scholarly journals Efficacy of the Subclavian Portal Approach in Arthroscopic Repair of Isolated Subscapularis Tendon Tear

2014 ◽  
Vol 17 (1) ◽  
pp. 18-24
Author(s):  
Seung Bum Chae ◽  
Chang Hyuk Choi ◽  
Suk Han Jung
Keyword(s):  
External Rotation ◽  
Scoring Systems ◽  
Clinical Results ◽  
Arthroscopic Repair ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Subscapularis Tendon Tear ◽  
Additional Surgery ◽  
Functional Scores

BACKGROUND: To evaluate the efficacy of the subclavian portal approach for the arthroscopic repair of isolated subscapularis tendon tear.METHODS: We used the subclavian portal to carry out arthroscopic repair of the isolated subscapularis tendon tear. The surgery was carried out in 18 cases (average age of 53) from May 2006 to December 2009 with a mean follow-up period of 35 months. Of these cases, 13 patients had the tear in their dominant arms, 16 were male, and 12 were from traumatic ruptures with on average 7.6 months of symptom period to operation. Additional surgery, acromioplasty and subacromial debridement, were carried out on 4 cases each during the subscapularis repair. The integrity of cuff status was assessed by ultrasonographic examination at 6 months and at 1 year after operation.RESULTS: The initial average range of motion in forward flexion, external rotation, and internal rotation were 160degrees, 50degrees and L4, respectively. At the 1 year follow-up period, these improved to 160degrees, 52degrees and T12, respectively. The initial average functional scores were assessed by KSS, ASES, UCLA, and Constant scoring systems, which were 67, 60, 26, and 65, respectively. These scores improved progressively with time. At 3 months after operation, the scores were 74, 67, 27, and 74; at 6 months, 83, 77, 31, and 75; at 1 year, 88, 86, 32, and 79; and at the final follow-up of 35 months, 84, 92, 34, and 84.CONCLUSIONS: In the repair of isolated subscapularis tendon tear, the subclavian portal approach provided a good angle for anchor insertion and sufficient space to manage the upper portion of the tendon tear. In turn, these provisions resulted in satisfactory clinical results.

Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review

2021 ◽  
pp. 036354652110182
Author(s):  
Zhiwen Luo ◽  
Jinrong Lin ◽  
Yaying Sun ◽  
Kesen Zhu ◽  
Chenghui Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Latissimus Dorsi Transfer ◽  
Subscapularis Tendon Tear ◽  
Pectoralis Major Transfer ◽  
The Mean ◽  
Lift Off

Background: Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear. Purpose: To systematically review and compare the outcomes of LDT and PMT for ISScT. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically ( P < .05). Results: Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P < .001), active forward flexion (44.3° vs 14.7°; P < .001), abduction (35.0° vs 17.6°; P < .002), and positive belly-press test rate (45% vs 27%; P < .001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV. Conclusion: In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.

Early Prospective Results of the Salto-Talaris™ Total Ankle Prosthesis

2012 ◽  
Vol 2 (1) ◽  
pp. 23-34 ◽  
Author(s):  
Karl M Schweitzer ◽  
Samuel B Adams ◽  
Nicholas A Viens ◽  
Robin M Queen ◽  
Mark E Easley ◽  
...  
Keyword(s):  
Clinical Results ◽  
The United States ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Ankle Prosthesis ◽  
Additional Surgery ◽  
Sf 36 ◽  
Functional Scores ◽  
End Stage

