Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs.

BACKGROUND: Fatty infiltration (FI) compromises outcomes of rotator cuff repairs. Most clinicians consider FI of the infraspinatus, whether it is torn or intact, because it is most rapidly affected. The purpose of this study was to report long-term outcomes of isolated supraspinatus repairs and to determine their associations with FI of the infraspinatus and supraspinatus. METHODS: The records of 182 patients who underwent repair of isolated supraspinatus tears and had preoperative magnetic resonance imaging were retrieved. Of these, 147 patients were evaluated at 10 years' follow-up using the Constant score and magnetic resonance imaging scans. RESULTS: Preoperative FI was greater in the supraspinatus (52% stage ≥1) than in the infraspinatus (29% stage ≥1). The 10-year Constant scores were influenced by FI of the supraspinatus (P = .006) but not of the infraspinatus (P = .422). Multivariable regression confirmed that Constant scores were significantly lower for female patients, repetitive work, and stage 1 and stage 2 FI of the supraspinatus in addition to open surgery. Retear rates (Sugaya types IV-V) were also influenced by FI of the supraspinatus (P = .001) but not of the infraspinatus (P = .979). Shoulders with supraspinatus FI at stages 0, 1, and 2 had retear rates of 10%, 22%, and 31%, respectively. Multivariable regression affirmed that the odds of retears are significantly increased by both stage 1 and stage 2 FI of the supraspinatus. CONCLUSIONS: The Constant scores and retear rates were significantly associated with FI of the torn supraspinatus (stage ≥1) but not of the intact infraspinatus. The authors recommend that rapid surgical intervention be considered, before accumulation of fat, especially for young, active patients.

Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up.

PURPOSE: The purpose of this study was to evaluate long-term clinical and anatomic results after open rotator cuff repair. MATERIALS AND METHOD: Fifty-three patients were included in this study. Rotator cuff tears were limited to one tendon in 34, and two tendons or more in 19. The supraspinatus tendon was involved alone in 30 cases, and the subscapularis in four. Clinical, radiographic and MRI evaluations were performed for all patients at ten-year minimum follow-up. RESULTS: At 11.4-years average follow-up, satisfactory results were obtained with improvement on pain level, in range of motion with a gain in active anterior elevation and in external rotation as well as in strength in abduction. Absolute Constant score reached 74.7 points and adjusted Constant score 99.6%. SSV was 82.5% with a SST score of 10 points. Osteoarthritis changes increased with follow-up with osteoarthritis lesion in 69% of the cases. MRI evaluation found a re-tear of the repair in 42% of the cases: 30% when only the supraspinatus tendon was initially involved, and 63% when two or more tendons were repaired. Tear size and quality of the repair were the most important prognosis factors for re-tear of the repair. No correlation was found between the occurrence of a new tear and the clinical outcome. CONLCUSION: Surgical repair of chronic rotator cuff tendon tear can produce consistent and lasting pain relief and improvement in range of motion. Re-tear of the repair was not correlated with degradation of clinical results. Best results were obtained for isolated supraspinatus tear with a complete surgical repair.

Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability.

PURPOSE: The aim of this study was to evaluate mid-term outcomes of Bankart repair with Hill-Sachs remplissage (BHSR) and to highlight prognostic factors of failure. METHODS: Thirty-four patients operated on for anterior shoulder instability with BHSR were enrolled in a prospective non-randomised study. Clinical and radiographic evaluation was performed at 1.5, three, six months and yearly thereafter. Outcome measures included Rowe and Walch-Duplay score. RESULTS: At mean follow-up of 35 months (24-63), the Rowe and Walch-Duplay scores reached respectively 92.7 and 88.2 points. The mean deficit in external rotation was 6° in ER1 and 1° in ER2 (p = 0.4, p = 0.9 respectively). Five patients (14.7%) had a recurrence of instability and three others had a persistent anterior apprehension. In the failure group, the Hill-Sachs lesion was deeper (26% vs 19% of the humeral diameter; p = 0.04) and range of motion at 1.5 months postoperatively was greater. Age at surgery, pre-operative instability severity index score (ISIS), hyperlaxity, type and level of sport, amount of glenoid bone loss had no correlation with failure rate. CONCLUSIONS: The rate of failure at mid-term follow-up of BHSR was higher than commonly reported. The premature recovery of range of motion seems to be a clinical sign of failure at follow-up. Moreover, in case of deep Hill-Sachs lesion (>20%) an alternative procedure should be considered. LEVEL OF EVIDENCE: Level IV.

Evaluation of thirty eight cemented pegged glenoid components with variable backside curvature: two-year minimum follow-up.

