Editorial Commentary: Repair of Lateral Ankle Ligament: Is Arthroscopic Technique the Next Station?

Arthroscopic lateral ankle ligament repair (ALALR) is safe and effective, yet a review of the current literature does not show the superiority of ALALR over the open technique. ALALR is a relatively new procedure, and, in the future, it is likely that arthroscopic rather than open lateral ankle ligament repair will become the standard of care.     

Prevalence and Clinical Impact of Acromial Cupping after Arthroscopic Rotator Cuff Repair: Does Acromioplasty Matter?

BackgroundAlthough the effectiveness of acromioplasty is controversial, it is commonly performed during rotator cuff repair to reduce external impingement. During follow-up, osteolysis under the acromion (acromial cupping) could be observed. However, this phenomenon has been rarely addressed in the literature. The purpose of this study was to compare the prevalence and severity of acromial cupping after rotator cuff repair depending on the concomitant performance of acromioplasty and evaluate the influence of acromial cupping on clinical and radiological outcome.MethodsThis is a retrospective study involving patients who underwent arthroscopic rotator cuff repair for small-to-large full-thickness rotator cuff tears from October 2015 to March 2019 and clinical follow-up and magnetic resonance imaging at least 1 year postoperatively. A total of 110 patients were enrolled and divided into two groups depending on whether acromioplasty had been performed (group A) or not (group N). The prevalence of acromial cupping was evaluated in each group. In addition, we stratified patients according to the severity of acromial cupping to investigate its influence on healing and functional scores (visual analog scale [VAS], American Shoulder and Elbow Surgeons [ASES] score, simple shoulder test [SST], and Constant-Murley score).ResultsThere were 85 patients in group A and 25 patients in group N. The prevalence of acromial cupping and acromial cysts was as follows: 36.4% (40 patients) and 6.4% (7 patients), respectively, in the total subjects; 43.5% (37/85) and 5.9% (5/85), respectively, in group A; and 12.0% (3/25) and 8.0% (2/25), respectively, in group N. The prevalence of acromial cupping was significantly different between the two groups (p = 0.012). However, functional outcomes were not significantly different between groups stratified by the severity of acromial cupping (VAS, p = 0.464; ASES score, p = 0.902; SST, p = 0.816; and Constant-Murley score, p = 0.117). The difference in healing rate was statistically insignificant between groups (p = 0.726).ConclusionsThe incidence and severity of acromial cupping were significantly greater in patients who underwent rotator cuff repair with acromioplasty. It was a relatively common phenomenon, especially after acromioplasty. However, neither the existence nor the severity of acromial cupping affected functional outcomes or healing.     

Editorial Commentary: Is Arthroscopic Bankart Repair Using Suture Anchors on the Glenoid Appropriate Treatment for Traumatic Anterior Shoulder Instability?

Fracture of the anterior glenoid rim along the sites of suture anchor insertion is not rare after arthroscopic Bankart repair for traumatic anterior shoulder instability. In addition to the influence of the number, type, and size of the suture anchors, placing multiple anchors in a linear arrangement might impose excessive stress on the surrounding bone, leading to critical loss of osseous integrity and glenoid fracture. Although highly active young male collision or contact athletes are most at risk, such fractures sometimes occur after relatively minor trauma at a long interval after surgery, suggesting persistent impairment of bone quality. In patients with postoperative recurrence of instability, detailed examination using computed tomography is recommended.     

Editorial Commentary: Taking a “PEEK” at Suture Anchor Composition following Arthroscopic Rotator Cuff Repair: Is Bio Really Better?

The advent of modern suture anchor technology has not only revolutionized arthroscopic treatment options for management of complex shoulder pathology, but also engendered a materials science quest to identify the ultimate composition and design. What began as an open procedure with transosseous suture fixation has evolved dramatically with the widespread adoption of an arthroscopic, anchor-based technique for rotator cuff repair. Currently, a litany of commercially available “hard” and “soft” anchors are flooding the market, with limited qualitative comparisons to suggest superiority of one type. Ideally, suture anchor design should permit preservation of native glenohumeral bone stock with gradual osseointegration, limit disruption of local tissue homeostasis, and maintain time-zero mechanical strength until soft-tissue healing has occurred. At present, a vented, open-anchor architecture may facilitate better biologic incorporation with increased bony ingrowth through access to marrow elements, although these radiographic advantages have not conferred any clinically meaningful differences for our rotator cuff repair patients. For anchor composition, the jury is still out, and we need to continue to critically evaluate for perianchor cyst formation and longer term remodeling. In fact, the true merits of increased bony ingrowth and limited osteolysis may only be realized at the time of revision rotator cuff repair, during which prior implant position or secondary cystic change may further dictate suture anchor design, size, and placement.     

Editorial Commentary: Arthroscopic Subscapularis Repair: Are We Any Further Forward?

Arthroscopic repair is a well-established treatment option for tears of the subscapularis tendon. However, it is clear that to further our understanding, additional study is required to more clearly define the influence of tear morphology, repair type, and associated pathologies and procedures on outcomes. It should be noted that there is rather sparse literature reporting long-term outcomes—10 years or more—after surgery. Future studies should focus on these aspects and use validated and widely used outcome measures to detect important differences and allow comparison with previous studies.     

The “All-Inside” Arthroscopic Broström Procedure Augmented With a Proximal Suture Anchor: An Innovative Technique

Arthroscopic treatments of chronic lateral ankle stability have been reported in the literature. The authors report on an innovative technique augmenting the “All- Inside” Arthroscopic Broström procedure with an additional suture anchor.     

Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear?

BackgroundThe aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair.MethodsPatients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated.ResultsWhile 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2.ConclusionAlthough there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better.Level of EvidenceRetrospective comparative study, Level III.