Which Factors Are Associated With Rerupture After Superior Capsular Reconstruction of the Shoulder With Autologous Long Biceps Tendon? - A Systematic Review. / Welche Faktoren sind mit einer Reruptur nach superiorer Kapselrekonstruktion der Schulter mit autologer langer Bizepssehne assoziiert? ­ Ein systematischer Review.

Based on a systematic review, the present work analyses factors associated with the rerupture rate or non-healing after superior capsular reconstruction with autologous long biceps tendon in the reconstruction of the rotator cuff of the shoulder.A systematic review of the U.S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was conducted in September 2021 using the PRISMA checklist. Articles were identified and analysed that contained data on the rerupture rate after superior capsular reconstruction with autologous long biceps tendon in reconstruction of the rotator cuff of the shoulder. The aim was to identify factors associated with rerupture or non-healing. The risk of bias was determined using the Newcastle-Ottawa scale.Primarily 86 hits could be generated. Seven articles from 2020 and 2021 met the inclusion criteria and were further analysed in terms of content. The evidence level was III to IV. Follow-up was between 12 (minimum) and 24 to 48 months. The risk of bias was not low. Factors that may be associated with rerupture or non-healing are diabetes mellitus and high-grade fatty degeneration of the subscapularis, infraspinatus, or teres minor as preoperative factors. Age, percent footprint coverage, tear size, symptom duration, number of bundles, acromioplasty performed, and tear configuration were not significant factors. Gender, degree of fatty degeneration of the supraspinatus and lesions of the subscapularis tendon were rated differently.According to the literature, but still currently with short-term observation periods, superior capsular reconstruction with an autologous long biceps tendon is another treatment option in the case of massive tears and elderly patients, if there is no high-grade fatty degeneration of the subscapularis, infraspinatus or teres minor. Diabetes mellitus has an unfavorable prognosis. Additional acromioplasty has so far not been associated with better outcomes.

Mesenchymal stem cell implantation provides short-term clinical improvement and satisfactory cartilage restoration in patients with knee osteoarthritis but the evidence is limited: a systematic review performed by the early-osteoarthritis group of ESSKA-European knee associates section.

PURPOSE: Implantation of mesenchymal stem cells (MSCs) is a potential cell-based modality for cartilage repair. Currently, its clinical use largely surrounds focal cartilage defect repair and intra-articular injections in knee osteoarthritis. The MSCs' implantation efficacy as a treatment option for osteoarthritis remains contentious. This systematic review aims to evaluate studies that focused on MSCs implantation in patients with knee OA to provide a summary of this treatment option outcomes. METHODS: A systematic search was performed in PubMed (Medline), Scopus, Cinahl, and the Cochrane Library. Original studies investigating outcomes of MSCs implantations in patients with knee OA were included. Data on clinical outcomes using subjective scores, radiological outcomes, and second-look arthroscopy gradings were extracted. RESULTS: Nine studies were included in this review. In all included studies, clinical outcome scores revealed significantly improved functionality and better postoperative pain scores at 2-3 years follow-up. Improved cartilage volume and quality at the lesion site was observed in five studies that included a postoperative magnetic resonance imaging assessment and studies that performed second-look arthroscopy. No major complications or tumorigenesis occurred. Outcomes were consistent in both single MSCs implantation and concurrent HTO with MSCs implantation in cases with excessive varus deformity. CONCLUSION: According to the available literature, MSCs implantation in patients with mild to moderate knee osteoarthritis is safe and provides short-term clinical improvement and satisfactory cartilage restoration, either as a standalone procedure or combined with HTO in cases with axial deformity. However, the evidence is limited due to the high heterogeneity among studies and the insufficient number of studies including a control group and mid-term outcomes. LEVEL OF EVIDENCE: IV.

Risk Analysis of Perioperative Injections in Arthroscopic Reconstruction of the Rotator Cuff of the Shoulder - A Systematic Review. / Risikoanalyse perioperativer Infiltrationen bei arthroskopischer Rotatorenmanschettennaht der Schulter ­ ein systematischer Review.

