scholarly journals Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athletes: 5- to 12-Year Follow-up

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774453 ◽  
Author(s):  
Yusuke Ueda ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Osteochondritis Dissecans ◽  
Functional Outcomes ◽  
Case Series ◽  
Skeletally Immature ◽  
Patient Satisfaction Scores ◽  
Functional Scores ◽  
Group 2 ◽  
Group 1

Background: Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial. Purpose: To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups. Results: All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 ( P = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; P = .002). Extension ROM showed significant improvement in both groups (group 1: from –8° to 3°; group 2: from –17° to –1°; P < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups ( P = .005). Conclusion: Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions.

Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

2020 ◽  
Author(s):  
Pablo E. Gelber ◽  
Raúl Torres-Claramunt ◽  
Francesco Poggioli ◽  
Daniel Pérez-Prieto ◽  
Joan C. Monllau
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Meniscal Extrusion ◽  
Level Of Evidence ◽  
Meniscal Scaffold ◽  
Functional Scores ◽  
The Mean ◽  
Group 2 ◽  
Group 1

AbstractMeniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.

Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years’ Follow-up

2021 ◽  
Vol 49 (5) ◽  
pp. 1145-1151
Author(s):  
Yusuke Ueda ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Radial Head ◽  
Skeletally Immature ◽  
Osteochondral Autograft ◽  
Radiographic Outcomes ◽  
Functional Scores ◽  
Group 2 ◽  
Surgical Option ◽  
Group 1

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. Purpose/Hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years’ follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: –17° to 0°; group 2: –18° to −6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. Conclusion: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years’ follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.

scholarly journals Osteochondral Autograft Transportation vs Arthroscopic Fragment Resectionfor Large Capitellar Osteochondritis Dissecans in Adolescent Athletes - A Minimum of 5-year Follow-up

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Yusuke Ueda ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Hiroshige Hamada ◽  
...  
Keyword(s):  
Radial Head ◽  
Functional Outcomes ◽  
Dash Score ◽  
Functional Scores ◽  
The Mean ◽  
Group 2 ◽  
Grade 3 ◽  
Osteochondral Grafting ◽  
Group 1

Objectives: Small capitellar osteochondritis dissecans (OCD) lesions have shown excellent functional and radiographic outcomes after arthroscopic (AS) fragment resection in previous studies. However, surgical options for unstable large capitellar OCD lesions in skeletally immature athletes remains controversial. Before 2007, we exclusively performed AS fragment resection for all inviable lesions regardless of lesion size. However, we initiated to perform osteochondral grafting for selected larger lesions in the year of 2007. The purpose of this study is to investigate functional outcomes and radiographic changes after osteochondral grafting and AS fragment resection for unstable large capitellar OCD lesions(>1/2 radial head diameter) in skeletally immature athletes with a minimum of 5-years follow-up. Methods: Group 1 consisted of 19 elbows in 19 patients (19 males; 16 baseball, 2 badminton and 1 gymnastics) that underwent osteochondral grafting for capitellar OCD (mean age, 14; range, 13-15), and the mean follow-up was 8 years (range; 5-11). Group 2 consisted of 21 elbows in 19 patients (17 males and 2 females; 16 baseball, 2 gymnastics and1 handball) that underwent AS fragment resection (mean age, 14. range, 13-15), and the mean follow-up was 8 years (range, 5-10). Preoperatively, the mean transverse diameter of lesions was 13 mm (range, 11-14) in Group 1 and 13 mm (range, 10-16) in Group 2. Superior migration of the radial head (>2-mm side-to-side difference) was seen in four elbows in Group 1 and one elbow in Group 2. Radial head enlargement with more than 20% of the contralateral side was seen in seven elbows in Group 1 and one elbow in Group 2. Functional scores (JOA score, DASH score and patient satisfaction), range of motion (ROM), and radiographic findings including Kellgren-Lawrence osteoarthritis (OA) grade were evaluated and compared between the groups. Results: All patients returned to sports activity. Functional scores at the final follow-up were not different between Group 1 and 2: JOA score, 90 (range, 68-100) vs 91 (range, 82-100); DASH score, 1 (range, 0-7) vs 3 (range, 0-14); Patient satisfaction, 84 (range, 50-100) vs 81 (range, 50-100). Flexion ROM at the final follow-up did not show significant improvement in both groups compared to preoperative values, though there was a significant difference at the final follow-up between the groups: Group 1, 133º (range, 115-150º); Group 2, 133º (range, 120-145º). Extension ROM showed significant improvement in both groups (P<.001 for both): Group 1, -18º (range, -35-0º) to -8º (range, -22-10º); Group 2, -17º (range, -50-0º) to 0º (range, -10-20º). Group 2 had significantly better extension than Group 1 at the final follow-up (P =.003). OA change progressed in 12 elbows (63%) in Group 1 and in 9 elbows (47%) in Group 2. There were four grade 3 OA elbows in Group 1, which preoperatively had superior migration and enlargement of the radial head. No elbows showed severe OA change in Group 2. Conclusion: Functional outcomes and radiological findings after both osteochondral grafting and AS fragment resection for unstable large capitellar OCD lesions in adolescent athletes were satisfactory with a mean follow-up of 8 years. However, grade 3 OA were seen after osteochondral grafting in four elbows with preoperativesuperior migration of the radial head. Osteochondral grafting should be performed before radiographical changes become severe.

