Arthroscopic repair techniques for massive rotator cuff tears.

Patients with massive rotator cuff tears present with pain, weakness, and loss of function. Candidates for arthroscopic repair include symptomatic, young, active patients; those with an acute tear or tears with early changes of atrophy; and patients willing to comply with recovery and rehabilitation processes after surgery. As massive rotator cuff tears extend, the glenohumeral articulation is destabilized, allowing superior migration. Repair of the force couples and reinforcement of the anterosuperior rotator cuff cable can restore functional elevation via the deltoid. Muscle changes, including rotator cuff atrophy and fatty infiltration, will affect shoulder strength and function. As chronic changes become more extensive (such as the absence of the acromiohumeral interval and degenerative joint changes), other repair options may be more durable. Other arthroscopic options, including partial rotator cuff closure, graft to augment the repair, and use of the long head of the biceps tendon, have been helpful in pain relief and functional gains.

Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis.

BACKGROUND: Despite improved results with reverse shoulder arthroplasty (RSA), questions still remain regarding certain technical aspects of the operation. One particular area of question is the effect of subscapularis repair on complication rates, dislocation, pain, and overall range of motion. Some authors suggest that when a deltopectoral approach is used, not repairing the subscapularis leads to a higher complication rate, especially for dislocation. MATERIALS AND METHODS: From a reverse total shoulder arthroplasty database of 3 surgeons at 1 institution, we identified 55 patients who underwent RSA using the deltopectoral approach without subscapularis repair and 65 patients with subscapularis repair. RESULTS: Complications were documented in 11 of 55 shoulders (20%) without subscapularis repair and in 13 of 65 shoulders (20%) with subscapularis repair. Dislocation occurred in 3 shoulders in the nonrepair group and in 2 shoulders in the repair group. These data indicate that nonrepair of the subscapularis did not have a significant effect on the risk of any complication, dislocation, infection, disassociation, or function. CONCLUSION: Repairing the subscapularis has no appreciable effect on complication rate, dislocation events, or range of motion gains and pain relief.

The incidence of occult dysplasia of the contralateral hip in children with unilateral hip dysplasia.

BACKGROUND: The purpose of this study is to determine the incidence of contralateral hip dysplasia in children with unilateral hip dysplasia. METHODS: We reviewed all patients with developmental dysplasia of the hip (DDH) who were evaluated at our institution until skeletal maturity (at least age 13 years). In the contralateral ("normal") hip, radiographic measurements of the acetabular angle >46 degrees, center edge angle <20 degrees, and migration index >20% were considered abnormal. RESULTS: Of the 43 patients in the study, 18 (42%) were diagnosed with bilateral hip dysplasia as an infant or toddler; 8 on the initial visit, and 10 after repeated evaluations. Twenty-five patients had no evidence of contralateral hip dysplasia, even on repeated examinations. Of this group, 10 of 25 (40%) had mild acetabular dysplasia at maturity (mean center edge angle, 31 degrees; acetabular angle, 43 degrees; and migration index, 14%). No child in this group was diagnosed with significant hip dysplasia at skeletal maturity that required treatment to date. DISCUSSION: The results of this study indicated that mild acetabular dysplasia occurs at maturity in the contralateral hip in up to 40% of patients diagnosed with unilateral DDH, even when the contralateral hip was carefully evaluated as a child. The significance of mild acetabular dysplasia is not well defined, but intermittent evaluation of the contralateral hip in children with DDH would seem prudent. LEVEL OF EVIDENCE: IV.