BACKGROUND: The present study used a systematic review to analyse the risk of perioperative injections during arthroscopic reconstruction of the rotator cuff of the shoulder. The questions of interest were whether perioperative local injection increases the infection risk and whether the number of postoperative revisions is increased. MATERIAL AND METHODS: A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The keywords used were "shoulder" and "arthroscopy" and "injection" and "risk". In the course of the study, work that was not also primarily concerned with the reconstruction of the rotator cuff was excluded. English original articles and case series were included that contained at least some arthroscopic reconstructions of the rotator cuff. The risk of bias was determined using the Newcastle-Ottawa Scale. The content of the articles relevant to the research questions was analysed. RESULTS: 48 hits were primarily generated. 9 articles corresponded to the inclusion criteria and were analysed. In the 6 studies with details on the injected substances, cortisone was used in 98 - 100% of the cases. The reported infection and revision rates based on insurance data were higher with injection than without. The risk of bias in the studies analysed here was rather low based on the Newcastle-Ottawa Score. The risk of infection after a cortisone injection before, during or after surgery was increased. Injection was associated with infection in up to 8% of cases with injections within two weeks of surgery. The risk of infection was increased by up to 11 times with injections within 4 weeks after the operation. Likewise, the risk of revision surgery after injection was increased, with the time intervals between injection and surgery sometimes differing between studies. DISCUSSION: Local infections and to a lesser extent revision surgery are associated with perioperative injections (with cortisone) within 3 months preoperatively and 4 weeks postoperatively. However, there were only database studies of insurance data with several studies from a few centres. Thus, no causal relationships could be proven. Currently, however, the following can be recommended using a cautious approach: The interval between injection with cortisone before surgery should be at least 2 weeks, better 3 months. No cortisone injections should be applied intraoperatively. Postoperatively, cortisone should not be injected for at least 4 weeks. If, in exceptional cases, deviations from these time limits are required, patients should be informed about an increased risk of complications.

Motor Recovery of the Suprascapular Nerve after Arthroscopic Decompression in the Scapular Notch - a Systematic Review. / Die motorische Erholung der Rotatorenmanschette nach arthroskopischer proximaler Dekompression des N. suprascapularis in der Incisura scapulae ­ ein systematischer Review.

BACKGROUND: The suprascapular nerve can be compromised as a result of a compression syndrome in different locations. A (proximal) compression within the scapular notch can lead to dorsal shoulder pain and simultaneous weakness of the infraspinatus and supraspinatus muscles. By transection of the lig. transversum this compression syndrome can be treated. By means of a systematic review, the present work analyzes the motor recovery potential after arthroscopic decompression. MATERIAL AND METHODS: A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The search words used were "suprascapular" and "arthroscopic"; "suprascapular" and "arthroscopy". Based on the evaluated literature, articles in English with at least a partial arthroscopic case series from 4 cases on and a compression syndrome of the suprascapular nerve treated with arthroscopic decompression in the scapular notch were identified. Motor recovery was described by means of EMG, clinical strength and MRI. RESULTS: Primarily 408 hits were generated. Six articles met the inclusion criteria and were further analyzed. The number of arthroscopic cases was between 4 and a maximum of 27. The level of evidence was between III and IV. The majority of the reported clinical results were good. Motor recovery as measured by EMG was observed, recovery of full strength was not achieved in the majority of reported cases (60%), neither was regression of structural (fatty) degeneration of the muscle bellies. CONCLUSION: Arthroscopic decompression of the suprascapular nerve in the scapular notch provides good clinical results and considerable pain relief. However, in the majority of cases it does not lead to a complete recovery of the strength of the supra- and infraspinatus muscles. Patients should be informed about this. An early decompression after diagnosis in the event of proximal compression within the suprascapular notch combined with beginning EMG or MRI changes appears reasonable. These beginning changes should be further defined. Future studies should develop prognostic criteria for motor recovery. Awareness regarding the diagnosis needs to be improved due to the probably time-dependent irreversibility of resulting muscular weakness.

Using the Oxford Foot Model to determine the association between objective measures of foot function and results of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index: a prospective gait analysis study in Germany.

