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1.
Arch Orthop Trauma Surg ; 141(2): 189-196, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32221703

RESUMEN

INTRODUCTION: Different surgical techniques (open and arthroscopic) have been described for the treatment of post-traumatic recurrent anterior instability. The aim of the surgery is to restore when possible, normal shoulder anatomy by repairing the underlying pathology responsible for the instability. Sometimes other surgical techniques are indicated. The purpose of this retrospective study was to investigate the long-term clinical and radiographic results and complications of the open Latarjet procedure after a minimum follow-up of 24 years. MATERIALS AND METHODS: A retrospective study was performed for 67 patients treated with an open Latarjet procedure in a single center. Forty of these 67 patients returned for follow-up evaluation and clinical/radiological examination during the year 2018, having had a minimum of 24-year follow-up. Clinical outcomes were analyzed using two functional scores, in addition to the ROM and strength assessment. Radiographic evaluation included several views (AP views in neutral, internal and external rotation and a comparative Bernageau view) RESULTS: A total of 40 patients underwent an open Latarjet procedure. All the patients were avaible for follow-up at an average of 25.6 years. Clinically, no patient reported any episode of dislocation at the time of follow-up. The mean Rowe score and the Walch-Duplay score were 84.5 (range 45-100) and 83.5 (range 55-100), respectively. Non-union/fibrous union was reported in 12.5% of cases, partial resorption of the graft was found in 7.5% of cases, while total resorption was found in 5% of cases. Osteoarthritis was identified in 52.5% (21) of the patients. CONCLUSIONS: This long-term follow-up study demonstrated that the open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability. The Latarjet procedure provides good long-term stability although associated with a slight limitation in external rotation. LEVEL OF EVIDENCE: Level III; retrospective cohort comparison; treatment study.


Asunto(s)
Artroplastia , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Artroplastia/efectos adversos , Artroplastia/métodos , Artroplastia/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Rango del Movimiento Articular
2.
Eur J Orthop Surg Traumatol ; 28(6): 1215-1223, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29564612

RESUMEN

Superior capsular reconstruction (SCR) demonstrated its efficacy as a treatment option available in patients affected with irreparable posterosuperior rotator cuff tears without any signs of arthritis. Originally, the fascia lata autograft was fixed medially to the glenoid (with two or more anchors) and laterally to the greater tuberosity (with a compression double-row technique using four anchors or three transosseous tunnels). Additionally, side-to-side sutures were used to anteriorly and posteriorly connect the graft to the native residual rotator cuff tissue. However, the fascia lata as an autograft has a disadvantage related to the donor-site morbidity. To solve this aspect, allografts were employed with initial promising results. Nowadays, SCR is to be considered a technically demanding and expensive procedure, because of the cost of the allograft plus that of all the anchors employed to fix it. The Arthroscopic Biceps Chillemi's technique addresses these concerns in performing SCR and presents numerous advantages being a safe, easier, time and cost-saving way compared to the other published techniques. This technique has only one conditio sine qua non: the presence of the long head of the biceps tendon (LHB), used as an autograft. This condition may be interpreted as a disadvantage of this procedure in the presence of some anatomic variations of the intra-articular portion of the LHB and the very rare absence of the tendon or in case of partial or complete rupture of the LHB tendon associated with a rotator cuff tear.


Asunto(s)
Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Hombro/cirugía , Anciano , Artroscopía , Femenino , Humanos , Cápsula Articular/cirugía , Masculino , Tendones/cirugía
3.
Eur J Orthop Surg Traumatol ; 27(3): 399-404, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28124131

RESUMEN

All-arthroscopic anchorless transosseous suture techniques combine the advantages of the open transosseous repair with the benefits of arthroscopic technique. However, all the techniques described until now are very complex, difficult to reproduce and associated with an increased surgical time. The authors developed a novel all-arthroscopic anchorless transosseous suture technique easy to perform and to reproduce. This procedure maximizes the tendon-footprint contact area obtaining both medial and lateral fixation without using any device, employing only 1 suture tape so to avoiding the risk of suture twist. The preparation of two transosseous tunnels is very easily and safely performed thanks to a dedicated instrument. The procedure is described in details. Moreover, the preliminary favorable results after a minimum follow-up of 12 months are reported.


