Does having a rotator cuff repair prior to reverse total shoulder arthroplasty influence the outcome?

AIMS: The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. PATIENTS AND METHODS: All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair. RESULTS: The study group included 45 patients. Their mean age was 69 years (sd 8.6) and 27 patients (60%) were women. The mean ASES score improved from 43.1 to 76.6 two years postoperatively, and to 66.9 five years postoperatively. There was no significant difference between the outcomes at two years in the two groups (all p ≥ 0.05), although there was significantly more improvement in ASES scores in the control group (44.5 vs 33.4; p = 0.01). However, there was no significant difference between ASES scores at two and five years when baseline ASES scores were matched in the two groups (p = 0.42 at two years; p = 0.35 at five years). CONCLUSION: Significant improvements in ASES scores were seen following RSA in patients who had previously undergone rotator cuff repair. They had higher baseline ASES scores than those who had not previously undergone this surgery. However, there was no significant difference in outcomes between the two groups, two years postoperatively. Previous rotator cuff repair does not appear to affect the early outcome after RSA adversely.

Mucoid degeneration of the anterior cruciate ligament.

A case of intraligamentous mucoid degeneration of the anteromedial band of the anterior cruciate ligament (ACL) is presented. The patient had knee pain without clinical or diagnostic evidence of instability. Isolated debridement of the anteromedial band resulted in immediate pain relief with rapid return to athletic activities without instability. We present this case to demonstrate the presence of intraligamentous mucoid degeneration in the ACL as a source of knee pain without instability. Partial ACL debridement did not preclude adequate knee stability.

Pretibial cyst formation after anterior cruciate ligament surgery with soft tissue autografts.

Four cases of subcutaneous pretibial ganglion, with direct communication to the tibial tunnel after autologous reconstruction of the anterior cruciate ligament (ACL) with hamstrings or iliotibial band, are reported. Tibial graft fixation was with a staple in three cases, and with a screw and soft tissue washer in one. The average time to ganglion development was 44 months, and all occurred more than 2 years after ACL surgery. At the time of cyst development, no patient had subjective or objective knee instability. No patient had evidence of tibial tunnel enlargement. All ganglion communicated with the tibial tunnel. This communication was shown with magnetic resonance imaging in two cases, which showed the origin at the joint. Three patients elected to have the ganglion removed; in each of these there was a direct communication with the tibial tunnel. Additionally, hardware was removed in all cases, and local autologous bone grafting of the tibial tunnel aperture was done in two. Minimum follow-up after surgical excision was 2 years, without evidence of recurrence.