scholarly journals Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988904 ◽  
Author(s):  
Giussepe Aguado ◽  
Daniel Vernaza Obando ◽  
Gilberto A. Herrera ◽  
Alejandro Ramirez ◽  
Paulo J. Llinás
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Statistical Significance ◽  
Case Series ◽  
Level Of Evidence ◽  
Double Row ◽  
Initial Surgery ◽  
The Difference ◽  
Clinical Records ◽  
Massive Tears

Background: Surgical repair of rotator cuff (RC) tears is an effective treatment option. However, the prevalence of recurrent ruptures is high. Hypothesis: Recurrent tears are a frequent complication of surgical repair of RC tears. Their incidence might be influenced by factors such as the patient’s age and size of the initial tear. Study Design: Case series; Level of evidence, 4. Methods: Data from 90 adult patients who underwent arthroscopic RC repair between 2014 and 2017 and underwent an ultrasound examination 6 to 12 months after surgery were analyzed retrospectively. Massive tears were repaired using a double-row technique, and nonmassive tears were repaired with a single-row technique. Clinical records were reviewed for demographic information. Results: All patients (57.8% women; 42.2% men) were older than 18 years (mean, 58.9 years). Of these patients, 30.0% (27/90) had massive tears, which were primarily found in patients ≥60 years (74.1%; 20/27). Complete healing was seen in 74.5% of all repairs during follow-up. A total of 23 patients (25.5%) had retears (13 complete; 10 partial), which were diagnosed by ultrasound imaging 6 to 12 months after the initial surgery. The occurrence of retears was more prevalent in patients with massive tears than in patients with nonmassive tears (40.7% vs 19.0%, respectively); the difference was statistically significant ( P = .03). Reruptures occurred in 50.0% of patients older than 60 years with massive tears. Although patients older than 60 years had more recurrent tears (32.6%) compared with younger patients (18.2%), the difference was not statistically significant ( P = .12). Conclusion: One-quarter of the patients who had undergone surgical repair of an RC tear had recurrent ruptures. There was a statistically significant association between the initial massive tear and a retear. Patients older than 60 years showed a higher recurrence rate, but this difference lacked statistical significance. Reruptures occurred in 50.0% of patients older than 60 years with massive tears.

Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs

2021 ◽  
pp. 036354652110151
Author(s):  
Surena Namdari ◽  
Thema Nicholson ◽  
Tyler J. Brolin ◽  
Jeffrey Lu ◽  
Joseph A. Abboud ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Short Form ◽  
Case Series ◽  
Functional Results ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Double Row ◽  
Patient Age ◽  
Postoperative Mri ◽  
Patient Âgé

Background: Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing. Purpose: To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively. Results: A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively ( P < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; P = .04) and SANE (84.1 vs 50.5; P = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus ( P = .024). Conclusion: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Radiographic assessment of the percutaneous Bianchi system technique for treatment of hallux valgus

2021 ◽  
Vol 15 (2) ◽  
pp. 140-145
Author(s):  
Tércio Manoel de Vasconcelos Silva ◽  
Marcus Vinicius Mota Garcia Moreno ◽  
Janice de Souza Guimarães ◽  
Túlio Eduardo Vieira Marçal ◽  
Thiago Batista Faleiro ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Valgus Angle ◽  
Assessment Period ◽  
System Technique ◽  
Student’S T

Objective: To present initial radiographic results of surgical correction of the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) using the percutaneous Bianchi system (PBS) technique. Methods: Seventeen patients with moderate to severe hallux valgus (HV) were exclusively treated with the PBS technique and assessed radiographically preoperatively and during the postoperative period, from January 2019 to January 2020. The degree of deformity correction was recorded, based on the HVA and the IMA. Stata (v. 14.0) software was used for statistical analyses. Pre-surgical and post-surgical mean HVA and IMA were compared using Student’s t test for paired samples and the McNemar test was used to compare HVA and IMA categories. Statistical significance was set at 5% and 95% confidence intervals were estimated. Results: Both HVA and IMA were reduced significantly during the assessment period. Mean radiographic correction of the HVA was 15.1° and mean radiographic correction of the IMA was 7.3. Conclusions: According to the results presented, use of the PBS technique achieved adequate correction of the radiographic parameters of the patients who underwent the treatment as proposed, although it is necessary to conduct additional studies with longer follow-up to achieve a higher recommendation level. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711984987 ◽  
Author(s):  
Yusuke Ueda ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Anterior Border ◽  
Level Of Evidence ◽  
Rotator Cuff Lesions

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability. Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability. Study Design: Case series; Level of evidence, 4. Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined. Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 53 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs. Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.

