Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment.

BACKGROUND: Reports of return to shoulder-dependent sport after surgical stabilization previously underestimated impairments, which were not reflected in the score systems used. HYPOTHESIS: Return to shoulder-dependent sport depends on the type of sport performed. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty-seven athletes (26.9 years of age at surgery) who underwent isolated arthroscopic Bankart repair were longitudinally monitored by shoulder-dependent sport-specific activity (Shoulder Sport Activity Score [SSAS]) and ability (Athletic Shoulder Outcome Scoring System [ASOSS]) scores and visual analog scales for reachieved proficiency level, sport-specific shoulder pain, and functional deficits. Data were assessed at 4 points of treatment: preoperatively, and postoperatively after 6, 16, and 32 months (P0-P3). Athletes were analyzed separately according to shoulder sport: noncollision/nonoverhead (G1), collision (G2), overhead (G3), and martial arts (G4). RESULTS: The G1 and G2 athletes had re-achieved the preinjury sport activity and sport proficiency status and excellent ASOSS scores after 32 months (SSAS(G1) = 7.2, SSAS(G2) = 8.1, ASOSS(G1) = 94.4, ASOSS(G2) = 95.2), whereas G3 and G4 athletes remained at an inferior activity level (SSAS(G3) = 8.0, SSAS(G4) = 8.3) and proficiency level. The ASOSS documented a prolonged period of shoulder rehabilitation for G3 and G4 athletes to reach a good shoulder-dependent sport ability outcome after 32 months (ASOSS(G3) = 89.0, ASOSS(G4) = 93.1). All groups recorded persisting limitations in visual analog scales for sport-specific shoulder function and pain. The established scores (Rowe = 95.9, Walch-Duplay = 93.3, Constant = 94.0) did not reflect these sport-specific impairments. Athletes with 5 or more preoperative dislocations had significantly longer surgery-to-sport resumption intervals with a prolonged proficiency recovery. CONCLUSION: The athletes' shoulder stabilization resulted in a prolonged rehabilitation depending on the functional demand of the performed shoulder-dependent sport, as shown by the specific shoulder sport score systems.

Functionalized, biocompatible coating for superparamagnetic nanoparticles by controlled polymerization of a thioglycosidic monomer.

It is demonstrated that water-soluble, glucosylated poly(pentafluorostyrene) derivatives revealed favorable coating material properties for magnetic iron oxide nanoparticles. To prepare the coating material in high reproducibility and purity as well as in sufficient amounts, a new route of synthesis is established. The preparation and characterization of the glucosylated, tetrafluorostyryl monomer, by thiol-para-fluorine "click" reaction, and its polymerization, via nitroxide-mediated radical process, is presented in detail. In addition, the coating material and the resulting particle properties are investigated by means of XPS, DLS, TGA, TEM, and cryo-TEM as well as flow cytometry. The glycopolymer acts as an appropriate stabilizing agent for the superparamagnetic nanoparticles by the formation of an approximately 10 nm thick shell, as shown by the XPS analysis. Furthermore, the application of FITC-labeled glycopolymer yielded fluorescent, superparamagnetic nanoparticles, which can be used for monitoring cell-carbohydrate interactions, because these particles show no cytotoxicity toward 3T3 fibroblasts.

Replacement of the Meniscus with a Collagen Implant (CMI).

OBJECTIVE: Replacement of an almost completely absent medial meniscus with a collagen implant (CMI), reconstruction of form and function of the medial meniscus, delay of the development of arthrosis deformans. INDICATIONS: Subtotal degenerative or traumatic loss of the medial meniscus, stable meniscal periphery, stable anterior and posterior meniscal insertions, joint with stable ligaments. CONTRAINDICATIONS: Complete loss of the medial meniscus. Untreated knee ligament instability. Extreme varus deformity. Extensive cartilaginous damage, i.e., levels IV and VI as described by Bauer and Jackson. Advanced unicompartmental or generalized arthrosis. Replacement of the lateral meniscus. SURGICAL TECHNIQUE: Standard anterior arthroscopy portals. Resection of the medial meniscus leaving a complete and stable outer rim. Revitalization of the periphery to promote healing. Measurement of defect size. Insertion and fixation of the CMI with nonresorbable suture material in inside-out technique. POSTOPERATIVE MANAGEMENT: Postoperative knee brace with limited motion in extension/flexion of 0/0/60° until week 4, 0/0/90° until week 6. Coutinuous passive motion within the limits of motion from the 1st postoperative day, actively assisted physiotherapy. No weight bearing for 6 weeks, then increased weight bearing for 2 weeks until full weight bearing is achieved. Cycling can commence from 3 months postoperatively. Full sporting activity after 6 months. RESULTS: 60 patients (19-68 years, average 41.6 years) with subtotal loss of the medial meniscus and varus morphotype were treated from January 2001 to May 2004 as part of a prospective, randomized, arthroscopically controlled study. The sample consisted of 30 patients with high tibial valgus osteotomy combined with implantation of a CMI, and 30 patients with valgization correction osteotomy only. The CMI had to be removed from one patient because of a dislocation. Evaluation on the Lysholm Score, IKDC (International Knee Documentation Committee), and subjective pain data revealed only slight, nonsignificant differences for 39 patients after 24 months (CMI and correction n = 23; correction only n = 16). The chondroprotective effect of the CMI in the long term remains to be seen.

[Replacement of the meniscus with a collagen implant (CMI)].

OBJECTIVE: Replacement of an almost completely absent medial meniscus with a collagen implant (CMI), reconstruction of form and function of the medial meniscus, delay of the development of arthrosis deformans. INDICATIONS: Subtotal degenerative or traumatic loss of the medial meniscus, stable meniscal periphery, stable anterior and posterior meniscal insertions, joint with stable ligaments. CONTRAINDICATIONS: Complete loss of the medial meniscus. Untreated knee ligament instability. Extreme varus deformity. Extensive cartilaginous damage, i.e., levels IV and VI as described by Bauer and Jackson. Advanced unicompartmental or generalized arthrosis. Replacement of the lateral meniscus. SURGICAL TECHNIQUE: Standard anterior arthroscopy portals. Resection of the medial meniscus leaving a complete and stable outer rim. Revitalization of the periphery to promote healing. Measurement of defect size. Insertion and fixation of the CMI with nonresorbable suture material in inside-out technique. POSTOPERATIVE MANAGEMENT: Postoperative knee brace with limited motion in extension/ flexion of 0/0/60 degrees until week 4, 0/0/90 degrees until week 6. Continuous passive motion within the limits of motion from the 1st postoperative day, actively assisted physiotherapy. No weight bearing for 6 weeks, then increased weight bearing for 2 weeks until full weight bearing is achieved. Cycling can commence from 3 months postoperatively. Full sporting activity after 6 months. RESULTS: 60 patients (19-68 years, average 41.6 years) with subtotal loss of the medial meniscus and varus morphotype were treated from January 2001 to May 2004 as part of a prospective, randomized, arthroscopically controlled study. The sample consisted of 30 patients with high tibial valgus osteotomy combined with implantation of a CMI, and 30 patients with valgization correction osteotomy only. The CMI had to be removed from one patient because of a dislocation. Evaluation on the Lysholm Score, IKDC (International Knee Documentation Committee), and subjective pain data revealed only slight, nonsignificant differences for 39 patients after 24 months (CMI and correction n = 23; correction only n = 16). The chondroprotective effect of the CMI in the long term remains to be seen.