,术后骨折复位Matta标准:优17例,良2例,一般1例。术后末次随访时Majeed功能评分:优15例,良3例,一般2例,优良率90%。1例Tile C型骨盆骨折的患者,术前合并骶丛神经损伤,术后骶丛神经没有完全恢复,遗留感觉部分障碍和跛行步态。结论对于不稳定骨盆骨折的患者采用微创髂腰肌下通道入路钢板治疗,重建骨盆前环,具有创伤小,不需显露股神经和血管等结构,手术时间短,出血少,临床疗效满意和手术安全的特点。     

全肩关节镜与关节镜辅助下小切口治疗肩袖损伤的Meta分析

目的采用Meta分析方法比较全肩关节镜与关节镜辅助下小切口治疗肩袖损伤的临床疗效。方法计算机检索MEDLINE（1966.6～2008.12）、EMbase（1966.6～2008.12）、Cochrane图书馆（2008年第2期）、Cochrane协作网肌骨创伤组试验数据库（2008年第2期）和中国生物医学文献数据库（1979.6～2008.12）,手工检索近5年国内已发表的有关骨科论文及会议资料。收集所有随机对照试验（RCT）及非随机对照试验,评价纳入研究的方法学质量后,采用Cochrane协作网提供的RevMan4.2.8软件进行Meta分析。结果未检索到RCT,共纳入12个非随机对照试验。Meta分析结果显示：与小切口组相比,全肩关节镜组手术治疗肩袖损伤术后疼痛较轻,其差异有统计学意义[RR=0.94,95%CI（0.28,1.60）];但在肩关节活动范围-前屈[RR=0.17,95%CI（–0.10,0.45）]、肩关节功能评分[RR=0.04,95%CI（–0.10,0.19）]、病人满意度[RR=1.03,95%CI（0.98,1.08）]及术后并发症[RR=1.11,95%CI（0.54,2.27）]等方面,两组疗效差异无统计学意义。结论与关节镜辅助下小切口手术相比,全肩关节镜手术治疗肩袖损伤术后疼痛较轻,而两种治疗方法在肩关节活动范围、肩关节功能评分、病人满意度及术后并发症方面,疗效基本相同。     

Role of biomechanical assessment in rotator cuff tear repair: Arthroscopic vs mini-open approach

BACKGROUNDRotator cuff (RC) tears are one of the most frequent pathologies within the shoulder girdle. Hand dominance and older age are associated with RC tears. Two different surgical procedures, the mini-open (MO) and all-arthroscopic (AA) approach, represented the standard of treatment.AIMTo compare the clinical and biomechanical outcomes of two surgical techniques (AA vs MO procedure) performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODSEighty-eight participants, 50 following RC repair with AA and 38 with MO approach, were recruited in the present cross-sectional case-control study (ORTHO-SHOULDER, Prot. 0054602). All patients underwent postoperative clinical evaluation for pain (Visual analogic scale), impairment, and disability (disability of the arm, shoulder, and hand) and limitation in daily activity (Constant-Murley score). Patients’ shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal (abduction/adduction) and sagittal (flexion-extension) planes.RESULTSNo statistically significant differences between the two procedures were observed in either main clinical score or range of motion. A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSIONIn terms of clinical scores, our findings were in line with previous results. However, the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.     

Arthroscopic versus mini-open rotator cuff repair: A meta-analysis

BackgroundAn all-arthroscopic rotator cuff repair (ASR) may result in less postoperative pain and better functional outcomes than the mini-open (MOR) approach. This meta-analysis provides an updated assessment of the current literature which compares the clinical outcomes of mini-open versus all arthroscopic rotator cuff repair techniques.Material and methodsThe main online databases were accessed in October 2021. All the trials directly comparing primary ASR versus MOR for rotator cuff rupture were accessed. Studies concerning revision settings were not eligible, nor where those combining the surgical procedures with other adjuvants.ResultsA total of 21 articles were retrieved. Data from 1644 procedures (ASR = 995, MOR = 649) were collected. The mean follow-up was 26.7 (6.0–56.4) months. Comparability was found between ASR and MOR groups at baseline with regards to age (P = 0.3), gender (P = 0.7) and mean duration of the follow-up (P = 0.7). No difference was found between ASR and MOR with regard to surgical duration (P = 0.05), Constant score (P = 0.2), University of California at Los Angeles Shoulder (P = 0.3), American Shoulder and Elbow Surgeons Shoulder (P = 0.5), VAS (P = 0.2), forward flexion (P = 0.3), abduction (P = 0.3), external rotation (P = 0.2), internal rotation (P = 0.7), re-tear (P = 0.9), adhesive capsulitis (P = 0.5).ConclusionArthroscopic and mini-open rotator cuff repair result in similar clinical outcomes. Male gender and older age lead to greater rates of rotator cuff re-tears, while longer surgical duration was associated with a greater rate of adhesive capsulitis.