OBJECTIVE: After cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction. DESIGN AND PARTICIPANTS: Results of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies.Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination 'translated' into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items. RESULTS: Objective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score-as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function-compared with the FFI-D score.Factor analysis, however, could not identify FFI-D items consistently related to these three indicator parameters (pain, disability and function) found in the AOFAS-AHS. Furthermore, factor analysis did not support stratification of the FFI-D into two subscales. CONCLUSIONS: The AOFAS-AHS showed a good agreement with objective gait parameters and is therefore better suited to evaluate disability and functional limitations of patients suffering from foot and ankle pathologies compared with the FFI-D.

Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement.

BACKGROUND: Aseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement. MATERIALS AND METHODS: A consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic. RESULTS: Twenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher's exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003). CONCLUSIONS: Smoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement. LEVEL OF EVIDENCE: Level 4 according to Oxford Centre of Evidence-Based Medicine 2011.

Midterm Outcome after Mega-Prosthesis Implanted in Patients with Bony Defects in Cases of Revision Compared to Patients with Malignant Tumors.

Use of mega-prostheses is a common option for the treatment of patients with malignant tumors as well as in patients with large osseous defects at the time of revision surgery. No studies have compared the two groups to determine whether there is a relative difference in clinical outcomes. We performed a midterm-outcome-study to evaluate our results in these two patient populations. Deep infection was found more often in our revision group (29.5% vs. 9.1%), however no significant differences in WOMAC-results could be found between the two groups. Surgeons should recognize the high complication rate as well as the differences in results using mega-prostheses in these two distinct groups of patients.

Advances in biology and mechanics of rotator cuff repair.

UNLABELLED: High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair. LEVEL OF EVIDENCE: Expert opinion, Level V.

Analysis of agreement between the German translation of the American Foot and Ankle Society's Ankle and Hindfoot Scale (AOFAS-AHS) and the Foot Function Index in its validated German translation by Naal et al. (FFI-D).

BACKGROUND: Despite its wide use in clinical outcome measurement, there is yet no validated German language version of the AOFAS-AHS available. After finishing cross-cultural adaption of the AOFAS-AHS according to the AAOS guidelines, an analysis of agreement was carried out. METHODS: This was done by means of the 18-item Foot Function Index in its validated German translation by Naal et al. (FFI-D). The results of 91 orthopedic patients as well as healthy persons in both scores were then compared intraindividually. The cohort consisted of 46 individuals with hindfoot disorders and 45 persons without any hindfoot complaints. The FFI-D-Score was linearly transformed in the range 0-100 points of the AOFAS. RESULTS: Encouraging correlation was then found for the patients with hindfoot disorders (Spearman's correlation 0.73 (95% CI 0.52-0.85); a median deviation of -2 points (interquartile range -13 points; +13 points) in patients with hindfoot disorders implied good median intraindividual score concordance. However, with 30 of these 46 patients showing score deviations beyond or below a pre-specified ±10 points range of clinically tolerable deviations, the scores cannot be considered exchangeable. CONCLUSION: Although the agreement analysis was performed for the German translation of the two questionnaires, analogous results can be expected also for other languages. It should be noted that the results do not allow for judging which of the scores is better suited to give a valid statement on patient outcome in treatment of hindfoot disorders. To verify which of these two scores is better suited to represent hindfoot-dysfunction a subsequent study using instrumental gait analysis and surface EMG is being carried out.

Cartilage repair techniques of the talus: An update.

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

Biomechanical and magnetic resonance imaging evaluation of a single- and double-row rotator cuff repair in an in vivo sheep model.

PURPOSE: To investigate the biomechanical and magnetic resonance imaging (MRI)-derived morphologic changes between single- and double-row rotator cuff repair at different time points after fixation. METHODS: Eighteen mature female sheep were randomly assigned to either a single-row treatment group using arthroscopic Mason-Allen stitches or a double-row treatment group using a combination of arthroscopic Mason-Allen and mattress stitches. Each group was analyzed at 1 of 3 survival points (6 weeks, 12 weeks, and 26 weeks). We evaluated the integrity of the cuff repair using MRI and biomechanical properties using a mechanical testing machine. RESULTS: The mean load to failure was significantly higher in the double-row group compared with the single-row group at 6 and 12 weeks (P = .018 and P = .002, respectively). At 26 weeks, the differences were not statistically significant (P = .080). However, the double-row group achieved a mean load to failure similar to that of a healthy infraspinatus tendon, whereas the single-row group reached only 70% of the load of a healthy infraspinatus tendon. No significant morphologic differences were observed based on the MRI results. CONCLUSIONS: This study confirms that in an acute repair model, double-row repair may enhance the speed of mechanical recovery of the tendon-bone complex when compared with single-row repair in the early postoperative period. CLINICAL RELEVANCE: Double-row rotator cuff repair enables higher mechanical strength that is especially sustained during the early recovery period and may therefore improve clinical outcome.