Asunto(s)
Artroscopía/métodos , Lesiones del Manguito de los Rotadores/cirugía , Técnicas de Sutura , Anciano , Artroscopía/instrumentación , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Técnicas de Sutura/instrumentación , Suturas
4.
Knee Surg Sports Traumatol Arthrosc ; 24(12): 3779-3786, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26003482

RESUMEN

PURPOSE: To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. METHODS: One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. RESULTS: Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P < 0.05). No association was found between pain and age of the patient and between pain and tear size. Histologically, hypertrophy and inflammation of the tendon and hypertrophy, inflammation, oedema and necrosis of the subacromial bursa were directly associated with pain (P < 0.05). Pain decreased significantly in the presence of fatty metaplasia and necrosis of the tendon (P < 0.05). CONCLUSIONS: This study defines the main clinical and histopathological features of painful rotator cuff tear. In particular, a greater association of pain was observed with the histopathological changes in the bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. LEVEL OF EVIDENCE: IV.


Asunto(s)
Bolsa Sinovial/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Dolor de Hombro/diagnóstico por imagen , Traumatismos de los Tendones/diagnóstico por imagen , Anciano , Bolsa Sinovial/patología , Bolsa Sinovial/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Radiografía , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/patología , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/complicaciones , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/fisiopatología , Dolor de Hombro/etiología , Dolor de Hombro/patología , Dolor de Hombro/fisiopatología , Traumatismos de los Tendones/complicaciones , Traumatismos de los Tendones/patología , Traumatismos de los Tendones/fisiopatología , Tendones/diagnóstico por imagen , Tendones/patología , Tendones/fisiopatología
5.
Eur J Orthop Surg Traumatol ; 25(5): 807-13, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25633128

RESUMEN

The management of articular fracture is always a matter of concern. While each articular fracture is different from one another, besides the classification system used and the surgical or non-surgical indication given by the specialist, main goals remain the same: anatomical reduction, stable fixation, loose body removal, and minimal invasiveness. Open procedures are the actual compromise, but unfortunately, it is not always possible to perfectly meet every treatment goal, associated lesions could pass unnoticed or delayed in treatment, and even in a best-case scenario, there could be several complications developing in the long term. In the last decades, arthroscopic joint surgery underwent an exponential evolution, expanding its application also in the trauma field with the development of arthroscopic and arthroscopically assisted reduction and internal fixation (ARIF) techniques; main advantages are an accurate diagnosis of fracture and associated soft tissue involvement, the potential for concomitant treatments, anatomical reduction, and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee, and ankle. The purpose of this paper was to provide a review of the most recent literature about arthroscopic and arthroscopically assisted reduction and internal fixation for articular and periarticular fractures of the lower limb, analyzing the results and suggesting clinical applications.


Asunto(s)
Artroscopía , Fracturas Intraarticulares/cirugía , Traumatismos del Tobillo/cirugía , Artroscopía/métodos , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/métodos , Lesiones de la Cadera/cirugía , Humanos , Traumatismos de la Rodilla/cirugía , Fracturas de la Tibia/cirugía
6.
Eur J Orthop Surg Traumatol ; 25(6): 975-85, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25638224

RESUMEN

Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.


Asunto(s)
Inestabilidad de la Articulación/fisiopatología , Luxación del Hombro/fisiopatología , Adulto , Fenómenos Biomecánicos/fisiología , Diagnóstico por Imagen/métodos , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Examen Físico/métodos , Recurrencia , Luxación del Hombro/diagnóstico , Luxación del Hombro/terapia , Articulación del Hombro/fisiología , Resultado del Tratamiento , Adulto Joven
7.
J Bodyw Mov Ther ; 37: 156-163, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38432799

