Outcome at 3 to 5 years of a treatment algorithm for rotator cuff tears in an elderly population.

The purpose of this study is to evaluate the results of a conservative approach of rotator cuff tears in an elderly population at 3 to 5 years of follow-up. Prospective comparative study. All patients started with a program of exercises of at least 1 to 3 months. When no satisfying results for pain relief and ADL were achieved, surgery for cuff tear repair was offered. Patients were contacted after 3 to 5 years for evaluation by questionnaire, an ultrasound and a strength measurement exam. 97 patients (104 shoulders) with a mean age of 68,5 years were included. 47.1% of shoulders were treated conservatively whereas 52.9% switched to surgical treatment. Evaluation after 3 to 5 years showed no significant difference between type of treatment and post treatment test scores (Constant score, SF12v2, OSS and WORC). Delaying surgery for 3 months does not seem to influence outcome negatively.

Magnetic resonance arthrography of glenohumeral lesions: anatomy and arthroscopically confirmed pathology.

Interpretation of magnetic resonance (MR) arthrography images of the glenohumeral ligaments is made difficult by anatomical variations and by the lack of descriptions of signs of pathology of the ligaments. In this review, we describe the normal and pathologic appearance of the glenohumeral ligaments of the shoulder. These ligaments play an important role in stabilization of the shoulder. Both 1.5 and 3 T MR units were used to acquire the MR images. The principal investigator reviewed the imaging reports and arthroscopic reports. All cases were correlated with arthroscopy. Lesions of the superior glenohumeral, middle glenohumeral, and inferior glenohumeral, including humeral avulsion of the glenoid ligament are discussed. Diagnosis of lesions of the glenohumeral ligaments remains a challenge.

Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture.

BACKGROUND: As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. PURPOSE: To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1) computerized histomorphometry and (2) evaluation of overall histological components of structural repair. Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score. Adverse events were recorded throughout the study. RESULTS: Characterized chondrocyte implantation resulted in better structural repair, as assessed by histomorphometry (P = .003) and overall histologic evaluation (P = .012). Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized chondrocyte implantation. Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months after characterized chondrocyte implantation was comparable with microfracture at this stage. Both treatment groups had a similar mean baseline overall Knee injury and Osteoarthritis Outcome Score (56.30 +/- 13.61 and 59.53 +/- 14.95 for microfracture and characterized chondrocyte implantation, respectively), which increased in both groups to 70.56 +/- 12.39 and 72.63 +/- 15.55 at 6 months, 73.26 +/- 14.66 and 73.10 +/- 16.01 at 12 months, and 74.73 +/- 17.01 and 75.04 +/- 14.50 at 18 months, respectively. Both techniques were generally well tolerated; the incidence of adverse events after characterized chondrocyte implantation was not markedly increased compared with that for microfracture. CONCLUSION: One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed to confirm these findings.

Arthroscopic management of Mason type 2 radial head fractures.

During decennia the treatment of radial head fractures has been controversial. For Mason type II fractures, more recent studies agree that open reduction and internal fixation is the treatment of choice. It restores biomechanical properties, allows an early mobilisation of motion and results in better functional outcome compared with other treatments. In this study, we present the mid-to-long-term results of an arthroscopic technique for reduction and percutaneous fixation. Fourteen patients were available for follow-up with a final assessment performed at an average of 5 years 6 months (range 1 year to 11 years 3 months). Patients were evaluated for pain, motion and radiological findings. The average elbow score (Broberg and Morrey in J Bone Joint Surg Am 68:669-674, 1986) was 97.6 points (range 86-100), corresponding with 3 good and 11 excellent results. Two of the patients with only good results had associated cartilage lesions of the capitellum. Our results show that arthroscopically assisted reduction and internal fixation of type II radial head fractures is a valid technique with consistently good outcome. Although the technique is technically demanding, it allows more precise articular fracture reduction control, as well as better evaluation of associated lesions.

Brucellar arthritis of the knee: a case report with delayed diagnosis.

Brucellar septic arthritis has become extremely rare in Western developed countries since bovine brucellosis has been successfully eradicated. Nevertheless, we should remain vigilant for this disease, as brucellosis is still endemic in many parts of the world. The authors present the rare manifestation of a brucellar septic arthritis of the knee joint, associated with a lytic lesion of the proximal tibia. The diagnosis of brucellosis was delayed by 11 months because of the microbiological and histological negativity of repeated joint fluid aspirations, bone biopsies and synovial specimens. Eventually Brucella melitensis could only be isolated from one extended culture of synovial fluid. The treatment with a combination antimicrobial therapy of rifampicin and tetracycline was successful, but the lytic lesion needed reconstruction with bone grafts. A high index of suspicion for brucellosis is needed in any patient coming from an endemic region with a non-specific and chronic arthritis to allow for early diagnosis and treatment.

The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis.

One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In four others, a lateral prosthesis was implanted subsequently to a medial one. One of these four was revised to a total knee prosthesis 6 years later. In another four cases, late complications of the meniscal bearing were treated with replacement of this bearing. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded. Since these results compare poorly to the survival of total knee arthroplasty, this prosthesis is not the first-choice implant. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in patients younger than 65. Further research is mandatory to confirm that this prosthesis very rarely needs revision in patients older than 75. It should not be used in osteotomized knees.

Functional outcome after intramedullary nailing of humeral shaft fractures: comparison between retrograde Marchetti-Vicenzi and unreamed AO antegrade nailing.

BACKGROUND: We compared anesthesia time, complications, fracture healing, as well as shoulder and elbow function after retrograde and antegrade nailing of humeral shaft fractures or impending fractures. METHODS: Thirty retrograde Marchetti-Vicenzi nails (MVN) and 22 antegrade locked AO unreamed humeral nails (AO-UHN) were inserted in 52 patients. Forty-three fractures were followed up until healing, and three required reoperation for nonunion (two MVN, one AO-UHN). Nineteen MVN and 17 AO-UHN patients were evaluated according to Constant's shoulder score and HSS elbow score after an average of 2 years (0.5-3.4 years). RESULTS: Anesthesia time did not differ significantly in both groups. Differences in Constant's shoulder score between healthy and affected side were more important in the AO-UHN group due to limitation in ROM and loss of abduction power. Differences in HSS elbow score were similar in both groups, although four supracondylar fractures occurred in the MVN group. CONCLUSION: The retrograde approach to the humeral medullary cavity using a MVN resulted in better shoulder function and similar elbow function compared with the antegrade approach using an AO-UHN.