scholarly journals Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

2018 ◽  
Vol 11 (1_suppl) ◽  
pp. 59-67 ◽  
Author(s):  
Claudia C. Sidler-Maier ◽  
Jennifer A. Mutch ◽  
Martin Sidler ◽  
Dimitra Leivadiotou ◽  
Jubin B. Payandeh ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Latissimus Dorsi ◽  
Negative Impact ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Level Of Evidence ◽  
Latissimus Dorsi Transfer ◽  
Cuff Repair

Background The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° ( p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. Level of evidence Level IV: Therapeutic study (case series)

scholarly journals LONGITUDINAL DEVELOPMENT OF THE SPINE AND SPINAL CORD IN HUMAN FETUSES

2020 ◽  
Vol 19 (1) ◽  
pp. 8-12
Author(s):  
PATRICIO MANZONE ◽  
JUAN ARMANDO GUIDOBONO ◽  
DANIEL FORLINO
Keyword(s):  
Spinal Cord ◽  
Case Series ◽  
Lumbar Vertebra ◽  
Cross Sectional Study ◽  
Foramen Magnum ◽  
Longitudinal Growth ◽  
Human Fetuses ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
The Difference

ABSTRACT Objective The spinal cord extends from the foramen magnum to the sacrum in the human fetus at the beginning of the 2nd quarter. However, the medullary cone is located at or above the level of the second lumbar vertebra at birth. The objective is to determine the difference between the rates of longitudinal growth of the spinal cord and the spine in human fetuses from the 13th to the 22nd week of gestation (WoG) using magnetic resonance imaging (MRI). Methods Descriptive observational cross-sectional study of 24 stillbirths (13 ♂, 11 ♀), between the 13th and 22nd WoG, using spinal MRI. We recorded spine and spinal cord lengths in millimeters from the foramen magnum to the coccyx for the former and to the medullary cone for the latter. We identified the position of the medullary cone according to vertebral level and its correlation with the gestational age and the literature. Results The spinal cord increased in length from 50 to 93 mm, the spine from 57 to 137 mm, and the medullary cone rose from S1 to L2. The rate of growth was 1.2 mm/day for the spine and 0.6 mm/day for the spinal cord. Conclusions Discordance in the rate of normal longitudinal growth of the spine and spinal cord caused the medullary cone to rise from S1 level to L2 in the second trimester of pregnancy. These results allow an understanding of normal development and certain congenital malformations. Level of evidence IV; Case series.

Effects of Intravenous Tranexamic Acid During Rhytidectomy: A Randomized, Controlled, Double-Blind Pilot Study

2020 ◽  
Author(s):  
Justin C Cohen ◽  
Robert A Glasgold ◽  
Les M Alloju ◽  
Mark J Glasgold
Keyword(s):  
Tranexamic Acid ◽  
Low Cost ◽  
Statistical Significance ◽  
Case Series ◽  
Skin Incision ◽  
Level Of Evidence ◽  
Double Blind ◽  
Intraoperative Bleeding ◽  
Randomized Controlled ◽  
Surgery Center

Abstract Background Tranexamic acid (TXA) is an antifibrinolytic agent shown to decrease intraoperative bleeding, reduce transfusions, and improve outcomes across multiple specialties. Within plastic surgery, initial reports are encouraging but formal studies are lacking. Objectives The aim of this study was to determine whether intravenous (IV) TXA has any effect on intraoperative bleeding or postoperative sequelae in patients undergoing a deep-plane facelift. Methods This is a prospective, randomized, double-blind, case series in a private practice surgery center. The participants were 44 patients undergoing rhytidectomy with the senior authors (R.A.G. or M.J.G). The treatment group received a 1-g dose of IV TXA prior to skin incision and the same dose 4 hours later (vs saline). Bleeding was rated mild, moderate, or severe. Postoperative ecchymosis and edema were subjectively evaluated by patient and surgeon and scores were aggregated for analysis. Results The TXA group showed decreased intraoperative bleeding but this difference did not reach statistical significance. Postoperative ecchymosis/edema ratings were lower for patients who received TXA, including a statistically significant decrease in surgeon-rated bruising. TXA resulted in a statistically significant decrease in postoperative collections in this study and no major complications occurred. Conclusions TXA is a safe, low-cost addition to any existing surgical protocol and may lead to fewer surgical sequelae and improved satisfaction. Although we did not observe a dramatically different intraoperative experience, postoperative bruising and collections were significantly reduced. TXA acid may have great value in the management of patients undergoing rhytidectomy and its use warrants further study. Level of Evidence: 2

The Influence of Breast Cancer on the Distribution of Cherry Angiomas on the Anterior Thoracic Wall: A Case Series Study