Impact of Length of Stay on Functional Outcomes of TBI Patients

2005 ◽  
Vol 71 (11) ◽  
pp. 920-930 ◽  
Author(s):  
M.L. Hawkins ◽  
F.D. Lewis ◽  
R.S. Medeiros
Keyword(s):  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Care ◽  
Average Length ◽  
Functional Independence ◽  
Average Length Of Stay ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

scholarly journals Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years

2013 ◽  
Vol 5 (3) ◽  
pp. 20 ◽  
Author(s):  
Régis Pailhé ◽  
Nicolas Reina ◽  
Etienne Cavaignac ◽  
Akash Sharma ◽  
Valérie Lafontan ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Hip Resurfacing ◽  
Harris Hip Score ◽  
Preliminary Results ◽  
Total Hip ◽  
Group 2 ◽  
Group 1

There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the <em>Partial Pelvic Replacement Hip Project </em>by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS) and Postel-Merle d’Aubigné (MDA) score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1) [100 Durom® (Zimmer Inc., Warsaw, IN, USA) and 42 Birmingham Hip Resurfacing® (Smith &amp; Nephew, Memphis, TN, USA)] and 278 patients with total hip arthroplasty (group 2). The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% <em>vs</em> 1.79% in group 2 (P&lt;0.0001). In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

scholarly journals Early Clinical Results of Arthroscopically Assisted Drilling via the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986893
Author(s):  
Yuji Arai ◽  
Kunio Hara ◽  
Hiroaki Inoue ◽  
Ginjiro Minami ◽  
Yoshikazu Kida ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Osteochondritis Dissecans ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Return To Sport ◽  
Functional Scores ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Flexion And Extension

