Long-term results of arthroscopic repair of type II SLAP lesions in sports: assessment of return to pre-injury playing level and critical risk factors for complication.

PURPOSE: The management of isolated SLAP lesions is still debated especially in athletes. Aims of the study were: 1. to analyse our algorithm to treat SLAP lesions starting from the selection of patients for surgery and 2. to correlate the familiarity for diabetes and hypothyroid disorders with post-operative results. METHODS: Seventy-eight patients with isolated SLAP lesion were arthroscopically treated using knotless anchors and microfractures. All patients had a pre-operative and post-operative clinical examination according to Walch-Duplay, Constant, Rowe and Dash scores and interviewed for familiarity to diabetes and hypothyroid disorders. RESULTS: About 68.8% of patients solved pain with rehabilitation. About 29% of patients returned to the sports activities. About 32% of patients were no responder to physiotherapy and were arthroscopically treated. About 53.9% of patients responded excellent, 34.7% good, 3.8% medium and 7.6% poor results according to Walch-Duplay score. The Constant score increased from 64 to 95, the Rowe score from 48 to 96. The outcomes were significantly worse in patients with familiarity for diabetes. CONCLUSIONS: Microfractures and knotless anchor give long-term good results for the treatment of SLAP lesions in athletes. The familiarity for diabetes is an important risk factor that can lead to decreased outcomes.

Arthroscopic Bankart repair associated with subscapularis augmentation (ASA) versus open Latarjet to treat recurrent anterior shoulder instability with moderate glenoid bone loss: clinical comparison of two series.

PURPOSE: The treatment of chronic anterior shoulder instability with glenoid bone loss is still debated. The purpose of this study is to compare short-term results of two techniques treating chronic shoulder instability with moderate glenoid bone loss: bone block according to open Latarjet-Patte procedure and arthroscopic Bankart repair in association with subscapularis augmentation. METHODS: Ninety-one patients with moderate anterior glenoid bone loss underwent from 2011 to 2015. From these patients, two groups of 20 individuals each have been selected. The groups were homogeneous in terms of age, gender, dominance and glenoid bone loss. In group A, an open Latarjet procedure has been performed, and in group B, an arthroscopic Bankart repair associated with subscapularis augmentation has been performed. The mean follow-up in group A was 21 months (20-39 months), while in group B was 20 months (15-36 months). QuickDash score, Constant and Rowe shoulder scores, were used for evaluations of results. RESULTS: The mean preoperative rate of QuickDash score was 3.6 for group A and 4.0 for group B; Rowe Score was 50.0 for group A and 50.0 for group B. Preoperative mean Constant score was 56.2 for Latarjet-Patte and 55.2 for Bankart plus ASA. Postoperative mean QuickDash score was in group A 1.8 and 1.7 in group B; Rowe Score was 89.8 and 91.6; Constant Score was 93.3 and 93.8. No complications related to surgery have been observed for both procedures. Not statistically significant difference was reported between the two groups (p > .05). Postoperatively, the mean deficit of external rotation in ER1 was -9° in group A and -8 in group B; In ER2, the mean deficit was -5° in both groups (p = .0942). CONCLUSIONS: Arthroscopic subscapularis augmentation of Bankart repair is an effective procedure for the treatment of recurrent anterior shoulder instability with glenoid bone loss without any significant difference in comparison with the well-known open Latarjet procedure.

Reverse shoulder prosthesis to treat complex proximal humeral fractures in the elderly patients: results after 10-year experience.

PURPOSE: The aim of this study is to report the clinical and radiological results of reverse total shoulder arthroplasty (rTSA) in elderly patients who have been treated for complex humeral fractures. MATERIALS AND METHODS: From January 2005 to December 2014, we have implanted rTSA for proximal humeral fractures in 95 patients (80 women, 15 men) about 75 years old on average (range 62-95 years). All rates and results on intraoperative and postoperative complications have been collected in a specific database. In all cases we have used a modular implant prosthesis (Lima Corporate, San Daniele del Friuli, Italy). The prosthesis was implanted cementless in 92 cases. Because of the presence of a high percentage of comorbidities in the elderly patients, we have retrospectively analyzed the necessity of a secondary hospitalization, from a week to a 6-month time after the discharge, due to general health problems and specific postoperative shoulder complications. The mean follow-up was 5 years (range 1-9 years) for 70 of 95 patients, 50 of whom had adequate radiographic controls. RESULTS: None of 95 patients has required a reoperation or a hospitalization for general health problems from 1 week to 6 months postoperative. No early or late infection of prosthesis has been observed. There were seven cases of perioperative complications, three humeral vertical bone fissuring, two glenoid fractures and two cases of deltoid muscle damage. We have had three cases of postoperative hematoma and one case of ulnar nerve neuropathy. The mean constant score was 85.4, and the mean simple shoulder test was 7.4. We have observed a grade 1 scapular notching in 15 cases (30 %). In the remaining 35 reviewed cases, there was no notching. Peri-articular heterotopic ossifications were found in 11 cases (22 %). CONCLUSION: Reverse shoulder prosthesis in complex humeral fractures in the elderly can be considered as a reliable surgical procedure, which leads to very good clinical and radiological results in case of cementless prosthesis, as well.