Dermatology ◽  
2018 ◽  
Vol 235 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Antonio Guastafierro ◽  
Vincenzo Verdura ◽  
Bruno Di Pace ◽  
Mario Faenza ◽  
Corrado Rubino
Keyword(s):  
Breast Cancer ◽  
Statistical Significance ◽  
Case Series ◽  
Thoracic Wall ◽  
Rank Test ◽  
P Value ◽  
Unilateral Breast Cancer ◽  
Case Series Study ◽  
Signed Rank Test ◽  
The Difference

Background/Aims: Cherry angiomas (CAs) are one of the most common vascular manifestations of the skin. By and large, these benign lesions often only represent an aesthetic problem. In the literature, few authors have focused on the pathogenesis of these lesions, and some risk factors have been identified, such as the presence of cutaneous and non-skin neoplasias. In this study, the correlation between the distribution of CAs and breast cancer was investigated. Methods: We carried out a study whereby 50 women with unilateral breast cancer and the presence of CAs on the anterior thoracic wall were evaluated, with a particular focus on the difference in the number of CAs between the two haemithoraces. The data was elaborated using the Wilcoxon signed-rank test in order to evaluate whether there was a statistical significance in the distribution of CAs. Results: In 31 patients we found that the number of CAs was greater on the cancerous breast than on the contralateral one (p value <0.0001). This was confirmed both in the group of patients suffering from ductal breast cancer and in the group with early invasive breast tumours. Conclusion: It is not clear whether CAs develop prior to or following breast cancer, indicating the possibility that this cutaneous manifestation could take on a predictive, prognostic development or represent only an epiphenomenon. Further in-depth studies into the pathogenesis of CAs and the relationship with breast cancer could lead to noteworthy diagnostic-therapeutic advances.

Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis

2020 ◽  
pp. 107110072095514
Author(s):  
Christopher J. Pearce ◽  
Dexter Seow ◽  
Bernard P. Lau
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Heel Pain ◽  
Level Of Evidence ◽  
Data Points ◽  
The Mean ◽  
The Difference ◽  
Night Splint ◽  
Gastrocnemius Tightness

Background: It is known that there is an association between gastrocnemius tightness and plantar fasciitis, but this has never been quantified. The purpose of the study was to determine the correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Methods: Thirty-three patients were prescribed physiotherapist-directed gastrocnemius stretching exercises, a Strassburg Sock or night splint, and silicone heel insoles as required. Outcome measures included (1) gastrocnemius tightness, (2) 100-mm visual analog scale (VAS) for pain on the first steps in the morning, and (3) 100-mm VAS for the worst pain felt during the previous week. Gastrocnemius tightness was measured by the difference in maximal ankle dorsiflexion between knee bent and straight with a goniometer. Results: The mean gastrocnemius tightness was 22 degrees at baseline compared with 9 degrees at the final follow-up ( P < .01). A reduction in VAS for pain on the first steps in the morning and VAS for the worst pain felt during the previous week from baseline to final follow-up was observed ( P < .01). Correlation analysis of 105 data points between gastrocnemius tightness and VAS for pain on the first steps in the morning was R = 0.757 ( P < .001), and between gastrocnemius tightness and VAS for the worst pain felt during the previous week was R = 0.781 ( P < .001). Conclusion: The study observed a strong, statistically significant correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Level of Evidence: Level IV, case series.

Surgical repair versus conservative treatment and subacromial decompression for the treatment of rotator cuff tears

2019 ◽  
Vol 101-B (9) ◽  
pp. 1100-1106 ◽  
Author(s):  
C. Schemitsch ◽  
J. Chahal ◽  
M. Vicente ◽  
L. Nowak ◽  
P-H. Flurin ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Conservative Treatment ◽  
Surgical Repair ◽  
Treated Group ◽  
Mean Difference ◽  
Rotator Cuff Tears ◽  
Subacromial Decompression ◽  
The Difference ◽  
One Year ◽  
Meta Analyses

Aims The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. Materials and Methods PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results Six studies were included. Surgical repair resulted in a statistically significantly better Constant–Murley Score (CMS) at one year compared with conservative treatment (mean difference 6.15; p = 0.002) and subacromial decompression alone (mean difference 5.81; p = 0.0004). In the conservatively treated group, 11.9% of patients eventually crossed over to surgical repair. Conclusion The results of this review show that surgical repair results in significantly improved outcomes when compared with either conservative treatment or subacromial decompression alone for degenerative rotator cuff tears in older patients. However, the magnitude of the difference in outcomes between surgery and conservative treatment may be small and the ‘success rate’ of conservative treatment may be high, allowing surgeons to be judicious in choosing those patients who are most likely to benefit from surgery. Cite this article: Bone Joint J 2019;101-B:1100–1106.

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