ABSTRACT Background Several fixed-bearing total ankle arthroplasty (TAA) systems are available in the United States (US). We report on the early clinical results of the largest known US cohort of patients who received a Salto-Talaris total ankle replacement for end-stage ankle arthritis. Methods We prospectively followed 67 TAA patients with a minimum clinical follow-up of 2 years. Patients completed standardized assessments, including visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score, short form (36) health survey (SF-36), and the short musculoskeletal function assessment (SMFA), along with physical examination, functional assessment, and radiographic evaluation, preoperatively and yearly thereafter through most recent follow-up. Results Implant survival was 96% using metallic component revision, removal, or impending failure as endpoints, with a mean follow-up of 2.81 years. Three patients developed aseptic loosening, all involving the tibial component. Of these, one underwent revision to another fixed-bearing TAA system, one patient is awaiting revision surgery, and the other patient has remained minimally symptomatic and fully functional without additional surgery. Forty-five patients underwent at least one additional procedure at the time of their index surgery. The most common concurrent procedure performed was a deltoid ligament release (n = 21), followed by removal of previous hardware (n = 16) and gastrocnemius recession (n = 11). Eight patients underwent additional surgery following their index TAA, most commonly debridement for medial and/or lateral impingement (n = 4). Patients demonstrated significant improvement in VAS, AOFAS hindfoot, several SF-36 subscales, SMFA, and functional scores at most recent follow-up (p < 0.001). Conclusion Early clinical results indicate that the Salto-Talaris fixed-bearing TAA system can provide significant improvement in pain, quality of life, and standard functional measures in patients suffering from end-stage ankle arthritis. The majority of patients underwent at least one concurrent procedure, most commonly to address varus hindfoot deformity, hardware removal, or equinus contracture. Schweitzer Jr KM, Adams Jr SB, Viens NA, Queen RM, Easley ME, DeOrio JK, Nunley II JA. Early Prospective Results of the Salto-Talaris™ Total Ankle Prosthesis. The Duke Orthop J 2012;2(1):23-34.

scholarly journals Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989812
Author(s):  
Sang Hoon Chae ◽  
Tae Wan Jung ◽  
Sang Hyeon Lee ◽  
Myo Jong Kim ◽  
Seung Min Park ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Predictive Value ◽  
Scoring System ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Cutoff Value ◽  
Subscapularis Tendon Tear ◽  
Arthroscopic Findings

Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

scholarly journals A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932095006
Author(s):  
Philip B. Kaiser ◽  
Erik T. Newman ◽  
Christopher Haggerty ◽  
Paul T. Appleton ◽  
John J. Wixted ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Distal Humerus ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Additional Surgery ◽  
Patient Reported ◽  
Functional Scores ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Purpose: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy. Methods: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS). Results: At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant. Conclusion: A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy

scholarly journals Recurrent Anterior Glenohumeral Instability-Arthroscopic Results of Bankart Repair

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0026
Author(s):  
Ahmet Guney ◽  
İbrahim Karaman ◽  
Murat Kahraman ◽  
Mithat Öner ◽  
Erdal Uzun ◽  
...  
Keyword(s):  
Open Surgery ◽  
External Rotation ◽  
Arthroscopic Repair ◽  
Daily Activities ◽  
Bankart Repair ◽  
Shoulder Abduction ◽  
Arthroscopic Bankart Repair ◽  
The Mean ◽  
The Difference

Objectives: In the treatment of traumatic anterior shoulder instability there is still not formed a ideal consensus. Although the results of the open technique for repairing Bankart lesions detected in these patients, in recent years with the development of arthroscopic methods, arthroscopic Bankart repair with the successful results are obtained. We aimed to present our results of Bankart repair with the arthroscopic method. Methods: The study included 42 patients who underwent arthroscopic Bankart repair in our clinic between the years 2011-2014. Mean age was 26.3 (18-37). Preoperative and postoperative pain and functions of the patients were assessed using the Constant and Rowe scores. The mean follow-up period was 19 months (range 6 to 30 months). Patients with at least two dislocations were included in the study. The mean number of dislocations was 4.8 (2-10). The mean time from the first trauma to surgical intervention was 2.5 years (range 0.5 to 10 years). Patients with multidirectional instability were excluded. Repair was performed using double-stranded double with the standard anterior portal. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Before surgery for all patients, a detailed clinical examination, conventional radiography and conventional MRI were evaluated. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities. Results: The mean passive shoulder abduction was 155 (145-170) degrees and mean external rotation was measured 80 (60-90) degrees. The mean preoperative Rowe score was 42 points, while the postoperative score was 89.1 points at the last time follow up. The difference was statistically significant (p <0.05). The Constant score was 52 preoperatively and increased to 85 points after the surgery. The difference was statistically significant (p <0.05). The mean loss of external rotation was observed %28.75 and the last time follow up decreased to %8.2. The difference was statistically significant (p <0.05). All of the patients returned to their daily activities and no dislocation has been occurred. Conclusion: Although, in the past, the results of arthroscopic repair were less satisfactory compared to open and mini open surgery. This condition has changed remarkably. The results of arthroscopic repair in our study were good enough compared to open surgeries. Also in patients who underwent arthroscopic repair, length of hospital stay is shorter, less pain and less scar tissue occurs after the surgery. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.

