Correlation between Severity of Synovitis and Clinical Features in Rotator Cuff Tears.

BACKGROUND: Rotator cuff tears can be asymptomatic in some cases; however, even when the tear size is small, clinical symptoms can be very severe. This suggests that symptoms of rotator cuff tears are related to factors other than the size. Although synovitis has been cited as one of the factors, there is no grading system for synovitis in rotator cuff tears. Moreover, there are few studies that evaluated the relationship between synovitis and clinical features in patients with rotator cuff tears. METHODS: Patients with medium-sized rotator cuff tears, who were scheduled for arthroscopic repair, were recruited for this study. The glenohumeral joint was divided into 4 quarters. Then, vascularity and hypertrophy of the joint were graded in each quarter using a modified scoring system. Clinical assessment was performed preoperatively and at 3 months and 6 months after surgery. Finally, correlation between the severity of synovitis and clinical features was analyzed. RESULTS: The intraobserver correlation coefficient was 0.815 to 0.918 and the interobserver correlation coefficient was 0.779 to 0.992 for the single measurement. Vascularity was significantly correlated with the range of motion, strength, and constant score within 6 months after surgery. Hypertrophy was correlated with the range of motion within 6 months after surgery. CONCLUSIONS: Synovitis in the shoulder with rotator cuff tears can be graded by using our modified scoring system. The severity of synovitis was closely related to the clinical features after surgery. Therefore, when treating patients with rotator cuff tears, treatment of synovitis should also be considered.

The Effect of Osteoporosis on the Outcomes After Volar Locking Plate Fixation in Female Patients Older than 50 Years With Unstable Distal Radius Fractures.

PURPOSE: The aim of this study was to investigate the effect of osteoporosis on radiological and clinical outcomes after volar locking plate (VLP) fixation in women older than 50 years with unstable distal radius fractures (DRFs). METHODS: We retrospectively reviewed data of 79 women older than 50 years with DRFs treated by VLP fixation. We collected patients' baseline data, including age and bone mineral density. We also measured the cortical thickness of the distal radius on plain radiographs and computed tomography to assess local bone density. Radiological outcomes included late displacement at 1 year after surgery, which was defined as a change in radiological parameters (radial inclination, volar tilt, and ulnar variance). Clinical outcomes were assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) and modified Mayo wrist score at 1 year after surgery. We compared mean values between the nonosteoporotic (group 1, T score > -2.5) and the osteoporotic groups (group 2, T score ≤ -2.5). We conducted linear and logistic regression analysis to investigate factors associated with poor outcomes. RESULTS: There were 49 patients in group 1 and 30 patients in group 2. Radiological outcomes were similar in both groups. The mean DASH score was 14.9 (SD, 16.4) for group 1 and 12.5 (SD, 13.5) for group 2, and the mean modified Mayo wrist score was 87.6 (SD, 8.8) for group 1 and 88.2 (SD, 11.4) for group 2. There were no significant differences in clinical outcomes between groups. Simple and multivariable linear regression analysis showed only older age was associated with the change in volar tilt. Osteoporosis and cortical thickness were not associated with poor clinical outcomes on simple logistic regression analysis. CONCLUSIONS: Osteoporosis and cortical thickness of the distal radius did not affect clinical outcomes after VLP fixation in women older than 50 years with unstable DRFs. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in patients with ankylosing spondylitis.

BACKGROUND CONTEXT: Sagittal translation, a potential complication of pedicle subtraction osteotomy (PSO), can result in neurologic damage. However, few studies have been conducted on sagittal translation and its risk factors after PSO in patients with ankylosing spondylitis (AS). PURPOSE: We aimed to report cases of sagittal translation that developed after PSO in patients with AS with kyphotic deformity and to analyze risk factors for sagittal translation. STUDY DESIGN: A retrospective case-control study was carried out. PATIENT SAMPLE: This study included 53 patients (58 cases) with AS who underwent PSO to correct their kyphotic deformity. OUTCOME MEASURES: The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) was measured before the surgery. Radiological pelvic and sagittal parameters were also measured before and after surgery. Developments of sagittal translation were confirmed with intraoperative radiograph. METHODS: The subjects were grouped according to the presence (ST group) and absence (non-ST group) of sagittal translation. The demographic and radiological parameters were compared between two groups. Through multivariate logistic regression analysis, the correlations between sagittal translation and relevant parameters were analyzed for risk factor evaluation. RESULTS: Sagittal translation developed in 16 patients (30.2%) [16 cases (27.6%)]. The mean lumbar lordosis angle and sagittal vertical axis of both ST group and non-ST group were successfully corrected. In a comparison of two groups, the ST group (58.2±13.3) showed a significantly higher mSASSS than the non-ST group (33.9±11.9) (p<.001). The ST group (50.4°±7.8°, 16.9°±6.8°) also showed a significantly higher preoperative pelvic incidence and sacral slope than the non-ST group (45.3°±7.2°, 11.0°±7.7°) (p=.026, p=.011). No significant differences were observed between the two groups for the rest of radiological parameters. In multivariate analysis, only mSASSS was positively correlated with sagittal translation (odds ratio 1.16, p=.001). CONCLUSION: The incidence of sagittal translation after PSO was closely related with severity of ankylosis in patients with AS. Therefore, surgeons must consider sagittal translation, which could induce neurologic complications, when PSO is performed for patients with AS with severe ankylosis.