Massive rotator cuff tear treated with a synthetic patch: a case report 16 years after surgery.

Massive rotator cuff tears usually cannot be repaired due to tendon atrophy and marked retraction, as well as muscles fatty degeneration. There are several options for surgical treatment: open or arthroscopic debridement with or without subacromial decompression, arthroscopic isolated biceps tenotomy, partial tendon repair, use of synthetic or biologic patches, tendon transfers, hemiarthroplasty, reverse arthroplasty, and arthrodesis. In this article, we will discuss a particular case of massive rotator cuff tear treated with Marlex mesh. The patient was clinically, radiologically, and MRI checked 16 years after the surgical implant. The active function of shoulder had preserved very well, the Constant score was 76. The X-rays showed a limited progression of osteoarthritis without further cranial migration of the humeral head. At MR cartilage preservation was appreciated, the patch being in good position and the teres minor being smaller than average but it was nonetheless present. This case report can highlight the usefulness of patches in patients with irreparable rotator cuff lesion both for the immediate benefit in terms of pain, strength, movement, and in perspective allowing for the preservation of anatomical structures that might avoid the need for a prosthetic implant over the years.

["Silent" gastroesophageal reflux and upper airway pathologies in childhood]. / Reflusso gastroesofageo "silente" e patologia delle alte vie respiratorie in età pediatrica.

In children, gastroesophageal reflux (GER) plays an important role in both acute and chronic upper airway disorders including stridor, chronic cough, recurrent upper respiratory infections, obstructive apnea, laryngospasm, and wheezing. Diagnosis may prove difficult unless there is reason to suspect GER and one is aware of the concept of "silent" GER. This paper presents our experience with chronic and/or recurrent respiratory disorders of uncertain origin and without gastrointestinal symptoms in children. Thirty-two pediatric patients with upper respiratory symptoms were evaluated. Out-patient 24-hour intraesophageal pH was monitored and 56% of the patients underwent pharyngo-laryngeal fibroscopy. The patients were divided into two subgroups: Group A (18 patients < 6 months of age) and Group B (14 patients > 6 months). All the patients tested positive for GER with a mean Reflux Index of 21.5. The most common symptoms in Group A were apnea-cianosis and stridor while they were chronic cough for group B. The present study confirms the association between GER and respiratory disease and between GER respiratory-related symptoms and patient age. Emphasis is placed on the importance of otolaryngological diagnostic procedures and 24-hour pH-gastroesophageal monitoring in evaluating patients with respiratory disorders related to silent GER.

[Gastric mucosa changes caused by anti-inflammatory agents in childhood]. / Alterazioni mucosali gastriche da assunzione di farmaci antinfiammatori in età pediatrica.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are very commonly prescribed. Morbidity and mortality from nonsteroidal anti-inflammatory drugs (NSAID) and steroids continue to be a significant health problem. In this paper are reported: 1) the biological insights into injurious effects of NSAIDs and steroids on mucosal protection and repair; 2) our clinical experience in the diagnosis and the management of children affected by secondary ulcer disease induced by therapeutic doses of NSAIDs and steroids; 3) the guidelines in the prevention of the NSAIDs and steroids-induced gastric damage.

[Treatment of acute respiratory infections in childhood with a new cephalosporin, ceftriaxone]. / Trattamento delle infezioni acute respiratorie in età pediatrica con una nuova cefalosporina, il ceftriaxone.

Results of the comparison between tobramicine and ceftriaxone (new long-acting 3rd generation cephalosporin) in the treatment of pediatric acute respiratory tract infections are referred. Treatment with ceftriaxone is judged more advantageous both for efficacy and for saving the number of administered doses.