TikTok content as a source of health education regarding epicondylitis: a content analysis.

PURPOSE: This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information. METHODS: The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). RESULTS: A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 ± 24.75 seconds; the mean number of views was 193,207.78 ± 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 ± 62.54, 1578.52 ± 8333.11, and 149.87 ± 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 ± 5.73, 0.80 ± 0.53, and 1.30 ± 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation. CONCLUSIONS: TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines. LEVEL OF EVIDENCE: Level IV-Cross-sectional study.

Great tuberosity fixation does not affect healing and clinical outcomes in RSA performed in proximal humeral fractures in elderly patients.

PURPOSE: Aims of our study were to define whether the great tuberosity (GT) positioning fixation in reverse shoulder arthroplasty (RSA) after proximal humeral fracture (PHF) could predict tuberosity healing and its impact on clinical outcomes. METHODS: We enrolled 59 patients treated with cementless reverse shoulder arthroplasty after PHF in our institute between 2012 and 2018. The mean follow-up was 57 months (± 23.4). We divided patients into two groups according to GT positioning after fixation: Group 1 GT in contact and Group 2 GT detached at least 1 mm from humeral diaphysis. Clinical and radiographic evaluations were conducted at last follow-up. RESULTS: Overall GT healing rate was 64.4%, (Group 1 70.7%-Group 2 50%). A statistically significant difference (P = 0.047) was found in cortical thickness narrowing at one-third of stem length. We found a correlation between lateral cortical narrowing and GT fixation in non-anatomical position, but we observed no statistically significant differences about GT healing according to GT anatomical or non-anatomical fixation. No differences were found in shoulder function in patients whose tuberosity was healed or failed to heal. CONCLUSION: GT reduction is not a predictive factor for GT healing; external stress shielding, instead, seems to be decreased in patients with postoperative anatomically reduced GT. In our study, GT healing did not affect clinical outcomes or patient's satisfaction in elderly low-demanding patients.

Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance.

Background: The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis: The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design: Case series; Level of evidence, 4. Methods: This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results: All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion: ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.

BIO-RSA vs. metal-augmented baseplate in shoulder osteoarthritis with multiplanar glenoid deformity: a comparative study of radiographic findings and patient outcomes.

BACKGROUND: Reverse shoulder arthroplasty (RSA) requiring extensive reaming to address severe glenoid bone loss increases the risk of glenoid medialization and baseplate failure. We hypothesized that (1) metal-augmented baseplate prevents the medialization of the joint line and preserves glenoid bone stock similarly to bony increased-offset (BIO)-RSA and (2) bone graft viability and healing in BIO-RSA patients become compromised over time. MATERIALS AND METHODS: Eighty-one patients (83 shoulders) underwent glenoid lateralization with bone (BIO-RSA group, 44) or metal-augmented baseplate (metallic increased-offset [MIO]-RSA group, 39) and a minimum follow-up of 24 months were included. The orientation and direction of glenoid erosion was identified and recorded using computerized 3D planning. Active range of motion, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index were assessed before arthroplasty and at the last follow-up visits. Radiographic changes around the glenoid and humeral components were assessed. Healing and thickness of bone graft were evaluated by predefined criteria. Postoperative global glenoid inclination (ß angle) and retroversion were also measured. RESULTS: Delta scores of active anterior elevation were higher in the MIO-RSA group (P = .027). The differences in the other planes of shoulder motion and in WOOS index scores between the groups were not significant. Preoperative glenoid retroversion was higher in BIO-RSA patients, and glenoid inclination was similar in both groups. Type B2 and B3 glenoids had a posterior-central (91%) and posterior-superior (90%) erosion with a mean posterior humeral head subluxation of 76% and 78%, respectively. The direction of erosion in type E2 and E3 glenoids was posterior-superior, with a mean posterior humeral head subluxation of 74%. The rate of high position of the glenosphere was higher in the BIO-RSA group (P = .022), whereas the values of ß angle and postoperative retroversion were similar in the 2 groups. BIO-RSA group showed radiolucent lines <2 mm around the bone graft in 16 patients (36.4%) and decreased thickness in 15 (34.1%). Incomplete baseplate seating was found in 4 MIO-RSA patients (10%). We found higher rates of humerus condensation lines in MIO-RSA patients (P = .01) and higher rates of cortical thinning and tuberosity resorption in the BIO-RSA group (P = .027 and P = .004, respectively). CONCLUSION: Metal-augmented glenoid is a suitable alternative to BIO-RSA to preserve bone and prevent the medialization of the joint line in arthritic glenoid with multiplanar glenoid deformity. Bone and metal augmentation provided satisfactory clinical outcomes. Bone graft resorption in BIO-RSA patients raise concern about the risk of baseplate loosening and requires further long-term studies.