Necrotizing fasciitis of the knee following primary total knee arthroplasty.

Necrotizing fasciitis is a rare, life-threatening and rapidly spreading soft-tissue infection that results in necrosis of the muscle, fascia and surrounding tissue. It can be result of a polymicrobial synergistic infection or a streptococcal infection. The authors report a case of necrotizing fasciitis occurring in the knee of a 65-year-old woman following an uneventful primary total knee arthroplasty and resulting in above-the-knee amputation. Having in mind severe infections like necrotising fasciitis, one should be aware of the possibility of such postoperative complications especially in patients with risk factors even in routine procedures like a total knee arthroplasty.

Surgical management of sternoclavicular septic arthritis.

INTRODUCTION: Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition and has many diagnostic and therapeutic standards. The purpose of this study was to evaluate our experience with surgical and diagnostic management to provide a surgical pathway to help surgeons treat this disease. METHOD: We retrospectively reviewed five patients who were managed surgically between 1999 and 2007. All patients underwent structured diagnostic and treatment protocols. The functional outcome was evaluated using the Constant Score. PATIENTS: The patients had the following underlying medical conditions: laryngeal cancer, port-explantation linked to a rectum carcinoma, spondylodiscitis, and brain stem infarct with reduced general condition; one patient had no underlying medical problems. Three patients underwent a simple incision, debridement and drainage, and two patients underwent an extended intervention with partial resection of the sternoclavicular joint. The mean duration of follow-up was 29 months (range 24-36 months). All patients had well-healed wounds without signs of reinfection. The Constant Score for the functional outcome at the time of the last follow-up was 76 points (range 67-93 points). All patients recovered completely from SCJ disease. CONCLUSION: Our recommendations for the management of septic arthritis of the sternoclavicular joint include standard treatment steps and assessments. The early stages of infection can be managed by simple incision, debridement and drainage. In advanced stages of infection, a more radical intervention is preferable.

Septic arthritis of the shoulder joint: an analysis of management and outcome.

We retrospectively reviewed the records of 21 patients (23 shoulders) who underwent surgical treatment for septic arthritis of the shoulder joint, between 2000 and 2007. Patients were on average 63.7 (41-85) years old; they were treated either by arthroscopic debridement (12 shoulders) or by combined arthroscopic and open procedures (11 shoulders). The mean duration of symptoms prior to surgery was 16 (5-76) days. The mean Constant score recorded at the last follow-up - on average 353 months (25-43) after surgery - was 73 (46-82) points. Patients with symptoms for two weeks or less prior to surgery had better results and a lower re-operation rate than those with symptoms longer than two weeks. Early infection can be managed arthroscopically, and satisfactory results can be expected. In advanced infection, a more radical approach is more appropriate.

Tendon-bone contact pressure and biomechanical evaluation of a modified suture-bridge technique for rotator cuff repair.

The aim of the study was to evaluate the time-zero mechanical and footprint properties of a suture-bridge technique for rotator cuff repair in an animal model. Thirty fresh-frozen sheep shoulders were randomly assigned among three investigation groups: (1) cyclic loading, (2) load-to-failure testing, and (3) tendon-bone interface contact pressure measurement. Shoulders were cyclically loaded from 10 to 180 N and displacement to gap formation of 5- and 10-mm at the repair site. Cycles to failure were determined. Additionally, the ultimate tensile strength and stiffness were verified along with the mode of failure. The average contact pressure and pressure pattern were investigated using a pressure-sensitive film system. All of the specimens resisted against 3,000 cycles and none of them reached a gap formation of 10 mm. The number of cycles to 5-mm gap formation was 2,884.5 + or - 96.8 cycles. The ultimate tensile strength was 565.8 + or - 17.8 N and stiffness was 173.7 + or - 9.9 N/mm. The entire specimen presented a unique mode of failure as it is well known in using high strength sutures by pulling them through the tendon. We observed a mean contact pressure of 1.19 + or - 0.03 MPa, applied on the footprint area. The fundamental results of our study support the use of a suture-bridge technique for optimising the conditions of the healing biology of a reconstructed rotator cuff tendon. Nevertheless, an individual estimation has to be done if using the suture-bridge technique clinically. Further investigation is necessary to evaluate the cell biological healing process in order to achieve further sufficient advancements in rotator cuff repair.

Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques.

The aim of the study was to evaluate the time zero contact pressure over a defined rotator cuff footprint using different repair and stitch techniques in an established sheep model. Forty fresh-frozen sheep shoulders were randomly assigned to five repair groups: single-row repair using simple stitches (SRA-s), single-row repair using horizontal mattress stitches (SRA-m), and single-row repair using arthroscopic Mason-Allen stitches (SRA-ama). Double-row repair was either performed with a combination of simple and horizontal mattress stitches (DRA-sm) or with arthroscopic Mason-Allen/horizontal mattress stitches (DRA-amam). Investigations were performed using a pressure-sensitive film system. The average contact pressure and pressure pattern were measured for each group. Contact pressure was lowest in SRA-m followed by SRA-s. SRA-ama showed highest contact pressure of all single-row treatment groups (P < 0.05). DRA-amam presented the highest overall contact pressure (P < 0.05), whereas DRA-sm exerted contact pressure equal to that of SRA-ama. Both double-row techniques showed the most expanded pressure pattern. Average contact pressures for the more complex single- and double-row techniques utilizing arthroscopic Mason-Allen stitches were greater than were those of the repair techniques utilizing simple and horizontal mattress stitches. However, the contact pattern between the anchors could be increased by using the double-row technique, resulting in more footprint coverage compared to patterns utilizing the single-row techniques. These results support the use of the more complex arthroscopic Mason-Allen stitches and may improve the environment for healing of the repaired rotator cuff tendon.

Biomechanical evaluation of rotator cuff repairs in a sheep model: suture anchors using arthroscopic Mason-Allen stitches compared with transosseous sutures using traditional modified Mason-Allen stitches.

BACKGROUND: The optimal method for rotator cuff repair of the shoulder is not yet known. The aim of this study was to compare the time-dependent biomechanical properties of the traditional open transosseous suture technique and modified Mason-Allen stitches (group 1) versus the double-loaded suture anchors technique and so-called arthroscopic Mason-Allen stitches (group 2) in rotator cuff repair. METHODS: Eighteen adult female sheep were randomized into two groups: in an open approach in which the released infraspinatus tendon was repaired with group 1, and with group 2. Animals were sacrificed at 6, 12, or 26 weeks; shoulders were harvested and magnetic resonance imaging was performed. Eight untreated contralateral shoulders served as controls. Tendons of 16 additional unpaired cadaver shoulder joints of adult female sheep were identically treated for analysis at time zero. In a biomechanical evaluation all specimens were loaded to failure at a constant displacement rate using a standard universal testing machine. The load-to-failure and stiffness of the healed bone-tendon interface were calculated. RESULTS: Magnetic resonance imaging analysis showed cuff integrity in all cases, and no evidence of foreign body reaction to the anchors. Load-to-failure and stiffness data did not indicate any significant difference between the two treatment groups, neither at 6 weeks nor at 12 or 26 weeks. However, at time zero the group 2 had a higher load-to-failure in comparison to the group 1 (P<0.010), but there was no difference for the stiffness (P<0.121). CONCLUSIONS: This in vivo study showed that, postoperatively, the group 2 technique provides superior stability and after healing would gain strength comparable to the group 1 technique.

The surgical technique of autologous chondrocyte transplantation of the talus with use of a periosteal graft. Surgical technique.