RESUMEN

BACKGROUND: The management of acute postoperative pain after rotator cuff surgery can be challenging. To our knowledge, there are no data available in the literature correlating satisfactory pain control with improvement in terms of function. The purposes of the present study were to evaluate: 1) pain pattern after arthroscopic rotator cuff repair in patients operated with two different techniques (transosseous vs transosseous equivalent); 2) safety/efficacy of three different pharmacological pain control strategies; 3) possible relationship between a correct shoulder pain management protocol in the early post-operative period and patients' functional improvement. METHODS: 114 patients underwent rotator cuff tear repair, either with a Transosseus or a Transosseus equivalent technique. 62 (54%) were male and 52 (46%) were female. The average age was 59 ± 9 years. They were randomly assigned into three different pain management protocols: Paracetamol as needed (max 3 tablets/day) for 1 week (Protocol A), Paracetamol + Codein 1 tablet three times per day for 7 days (Protocol B), or Paracetamol + Ibuprofen 1 tablet two times per day for 7 days (Protocol C). Immediate passive mobilization of the operated shoulder was allowed. VAS and Passive Flexion values were recorded at 7 (T1), 15 (T2) and 30 (T3) days post-surgery. DASH values were recorded at 90 days post-surgery. All patients were asked to register any kind of signs/symptoms that may appear during drug assumption according to each pain management protocols. RESULTS: All the pain management protocols administered were well tolerated by all the study population, and no adverse signs/symptoms were highlighted during drug assumption. Pain pattern: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean VAS at each time point examined when compared to Protocol B and C (p < 0,05). In patients within Protocol A, no statistically significant differences were found at each point time examined comparing the two surgical techniques, with the exception of T2, where the TO was associated with an higher VAS value than TOE (p < 0.05). No differences were highlighted in Protocol B and C when comparing the values between two surgical techniques. ROM: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean PROM at each time point examined when compared to Protocol B and C (p < 0,05). In the TO group, patients within Protocol B had better PROM values at T1 (p < 0,05) and T2 (p < 0,05) compared to Protocol C, but no differences were highlighted at T3. In the TOE group, no statistically significant differences were found between patients within Protocol B and C at each time point examined. DASH: In the TO group, no statistically significant differences were found regarding the DASH values comparing Protocol B vs Protocol C, but they were highlighted comparing the values between Protocol A and Protocol B (p < 0,05), and between Protocol A and Protocol C (p < 0,05). Similar results were recorded in the TOE group. CONCLUSION: Post-operative pain is influenced by the surgical technique used being transosseous more painful in the first 15 days after surgery. Oral anti-inflammatory drugs are a feasible strategy to appropriately control post-operative pain. An association between Paracetamol and either Codein or Ibuprofen can lead to better outcomes in terms of VAS reduction and early recovery of passive ROM.


Asunto(s)
Lesiones del Manguito de los Rotadores , Hombro , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Manejo del Dolor , Lesiones del Manguito de los Rotadores/cirugía , Acetaminofén , Ibuprofeno , Dolor de Hombro/terapia , Dolor Postoperatorio/tratamiento farmacológico , Comprimidos
8.
Arch Orthop Trauma Surg ; 132(3): 349-56, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21928055

RESUMEN

AIM: The aim of this prospective study was to analyze the results of meniscal tears repaired with Fast-Fix All-inside suture in stable versus anterior cruciate ligament (ACL)-deficient knees. PATIENTS: Forty patients, everybody professional players, all underwent arthroscopic surgery, were divided into two groups and followed-up for at least 24 months. Group A (stable knee affected with isolated meniscal tears) consisted of 20 patients treated exclusively with Fast-Fix suture. Group B (ACL-deficient knees affected with meniscal tears) consisted of 20 patients in which we performed a Fast-Fix suture with concurrent ACL reconstruction (hamstring duplicated). Comparing both Groups together, we have noticed that the good clinical result of meniscal sutures with ACL reconstruction associated has occurred faster than isolated meniscal suture, regardless of the meniscus, the knee, and age of the patient. In fact 6 months after surgery, in Group A, there was a success by 65% against 85% for the Group B with 8.3 points International Knee Documentation Committee (IKDC) difference in favor of the latter. Whereas 24 months after surgery, the percentage was increased achieving 90% in Group A and 95% in Group B with 12.6 points IKDC difference in favor of the Group B. A statistical analysis of variable, both after 6 and 24 months, showed a significant improvement of knee conditions for patients with ACL reconstruction. CONCLUSION: In conclusion, other than observing the better results in meniscal tears with ACL-deficient knee, we observed that among all cases the best healing occurred in patients affected by meniscal longitudinal vertical tears located in Red-Red zone of external meniscus with an extension of 10 mm in ACL-deficient knee, treated with Fast-Fix suture and ACL reconstruction associated.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Traumatismos en Atletas/cirugía , Meniscos Tibiales/cirugía , Técnicas de Sutura , Lesiones de Menisco Tibial , Adolescente , Adulto , Traumatismos en Atletas/diagnóstico , Femenino , Humanos , Masculino , Meniscos Tibiales/patología , Adulto Joven
9.
J ISAKOS ; 7(5): 142-147, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36057538

RESUMEN

The subscapularis (SSc) is the most powerful muscle of the rotator cuff. His role in shoulder stability and shoulder motion is well studied and due to functional and frequent association with concomitant other lesions, the repair of the SSc tendon is always desirable to restore force and stability to the shoulder.