The use of computer navigation in reverse shoulder arthroplasty revision: a case report.

Revision shoulder surgery is always a challenge, especially in the management of periprosthetic joint infection. Staged surgery with antibiotic-loaded cement spacer, seems to yield satisfactory and encouraging results. New technologies such as computer navigation are additional tools that could aid surgeons in particular conditions where the native anatomy is distorted. This study presents the unique experience of revision shoulder surgery with computer navigation assistance. Benefits related to this approach could lead to better prosthesis longevity and survivorship.

What to expect after revision shoulder arthroplasty? A comprehensive review of the literature.

The number of shoulder arthroplasties has increased tremendously over the last twenty years, creating a proportional increase in complications rates and revision. Shoulder arthroplasty surgeon should have a clear understanding of the reasons for failure based on the specific index procedure that was performed. The main challenge includes the need for component removal and managing glenoid and humeral bone defects. This manuscript aims to outline the most common indications for revision surgery and treatment options based on a careful and detailed review of the available literature.  This paper should help the surgeon in patient evaluation and selection of the optimal procedure for an individual patient.

Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures.

BACKGROUND: Proximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age. METHODS: This is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant-Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered. RESULTS: In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery. CONCLUSION: Anatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.

Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice?

BACKGROUND: Type III supracondylar fractures represent a difficult injury to treat and there is no universal consensus regarding the best treatment. The purpose of this study is to assess the incidence of complication associated with open reduction and compare open reduction vs closed reduction, in order to determine which treatment lead to better clinical and radiological outcomes. Is open reduction really associated with a higher number of iatrogenic complication and worse clinical outcomes in comparison to closed reduction? METHODS: A total of 55 patients, affected by type III supracondylar humerus fracture, were retrospectively selected and divided into two groups according to which type of treatment they received (open reduction or closed reduction). Major complications correlated with surgical procedure, such as infections, neurovascular iatrogenic lesions, elbow stiffness and painful scarring were assessed. The treatment outcomes and clinical features were compared among the two groups. A statistical analysis to find association between the type of reduction, the restored elbow anatomy and the clinical outcomes were performed. The follow-up varies between 1 year and 7 years. RESULTS: No major complications occurred in our series of patients. Excellent and good outcomes were reported among all 26 patients that underwent an open reduction surgery and in 23 out of the 29 patients who received a closed reduction surgery. A higher number of patients in the open reduction group presented angles with normal values; moreover 3 out of the 6 patients with unsatisfactory outcomes presented with angles not in range, underlying the presence of a connection between the restored elbow anatomy and the clinical outcomes. There were no differences among the two groups regarding the presence of complications. DISCUSSION: Open reduction should not be considered as a first line option of treatment in any pediatric patient with a type III supracondylar humerus fracture, but in several cases open surgery must be viewed as the choice with the best outcomes not only in presence of neurovascular lesion but also in case of irreducible fracture.

Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up.

BACKGROUND: Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. MATERIALS AND METHODS: In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. RESULTS: In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. CONCLUSIONS: Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. LEVEL OF EVIDENCE: Level IV-case series.

A vascular lesion in hip revision arthroplasty: a case report.