Background: We have previously reported the technique of arthroscopically assisted drilling of osteochondritis dissecans (OCD) lesions of the elbow via the radius in a distal-to-proximal direction. With this technique, the entire OCD lesion can be drilled vertically under arthroscopic guidance with pronation and supination of the forearm and flexion and extension of the elbow joint. Purpose: To retrospectively evaluate return to sport, range of motion, and the Japanese Orthopaedic Association–Japan Elbow Society Elbow Function Score (JOA-JES score) after treatment of an elbow OCD lesion by drilling through the radius. Study Design: Case series; Level of evidence, 4. Methods: From November 2003 to January 2006, a total of 7 male adolescent baseball players with OCD lesions of the elbow were treated through use of arthroscopically assisted drilling via the radius. The stage of the OCD lesion was evaluated based on preoperative plain radiographs. Patients were observed for a minimum of 36 months, and clinical analysis included time for return to sport, elbow range of motion, and the JOA-JES score before intervention and at final follow-up. Results: We evaluated all 7 patients at a mean follow-up time of 36.1 months (range, 24-68 months). The stage of the OCD lesion on plain radiography was “translucent” in 1 patient, “sclerotic” in 5 patients, and “loosening” in 1 patient. The mean range of motion before surgery was 131.2° and –4.7° in flexion and extension, respectively, and this improved to 138.6° and 1.1° at final follow-up. The improvement in extension was statistically significant ( P = .04). The mean JOA-JES score of 83.0 before surgery significantly improved to 94.0 at final follow-up ( P < .001). One patient required excision of a free body at 51 months postoperatively, but all patients returned to sports early and without pain at an average of 4.6 months postoperatively. No feature of osteoarthrosis was noted on radiography on the final examination in any patient. Conclusion: The findings of this study demonstrate that arthroscopically assisted drilling of an elbow OCD lesion through the radial head allows for early return to sporting activities as well as improved motion and functional scores.

scholarly journals Atelocollagen Injection Improves Tendon Integrity in Partial-Thickness Rotator Cuff Tears: A Prospective Comparative Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090401
Author(s):  
Jong-Ho Kim ◽  
Dong-Jin Kim ◽  
Hyo-Jin Lee ◽  
Baek-Kyu Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Pain Scores ◽  
Partial Thickness ◽  
Functional Scores ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Ongoing controversy surrounds the best treatment modality for partial-thickness rotator cuff tears. Purpose: To investigate the effects of atelocollagen injection in patients with small, symptomatic, intratendinous rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From January 2014 to December 2017, 94 patients who had small, symptomatic, intratendinous rotator cuff tears were enrolled and randomly allocated to 1 of 3 groups: intratendinous injection with 0.5 mL of type I atelocollagen (group 1, n = 32), intratendinous injection with 1 mL of type I atelocollagen (group 2, n = 30), and no injection of type I atelocollagen (group 3, n = 32). American Shoulder and Elbow Surgeons score, Constant Shoulder Score, visual analog scale pain score, and range of motion were evaluated before injection; at 3, 6, and 12 months after injection; and at final follow-up. Magnetic resonance imaging (MRI) was performed at least 6 months after injection to evaluate rotator cuff integrity. Results: Demographic data did not differ significantly among the 3 groups before injection ( P > .05). The mean follow-up period was 24.7 months. The functional and pain scores in groups 1 and 2 were significantly improved at final follow-up ( P < .05). No significant improvement was seen in functional or pain scores at final follow-up in group 3 ( P > .05). Groups 1 and 2 had significantly better functional scores compared with group 3 at final follow-up ( P < .05). The proportion of patients with a decrease in size of the torn tendon on follow-up MRI at least 6 months after atelocollagen injection was significantly higher in group 1 (28.1%; P = .02) and group 2 (36.7%; P = .003) compared with group 3 (6.3%). Conclusion: Atelocollagen injection can improve the functional outcome and integrity of the tendon in intratendinous rotator cuff tears.

Isokinetic Strength Comparison of Tuberosity Fractures of the Proximal Fifth Metatarsal Treated With Elastic Bandage vs Cast

2020 ◽  
Vol 41 (6) ◽  
pp. 674-682
Author(s):  
Serkan Bayram ◽  
Alper Şükrü Kendirci ◽  
Doğan Kıral ◽  
Türker Şahinkaya ◽  
Mehmet Ekinci ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Clinical Outcomes ◽  
Assistive Devices ◽  
Cast Immobilization ◽  
Functional Scores ◽  
Ankle Muscle ◽  
Group 2 ◽  
Elastic Bandage ◽  
Group 1

