Partial-thickness tears of the rotator cuff: evaluation and management.

The approach to management of a partial-thickness rotator cuff tear is best made with the understanding that this is not a singular condition. Rather, partial tears represent the common outcome of a variety of insults to the rotator cuff. Degenerative changes due to aging, anatomic impingement, and trauma may all be etiologic agents. Overhead athletes may develop tears due to repetitive microtrauma or internal impingement. Outlet radiographs and magnetic resonance imaging are recommended for routine preoperative evaluation. A nonoperative treatment program for rotator cuff strengthening and stretching is appropriate as initial treatment; modification of activities and anti-inflammatory medication are often used as well. Operative management may be considered when nonoperative treatment fails. Arthroscopic evaluation is required to determine the true extent of the cuff lesion. Arthroscopic subacromial decompression is recommended when outlet impingement is present. Rotator cuff debridement or formal cuff repair is dependent on the size of the cuff defect and the age and activity level of the patient. The importance of recognizing the different causes of partial-thickness rotator cuff tears is emphasized in this review of pathogenesis, clinical diagnosis, imaging, and treatment.

Anterior cruciate ligament graft tensioning in full extension.

The purpose of this study was to determine anterior laxity and graft forces in cadaveric knees after anterior cruciate ligament reconstruction in which the graft is tensioned with the knee in full extension. We also analyzed the clinical results from a series of patients who had ligament reconstructions using this technique. We performed anterior cruciate ligament reconstructions on seven fresh cadaveric knees and then measured the anterior laxity, graft set force, and graft tension. We also did a prospective minimum 2-year followup on 57 patients who underwent anterior cruciate ligament reconstruction. The in vitro data showed average anterior laxity of 1.1 mm greater than the intact knee with an 89-N anterior force at 30 degrees of knee flexion. Average graft set force was 68 N, and graft tension in extension was 18 N. In the clinical portion of the study, knee laxity improved from 7.5 to 0.8 mm (side-to-side difference at 89 N). The patients' Lysholm and Tegner scores improved from 65 to 90 and 3.9 to 5.6, respectively. Only one patient had a postoperative contracture. The results of this study suggest that graft tensioning in full extension provides a low incidence of flexion deformity, maintaining excellent functional results and satisfactory biomechanics.

The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction.

The purpose of this study was to examine the relationship of meniscal status at the time of anterior cruciate ligament (ACL) reconstruction with the ultimate function and stability of the knee joint. Seventy-one patients were studied prospectively following bone-patellar tendon-bone ACL reconstruction. Subjects were divided into six subgroups relative to the integrity (intact, partial meniscectomy, complete meniscectomy) of the two menisci. After a minimum of 2 years of follow-up (range 2-4.1 years), 56 subjects were available for subjective, objective, and radiographic assessment. Meniscal status at the time of ACL reconstruction proved to have no significant bearing on the ultimate stability of the knee. However, individuals who had undergone meniscal excision reported subjective complaints and activity limitations more commonly than those with intact menisci (p < 0.05). Radiographic changes also were more common in the meniscectomized subset.

Anterior cruciate reconstruction using a Dacron ligament prosthesis. A long-term study.

A single-center prospective study is presented on 35 patients who underwent anterior cruciate ligament reconstruction using a Dacron ligament prosthesis. All of the reconstructions were performed by the same surgeon, using the same technique. All of the patients had a history of symptomatic chronic ACL insufficiency. The mean follow-up interval for all patients was 50 months. There was an overall failure rate of 37.1% (13 patients), based on the presence of at least one of the following criteria: the presence of a pivot shift; a 2+ or greater anterior drawer or Lachman; instrumented laxity of greater than 3 mm side-to-side translation in 20 degrees of flexion at 89 N; or by arthroscopic documentation. Six of these 13 patients were documented by arthroscopy and 7 were clinical failures. There were 26 patients with only anterior cruciate ligament laxity, and 9 patients with multiple instabilities or failed previous ACL reconstruction ("salvage"). In the group with isolated anterior cruciate ligament insufficiency, the failure rate was 23% (6 patients). In the salvage group, the failure rate was 78% (7 patients). There was a significant improvement in patient performance with respect to clinical laxity, Lysholm scores, and Tegner activity levels at 2 years postoperatively. There has been a subsequent deterioration in the performance of these patients through time.

Bipolar hemiarthroplasty in degenerative arthritis of the hip. 100 consecutive cases.

This retrospective study represents the authors' experience with bipolar hemiarthroplasty in 100 consecutive patients with degenerative arthritis. Seventy of 100 patients were available for follow-up assessment. Mean follow-up interval was 4.3 years (range, two to 13.5 years). Mean modified Harris hip score was 78.8. Good-to-excellent results were obtained in 75.8% (excellent, 22.9%; good, 52.9%). Revision was required in six cases (8.6%). Subgroup analysis revealed comparable outcome in 50 patients with at least three years of follow-up assessment (mean, 5.1 years), indicating no deterioration of results. Anterior thigh pain, attributed to femoral component loosening, was the predominant patient complaint. Use of proportionately sized femoral components and use of cement when indicated should decrease the incidence of anterior thigh pain. This intermediate-term follow-up study suggests a role for bipolar hemiarthroplasty in the primary surgical treatment of osteoarthritis.