BACKGROUND: Despite its highly specialized nature, articular cartilage has a poor reparative capability. Treatment of symptomatic osteochondral defects of the talus has been especially difficult until now. METHODS: We performed autologous chondrocyte transplantation in twelve patients with a focal deep cartilage lesion of the talus. There were seven female and five male patients with a mean age of 29.7 years. The mean size of the lesion was 2.3 cm(2). All patients were studied prospectively. Evaluation was performed with use of the Hannover ankle rating score, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a visual analog scale for pain, and magnetic resonance imaging. RESULTS: All patients were available for follow-up at a mean of sixty-three months. There was a significant improvement in the Hannover score, from 40.4 points preoperatively to 85.5 points at the follow-up examination, with seven excellent results, four good results, and one satisfactory result. The AOFAS mean score was 88.4 points compared with 43.5 points preoperatively. Magnetic resonance imaging showed a nearly congruent joint surface in seven patients, discrete irregularities in four, and an incongruent surface in one. The patients who had been involved in competitive sports were able to return to their full activity level. CONCLUSIONS: The promising clinical results of this study suggest that autologous chondrocyte transplantation is an effective and safe way to treat symptomatic osteochondral defects of the talus in appropriately selected patients.

Biomechanical comparison of double-loaded suture anchors using arthroscopic Mason-Allen stitches versus traditional transosseous suture technique and modified Mason-Allen stitches for rotator cuff repair.

BACKGROUND: In recent studies objective evaluations have demonstrated that arthroscopic rotator cuff repairs can have higher failure rates than open repairs. Thus, there is a need for a stronger tissue-holding stitch for arthroscopical repair. The purpose of this study was to compare the biomechanical properties of traditional open transosseous suture technique and modified Mason-Allen stitches versus double-loaded suture anchors and arthroscopic Mason-Allen stitches in rotator cuff repair. METHODS: In 20 sheep shoulders the infraspinatus tendons were dissected from their insertion and were randomized to 2 repair groups: (1) repair with transosseous suture and modified Mason-Allen stitches, (2) repair with double loaded bioabsorbable suture anchors and arthroscopic Mason-Allen stitches: Both groups were coupled with braided, nonabsorbable polyester (Ethibond) suture sized USP No. 2. All repairs were cyclically loaded from 10 to 180N with the use of a materials testing machine. The number of cycles to gap formation of 5 and 10mm at the repair site and the mode of failure were recorded. RESULTS: The number of cycles to 5-mm gap was mean 634 (SD 106) for group 1 and mean 750 (SD 107) for group 2 (P<0.026). The corresponding values to 10-mm gap were mean 1573 (SD 161) for group 1, and mean 1789 (SD 183 cycles) for group 2 (P<0.012). In group 2 the mode of failure occurred by tissue pull-out, whereas in group 1 the failure occurred by a mixture of suture breakage and pull-out. CONCLUSIONS: This time-zero study demonstrates that the combination of bioabsorbable suture anchors and arthroscopic Mason-Allen stitches provides strength superior to that of the modified Mason-Allen transosseous suture technique under isometric cyclic loading conditions. However, additional evaluation is needed to examine the effects on the sustained strength of the repair throughout the healing process.

Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors.

INTRODUCTION: The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. MATERIALS AND METHODS: Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent arthroscopy by a single surgeon. The preoperative diagnosis was based on the clinical examination and MRI. Their mean age was 69 years (range 62-79 years), and the average follow-up was 31 months (range 24-46 months). If indicated, the performed arthroscopic debridement included acromioplasty, debridement of the cuff, resection of the distal part of the clavicle or tenotomy of the long head of the biceps. In 28 cases (85%) acromioplasties and in 6 cases (18%) biceps tenotomies were performed, 2 of which were a single tenotomy without any associated acromioplasty. One patient had been managed with concomitant resection of the distal part of the clavicle. RESULTS: The Constant and Murley Score improved by a mean of 30 points, from a mean of 37 points (range 21-52) preoperatively to a mean of 67 points (range 31-82) at the time of follow-up. Some 82% of the patients were satisfied with the procedure. The result was considered unsatisfactory because of inadequate pain relief in 4 shoulders, because of limited active abduction in 1 and because of limited external rotation in 1. A poor outcome was associated with a complete tear of the subscapularis tendon in 6 patients. The radiological study showed no significant narrowing of the subacromial space. CONCLUSION: Our early results suggest that arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands. However, its long-term consequences remain to be evaluated by studies with lengthy follow-up. Prognostic factors that may lead to a negative outcome are preoperative superior migration of the humeral head, presence of subscapularis tear, presence of glenohumeral arthritis and decreased range of motion.