Background: The aim of this study was to compare the strength of injured and healthy ankle muscle as well as functional and clinical outcomes between patients with proximal fifth metatarsal tuberosity fractures who received elastic bandage treatment and those who received cast immobilization. Methods: Sixty-five patients who presented to our clinic between February 2018 and April 2019 were randomly divided into 2 groups: 33 received elastic bandages (group 1) and 32 received cast immobilization (group 2). All patients were scheduled for follow-up appointments at our clinic after 2, 4, 8, 12, and 24 weeks. Visual analog scale–foot and ankle (VAS-FA) score, time missed from work, and using assistive devices were recorded as clinical outcomes. Both ankle plantarflexion-dorsiflexion and inversion-eversion muscle strengths (peak torque) were measured using an isokinetic dynamometer for each group and were compared with those of the healthy extremities. Results: The mean missed work was 11.3 days in group 1 and 27.6 days in group 2. Groups 1 and 2 used assistive devices for a mean of 6.7 and 16.2 days, respectively ( P = .001). Group 1 had a significantly higher VAS-FA score at the 2nd, 4th, and 8th week of follow-up compared with group 2, and no significant differences were observed at the time of injury and at the 12th and 24th weeks. The muscle strength deficits in group 1 were present at the 4th week, whereas those in the cast immobilization group were determined at the 4th and 8th weeks in all muscles. During the 12th and 24th week of follow-up, no significantly differences in both extremities were observed between the groups. Conclusion: Elastic bandage treatment was better than cast immobilization in terms of preserving ankle muscle strength, clinical outcomes, and functional scores regardless of the degree of fracture displacement. Moreover, the present study emphasized that cast immobilization offered no advantages in this fracture treatment. Level of Evidence: Level I, prognostic randomized controlled trial.

scholarly journals Surgical Treatment vs Nonsurgical Treatment for Brain Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia: A Retrospective Multicenter Consortium Study

Neurosurgery ◽  
2017 ◽  
Vol 82 (1) ◽  
pp. 35-47 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Helen Kim ◽  
Jeffrey Nelson ◽  
Steven W Hetts ◽  
Timo Krings ◽  
...  
Keyword(s):  
Functional Status ◽  
Surgical Resection ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Group 2 ◽  
Brain Avms ◽  
Group 1

Abstract BACKGROUND Cerebral arteriovenous malformations (AVMs) are common in patients with hereditary hemorrhagic telangiectasia (HHT). However, due to the rarity of HHT and little published evidence of outcomes from management of brain AVMs in this disease, current international HHT guidelines recommend an individualized approach. Specifically, the outcomes for surgical vs nonsurgical management of these lesions have not been reported to date. OBJECTIVE To report long-term outcomes of surgical resection of brain AVMs in HHT patients compared to outcomes in nonsurgically treated patients. METHODS From the database of the Brain Vascular Malformation Consortium HHT project, 19 patients with 20 resected AVMs (group 1) and 22 patients with 33 AVMs who received nonsurgical treatment (group 2) were studied. The groups were retrospectively reviewed for changes in functional status (modified Rankin Scale score) during the follow-up period. RESULTS During the follow-up period, 9% of patients in group 1 suffered from worsening of functional status, whereas this figure was 16% for group 2 (P &gt; .05). Functional outcomes were not statistically different between the 2 groups at the latest follow-up (P &gt; .05). CONCLUSION HHT patients treated surgically for brain AVMs appear to have long-term functional outcomes comparable to nonsurgical (including observational) therapy with fewer unfavorable outcomes. It is therefore reasonable to consider surgical resection as a management option in the multidisciplinary team's individualized treatment strategy for HHT patients with brain AVMs.

scholarly journals Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769737 ◽  
Author(s):  
Roger V. Ostrander ◽  
Jeffrey M. Klauser ◽  
Sanjay Menon ◽  
Joshua G. Hackel
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Functional Outcomes ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Partial Thickness ◽  
Ultrasound Evaluation ◽  
Functional Scores

Background: Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears. Hypothesis/Purpose: The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated. Results: Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test. Conclusion: The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

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