Vascular injuries during hip revision surgery can be life-threatening complications for patients. There are many aspects to consider when approaching this type of surgery for an optimal diagnostic and therapeutic strategy, as a careful planning with extensive preoperative investigations, a full attention during the surgical procedure and the use of suitable material for a proper treatment. This kind of surgery can require a dedicated and trained multidisciplinary team. We report a case of an acute intraoperative vascular lesion during an acetabular revision performed in a 55-years-old patient.

Supracondylar fractures in children: management and treatment.

Supracondylar humeral fractures are widely considered the most common elbow fracture in children. Gartland classification plays a fundamental role in decision-making regarding management and prognosis. Recent literature recommends conservative management for non or minimally displaced fractures, whereas there seems to be a trend towards surgical treatment for all displaced fractures. The preferred treatment for displaced Gartland II and Gartland III fractures is closed reduction and percutaneous fixation with lateral pins. In particular patterns medial pin is recommended for obtain a stable construct. Neurovascular complications are mostly associated with Type III fractures and sometimes surgical exploration with fracture reduction is needed. Correct diagnosis and proper management protocol is mandatory for avoid early and late complications such as neurovascular impairment and malunion.

Implant sonication versus intraoperative tissue sample cultures for Periprosthetic Joint Infection (PJI) of Shoulder Arthroplasty.

Introduction Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI.  Sixty - five patients respected the criteria for admission to the study. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty - four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty - seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5%  and 93,1% (P < 0.01) respectively. Conclusion Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it's a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with  tissue cultures.

Advantages of preoperative planning using computed tomography scan for treatment of malleolar ankle fractures.

Malleolar ankle fractures have been classified using plain radiographs, and there is no consensus regarding the role of computed tomography (CT) scans in preoperative planning. We analyzed critical aspects, such as limits of standard radiographs, types of injury, classification methods and cost/benefit evaluations. CT scans allow a 3D analysis of the fracture to be obtained and consequently assess the indication for surgical procedure, surgical access and the type of fixation devices required. This exam is useful for detecting lesions that may go unnoticed on radiographs and will help surgeons to clarify the pathoanatomy of ankle fractures. According to Arbeitsgemeinschaft fur Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification, CT scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures with posterior malleolar involvement and all type 44C fractures (according to AO/OTA). Also Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with CT scans.

Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty.

BACKGROUND: Constraint choice in revision total knee arthroplasty depends on the stability of the collateral ligaments and on the severity of bone loss, but the least degree of constraint necessary is recommended. The purpose of this retrospective matched-paired study was to compare clinical results, radiographic outcome and the survival of a stemmed medial pivot revision implant in aseptic revision TKA vs. medial pivot implant in primary TKA. METHODS: Records were reviewed for 69 cases of aseptic revision TKA using Advance® Medial Pivot Stemmed Revision Knee system between 2002 and 2016. These patients were then matched in a 1:2 ratio control group of patients who received a primary TKA with Advance® Medial Pivot system. American Knee Society Score and Visual Analogue Scale pain score were recorded. Alignment, loosening, and incidence of radiolucent lines were evaluated on X-rays. Implant survival was assessed by Kaplan-Meier survival analysis. RESULTS: The primary TKA group had significant superior AKSS clinical and functional score at baseline (52.3 and 68.2 points, respectively) and at last follow up (84.6 and 68.6 points) compared with the revision TKA group (47.9 and 40.9 points; 78.4 and 59.9 points; P < 0.05). No significant difference was observed in the mean change from baseline to last follow up of AKSS score between the two groups (P > 0.05). Radiographical outcome and implant survival were similar in the two groups (P > 0.05). CONCLUSION: The authors support the use of this revision system in knees with collateral ligaments competence and mild-to-moderate bone defect.

The "Ball in Basket" Technique for Tibiotalocalcaneal Fusion.