Asunto(s)
Laceraciones , Lesiones del Manguito de los Rotadores , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Artroscopía , Rango del Movimiento Articular/fisiología , Imagen por Resonancia Magnética , Rotura
10.
Arthrosc Sports Med Rehabil ; 4(3): e1039-e1049, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35747668

RESUMEN

Purpose: To evaluate whether an anatomic dry shoulder Dexter training model surgical simulator would be effective in augmenting orthopaedic residents' skills for arthroscopic rotator cuff repair. Methods: Nine residents, enrolled for this prospective study, watched a video presentation about transosseus equivalent (TOE) double-row, rotator cuff repair technique, repeating the aforementioned technique twice on the simulator. The time to complete all steps to final repair, as well as the quality of the final repair, were measured. Results: The data for repair completion time showed a statistically significant difference in the total duration time of performing the procedure, when comparing the timing in tests 1 and 2, demonstrating a reduced operative time. The qualitative data collected show an increase in the final score in 100% (9 out of 9) of the participants between the first and second tests, with an improvement in the average score of 16.4% (3.22 points with a standard deviation of 2.64). Hence, there is a statistically significant difference (P = .006) between the total scores obtained by the participants at the end of tests 1 and 2, presenting an improvement of the quality score, shifting from the first (average score 19.7) to the second (average score 22.9) test. Conclusion: The dry simulator may be a valuable device to improve arthroscopic technical skills. This improvement was observed both in the resulting reduced operative time required to carry out the surgical procedure and the increased quality score (established to evaluate the quality of the required tasks). Clinical Relevance: In order to provide as many training opportunities as possible, an arthroscopy simulator could be used to supplement clinical arthroscopy skills training for orthopaedic residents.

11.
World J Orthop ; 12(6): 403-411, 2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34189078

RESUMEN

BACKGROUND: Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world's population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components. AIM: To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis. METHODS: This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR. RESULTS: In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case. CONCLUSION: HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.

12.
Arthrosc Tech ; 10(5): e1233-e1238, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34141537

RESUMEN

The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach.

13.
Arthrosc Sports Med Rehabil ; 2(3): e241-e250, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32548590

RESUMEN

PURPOSE: To evaluate the short-term outcomes of rotator cuff repair in the presence of a greater tuberosity cyst (GTC) using a transosseous repair technique. METHODS: This study included patients who underwent arthroscopic rotator cuff tear repair with a transosseous technique and were evaluated clinically and by postoperative magnetic resonance imaging (MRI) after 1 year. The inclusion criteria were based on the results of preoperative MRI and were as follows: patients identified as having a repairable full-thickness rotator cuff tear associated with the presence of cystic changes at the tendon insertion site of the greater tuberosity, defined as a GTC involving the footprint area of the torn tendon (supraspinatus and/or infraspinatus tendons). RESULTS: We evaluated 25 patients. The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 39.48 (P = .530) and 84.64 (P = .035), respectively; Constant shoulder scores, 38.96 (P < .005) and 80.28 (P = .425), respectively; and University of California-Los Angeles shoulder rating scale scores, 10.6 (P = .045) and 29.04 (P = .315), respectively. The GTC mapping system was easily adopted in all the MRI examinations independently from the quality of the images. The GTCs were mostly located in the superficial anterolateral section of the humeral head and in both the posterolateral sections (superficial and deep). CONCLUSIONS: Arthroscopic transosseous rotator cuff repair led to significant mid-term improvement and satisfactory subjective outcomes with low complication and failure rates in this study. The GTC mapping system could be useful to evaluate GTCs and to aid surgeons in the choice of the best surgical technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

14.
Orthopedics ; 31(5): 447, 2008 05.
Artículo en Inglés | MEDLINE | ID: mdl-19292319

RESUMEN

This study evaluated mid-term functional results of the Grammont inverted prosthesis for the treatment of shoulder osteoarthritis associated with massive cuff rupture. Twenty-eight patients with a minimum of 6 years of follow-up were evaluated. Clinical evaluation was performed on all patients preoperatively and at follow-up using the Constant score. Radiologic assessment included radiographs and magnetic resonance imaging preoperatively and radiographs at follow-up. Constant score improved from 27.4 preoperatively to 64.6 postoperatively. The inverted prosthesis is attractive and remains one of the options for treating cuff tear arthropathy. However, glenoid loosening remains a serious problem.