BACKGROUND: The PERFORM™ pegged glenoid system has been used for shoulder arthroplasty since 2012. This system offers multiple backside curvatures per size to better match variable patient anatomy. As a result, less reaming is required and subchondral bone is preserved-a critical factor in preventing glenoid migration and loosening, thus enhancing implant longevity. PURPOSE: The purpose of this study was to analyze all radiographic modifications around this new glenoid implant. METHOD: Thirty-eight shoulders which received the PERFORM™ pegged glenoid component between June 2012 and January 2014 for primary or secondary osteoarthritis were reviewed at two-years minimum follow-up. There were 13 men and 22 women with an average age of 67 years. Humeral components were an uncemented short stem implant in nine (23%) and a resurfacing implant in 29 (77%). RESULTS: At 27-months average follow-up (24-41), Constant score improved from 30 to 65 points. Range of motion improved significantly at follow-up from 100° to 142° for the anterior elevation, and from 15 to 40° for the external rotation. Radiographic lucent lines (RLL) were observed post-operatively in eight cases (21%), and in 16 cases (42%) at the last follow-up with an increase of the RLL score from 0.36 ± 0.8 to 1.3 ± 2 (p < 0.001) without signs of loosening (RLL > 12). One revision has been performed after anterior shoulder dislocation, rotator cuff tear and glenoid component migration. RLL score was not correlated with dominant side, sex, age, or Constant score. DISCUSSION-CONCLUSION: The cemented pegged glenoid component with multiple backside curvatures gave satisfactory results at two-years minimum follow-up for up to three years with a low RLL score. Long-term studies are mandatory to confirm these results.

Modified head-neck offset for diagnosing anterior femoro-acetabular impingement.

PURPOSE: The head-neck offset described by Eijer et al. (eHNO), which is used to diagnose anterior femoro-acetabular impingement (FAI), can be difficult to measure. The aim of this study was to verify if a modified head-neck offset (mHNO) provides more accurate and reproducible values than those of the eHNO. METHODS: The eHNO, mHNO, cephalic radius and alpha angle were measured on frog-leg radiographs of a group of patients with FAI and a control group (T); three independent reviewers measured the 50 hips in each group twice. The comparison of the two HNOs focused on reproducibility (intraclass correlation coefficient), validity (correlation with alpha angle), practical utility (difference between means in the FAI and control groups) and accuracy of the diagnostic thresholds. RESULTS: The mHNO had better reproducibility (p < 0.05) within and between observers in all study subjects than that of the eHNO (0.938 and 0.979 vs 0.881 and 0.904). The correlation with the alpha angle was also better (p < 0.05) for the mHNO than that for the eHNO. The diagnostic performances of the mHNO and mAOR thresholds were higher than those of the eHNO, eAOR and alpha angle. CONCLUSIONS: The new HNO is easier to measure, more reproducible and more accurate. A modified HNO <5 mm and a modified AOR <0.100 on the frog-leg view argued in favour of a pathological cam-type head-neck junction.

Osteolysis at the insertion of L'Episcopo tendon transfer: Incidence and clinical impact.

INTRODUCTION: During a L'Episcopo transfer procedure, the tendons of the latissimus dorsi and teres major are reinserted on the posterolateral side of the humeral shaft to restore active external rotation. The aim of this study was to monitor the radiological changes at the insertion point of this transfer and to evaluate its impact on the clinical outcomes. MATERIALS AND METHODS: In this retrospective, single-center study, 13 patients (mean age 56 years; 19-84) were reviewed after a minimum follow-up of 2 years. The L'Episcopo transfer was done either alone (n=2) or in combination with reverse shoulder arthroplasty (n=11). The same transfer technique was used in both instances, with reattachment by transosseous sutures. The clinical assessment consisted of the Constant score (CS), the Activities of Daily Living Requiring Active External Rotation (ADLER) score and the Subjective Shoulder Value (SSV). Radiographs were used to look for signs of osteolysis of the cortical bone in the tendon transfer areas and classified as grade 1 (minor erosion), grade 2 (moderate erosion) and grade 3 (major erosion). RESULTS: At a mean follow-up of 37 months (24-72), the mean CS was 60 points (32-75), the ADLER was 21 points (15-30) and the SSV was 77% (10-95). In the radiographic analysis, 10/13 patients had osteolysis visible in the transfer area: 2 were grade 1 (15%), 1 was grade 2 (8%), 7 were grade 3 (54%). There was no statistical correlation between the presence of osteolysis and the clinical outcomes. Nevertheless, external rotation with elbow at side and forward flexion were better in the patients who had osteolysis≥grade 2. CONCLUSION: The L'Episcopo transfer is associated with frequent osteolysis of the humeral cortex where the transfer is attached, even though the transfer appears effective. Long-term follow-up will be needed to evaluate the impact of this osteolysis on the stability of any shoulder arthroplasty implants. LEVEL OF EVIDENCE: IV; retrospective study.

Periprosthetic shoulder infection: an overview.

Periprosthetic shoulder infection (PSI) is rare but potentially devastating. The rate of PSI is increased in cases of revision procedures, reverse shoulder implants and co-morbidities. One specific type of PSI is the occurrence of low-grade infections caused by non-suppurative bacteria such as Propionibacterium acnes or Staphylococcus epidemermidis.Success of treatment depends on micro-organism identification, appropriate surgical procedures and antibiotic administration efficiency. Post-operative early PSI can be treated with simple debridement, while chronic PSI requires a one- or two-stage revision procedure. Indication for one-time exchange is based on pre-operative identification of a causative agent. Resection arthroplasty remains an option for low-demand patients or recalcitrant infection. Cite this article: EFORT Open Rev 2017;2:104-109. DOI: 10.1302/2058-5241.2.160023.