Tibiotalocalcaneal arthrodesis (TTCA) in severe bone deficit represents a complex challenge for expert orthopedic surgeons also. This study aims to illustrate a surgical technique, defined as "ball in basket", that facilitates the fitting of the structural bone graft (femoral head from bone bank) and its placement, in order to fill the bone gap during instrumented arthrodesis. The proposed technique includes the preparation of the recipient bone surfaces with acetabular convex reamers and of concave reamers to shape the bone graft from bone bank. This preparation guarantees a maximum congruence of the bone surfaces and a greater stability of the bone graft during the placement of the fixation devices to optimize the bone fusion and to provide a good patient clinical outcome. The preliminary results obtained for two patients, initially presenting with severe anatomical deformity associated with severe bone gap, are described. Patients underwent clinical and radiographic follow-up evaluations (respectively at 4 and 30 months of follow-up) showing radiographic healing and good functional recovery. The results are encouraging, although long-term studies and a wider cohort of patients are necessary to consider this technique a reliable aid in case of severe bone deficit. (www.actabiomedica.it).

Reinsertion of distal biceps ruptures with a single anterior approach: analysis of 14 cases using tension-slide technique and interference screw.

BACKGROUND: Several techniques of surgical repair of biceps tendon ruptures are described in literature. Cortical button repair have shown minimal loss of elbow flexion, supination and strength. In this retrospective study we report the outcomes in terms of elbow function and complications of tension-slide technique and interference screw. Matherials and methods: 14 patients with complete distal biceps tendon rupture were included in the retrospective study and treated with the same tension-slide technique (BicepsButton® - Arthrex, Inc, Naples, Florida) evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 18 months. RESULTS: The flexion recovered compare to the healthy contralateral was 96% (min 115° - max 135°; average 128°), the extension was 97% (min: -2° - max 15°; average 4°), the supination was 90% (min 20° - max 90°; average 75°), the pronation was 95% (min 15° - max 90°; average 76°). The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 8.1 ± 10.5 and Mayo Elbow Performance Score overall (MEPS) score was 97.6 ± 8.2. Two patients had LABCN paresthesia, one case, treated 2 months after injury, had posterior interosseus nerve palsy. One patient had heterotopic ossification at the radiological examination without consequences for the clinical performances. No case of non-traumatic tendon re-rupture and no case of ROM deficiency > 20%. In all case the cortical button remains well positioned and no case of osteolysis were reported. CONCLUSIONS: Distal biceps tendon repair with BicepsButton® system seems to be a safe, relyable and reproducible technique providing excellent clinical, functional and radiological outcomes. Comparing with other techniques the BicepsButton® system has the advantages of the single approach procedures, the reduction of surgical time and risk of heterotopic ossifications. (www.actabiomedica.it).

The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review.

INTRODUCTION: Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a starting point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. METHODS: A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: "GlenoLabral Articular Disruption" OR "GLAD" AND "shoulder" AND "cartilage, articular". RESULTS: Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of glenohumeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. CONCLUSIONS: The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser's original definition described stable shoulders following a trauma in adduction.

Bio-inductive implant for rotator cuff repair: our experience and technical notes.

The treatment of chonic large and partial rotator cuff tears represents a common challenge for orthopedic surgeons. Numerous treatments were suggested but the best is still controversial. Into this field the use of an augment for rotator cuff repair aims to protect the tension of the suture in the postoperative phase and to facilitate the biological healing process. In our institution we treated 4 patients (3 males and 1 female) with rotator cuff tear with bio-inductive implant. All patients presented with a postero-superior rotator cuff tear: 3 patients with a type C-III tear according to Snyder classification and 1 patient with partial articular tear with significant degeneration and poor tendon quality (type A-III tear according to Snyder classification). The final outcome is highly satisfying intraoperatively and the postoperative protocol reflects our normal postoperative protocol following to rotator cuff repair. No complications occurred at 6 months follow-up. The use of the bio-inductive implant in the arthroscopic rotator cuff repair resulted easy, rapid and reproducible. Although no current scientific evidences regarding such implants exist, in selected cases and with the correct indications, the use of bio-inductive implant could represent an effective aid and an option in case of complex rotator cuff tears.