Asunto(s)
Prótesis Articulares , Osteoartritis/complicaciones , Osteoartritis/cirugía , Lesiones del Manguito de los Rotadores , Luxación del Hombro/complicaciones , Luxación del Hombro/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Resultado del Tratamiento
15.
Joints ; 6(3): 135-140, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30582099

RESUMEN

Purpose The aim of the present retrospective study is to describe the results obtained at 2-year follow-up by using a porcine dermis-derived collagen membrane implanted as augmentation to treat large rotator cuff tears. Methods Thirty-five patients in total were included according to the following criteria: large or massive rotator cuff tear, confirmed during surgery, measuring between 3 and 5 cm in width and stage 1 to 2 fatty infiltration documented at magnetic resonance imaging (MRI). Patients underwent arthroscopic repair of the cuff augmented by the implantation of a porcine dermal collagen membrane. Patients were evaluated up to 24 months after surgery by the Constant score and MRI imaging to assess functional outcomes and re-tear rate. The results obtained were compared to those of a matched cohort of 35 patients operated by arthroscopic repair alone by the same surgical team. Results The application of the porcine membrane proved to be safe without scaffold-related adverse events documented. A statistically significant difference in the Constant score in favor of the treatment group was documented at the final evaluation ( p = 0.036 ). Furthermore, a subgroup analysis revealed that patients treated by augmentation and presenting re-tear at MRI showed a significantly higher functional outcome compared with control patients with MRI evidence of re-tear ( p = 0.0136). Conclusion Arthroscopic repair augmented by porcine dermal xenograft for the treatment of chronic and retracted rotator cuff tears with low-grade fatty degeneration proved to be safe and also effective, with higher functional score compared with the arthroscopic repair alone. Level of Evidence This is a Level III, retrospective cohort study.

16.
Muscles Ligaments Tendons J ; 7(1): 19-25, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28717607

RESUMEN

BACKGROUND: Mechanical factors are at the basis of any tendon healing process, being pressure an aspect able to positively influence it. For this reason transosseous rotator cuff repair represents the gold standard procedure for patients affected by a cuff tear, maximizing the tendon footprint contact area and reducing motion at the tendon to bone interface. METHODS: The Authors present an all arthroscopic suture bridge-like transosseous repair with the preparation of a single transosseous tunnel perfor med thanks to a precise dedicated instrument (Compasso®) and one implant (Elite-SPK®) with the use of only 3 suture wires. In addition this technique permits to accurately prepare the bony side of the lesion without any risk or complication, such as anchor pull-out and greater tuberosity bone osteolysis. CONCLUSIONS: However, even if this technique seems less demanding, the arthroscopic transosseous repair is still an advanced procedure, and should be performed only by well prepared arthroscopic shoulder surgeons. LEVEL OF EVIDENCE: V.

17.
Muscles Ligaments Tendons J ; 5(4): 227-63, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26958532

RESUMEN

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.

18.
Muscles Ligaments Tendons J ; 4(4): 425-32, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25767779

RESUMEN

BACKGROUND: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient's pain and disability, surgery should be considered. METHODS: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation. PURPOSE: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears.

19.
Arthritis ; 2013: 370231, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23365745

RESUMEN

Osteoarthritis (OA) is the most frequent cause of disability in the USA, affecting up to 32.8% of patients over the age of sixty. Treatment of shoulder OA is often controversial and includes both nonoperative and surgical modalities. Nonoperative modalities should be utilized before operative treatment is considered, particularly for patients with mild-to-moderate OA or when pain and functional limitations are modest despite more advanced radiographic changes. If conservative options fail, surgical treatment should be considered. Although different surgical procedures are available, as in other joints affected by severe OA, the most effective treatment is joint arthroplasty. The aim of this work is to give an overview of the currently available treatments of shoulder OA.

20.
Open Orthop J ; 7: 243-9, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23919098

RESUMEN

Shoulder arthroplasty is considered the most effective surgical procedure for endstage shoulder pain from different causes including osteoarthritis, cuff-tear arthropathy, trauma, and tumors. Although uncommon and less frequent than knee or hip periprosthetic infection, periprosthetic shoulder infection represents a devastating complication and, despite treatment, is associated with unsatisfactory results. The most commonly identified microorganisms in periprosthetic shoulder infections are Staphylococcus aureus, coagulase-negative Staphylococci and Propionibacterium acnes. Diagnosis is not always easy and mainly derives from the integration of clinical symptoms, laboratory exams, radiological studies and microbiological swabs. Different options are available for treatment, including antibiotic therapy, lavage and debridement with retention of the prosthesis, one-stage reimplantation, two-stage reimplantation with antibiotic-impregnated cement spacer and resection arthroplasty. The aim of this review is to describe the current knowledge regarding risk factors, etiology, diagnosis and treatment of periprosthetic shoulder infection.

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