Isolated Subscapularis Tendon Tear

2018 ◽  
pp. 242-257
Author(s):  
Robert A. Arciero ◽  
Frank A. Cordasco ◽  
Matthew T. Provencher
Keyword(s):  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Subscapularis Tendon Tear

Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot

2018 ◽  
Vol 100-B (2) ◽  
pp. 190-196 ◽  
Author(s):  
M. Chraim ◽  
S. Krenn ◽  
H. M. Alrabai ◽  
H-J. Trnka ◽  
P. Bock
Keyword(s):  
Limb Salvage ◽  
Case Series ◽  
Foot And Ankle ◽  
Charcot Arthropathy ◽  
Charcot Neuroarthropathy ◽  
Additional Surgery ◽  
Functional Scores ◽  
Compression Nail ◽  
Hindfoot Arthrodesis

Aims Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. Patients and Methods We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70). Results The limb salvage rate was 16 of 19 limbs. Three patients had to undergo below-knee amputation due to persistent infection followed by osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement. Complications including infection, hardware removal, nonunion, and persistent ulcers requiring further intervention were also observed. Postoperative functional scores revealed significant improvement compared with preoperative scores on American Orthopaedic Foot and Ankle Society (AOFAS) – Hindfoot scale, Foot Function Index (FFI), visual analogue scale (VAS), and Foot and Ankle Outcome Score (FAOS). Conclusion The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article: Bone Joint J 2018;100-B:190–6.

Functional acetabular retroversion syndrome: description of a specific sub-type of FAI and results of treatment with minimally invasive PAO

2019 ◽  
Vol 30 (6) ◽  
pp. 779-786 ◽  
Author(s):  
Michael C Wyatt ◽  
Christian Smith ◽  
Ali Zavareh ◽  
Dominik Pfluger ◽  
Marcus JK Bankes
Keyword(s):  
Minimally Invasive ◽  
Smoking Status ◽  
Periacetabular Osteotomy ◽  
Clinical Results ◽  
Acetabular Retroversion ◽  
Crossover Sign ◽  
Results Of Treatment ◽  
Functional Scores ◽  
The Mean

Introduction: Acetabular retroversion syndrome is associated with pincer-type femoroacetabular impingement (FAI) and results, theoretically, from an externally rotated hemipelvis. The purpose of this study was to examine our surgical experience and the clinical results of functional acetabular retroversion syndrome treated with minimally-invasive periacetabular osteotomy (PAO). Methods: We performed a retrospective cohort study of prospectively collected data in consecutive patients who had an anteverting PAO from 01 November 2010 to 31 December 2015. All patients were followed up clinically and radiologically. Functional scores were ascertained using pre- and postoperative iHOT-12 and EQ-5D. The effect of hypermobility, smoking status and body mass index (BMI) on outcome measures was evaluated. Results: 31 anteverting PAOs were performed on 27 consecutive patients. All patients were female. The mean age was 26.7 years (SD 6.7). The mean BMI was 25.8 kg/m2 (SD 5.1). 5 patients were smokers (16.1%) and 11 exhibited signs of generalised joint laxity. 23 hips had undergone prior hip arthroscopy and 1 patient had previous open FAI surgery. The minimum clinical follow-up was 2 years (mean 3.4 years; range 2–7 years). A crossover sign was present in all cases. The mean iHOT-12 score improved from 19.5 to 51 at 6 months, 64.5 at 1 year and 48 at 2 years following surgery ( p < 0.05) EQ-5D improved from 0.42 preoperatively to 0.76 at 6 months and 0.69 at 1 year following surgery ( p < 0.05). Conclusions: We have characterised functional acetabular retroversion syndrome (FARS) as a condition affecting young, active females which severe symptoms out of proportion to demonstrable radiographic pathology.

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