Partial Articular Supraspinatus Tendon Avulsion Repair and Patch: A Technical Note for Augmenting the Supraspinatus Reinsertion with the Long Head of the Biceps Tendon.

BACKGROUND: There is no clear consensus on the treatment of partial articular-sided supraspinatus tendon avulsions. Debridement alone might not be sufficient to prevent further tendon degradation or alleviate patient complaints. Direct repair using a suture anchor without treating the concomitant conditions of the long head of the biceps tendon might come with residual anterior shoulder pain or even further loss of function in cases of failed repair. The purpose of the present study is to describe an arthroscopic technique by which the long head of the biceps tendon can be included in the partial articular-sided supraspinatus tendon avulsion repair. TECHNIQUE PRESENTATION WITH VIDEO: In this technical note we describe the arthroscopic repair and augmentation with tenotomized biceps of partial supraspinatus tendon tears to address three main concepts for successful rotator cuff repairs, namely rotator cuff biologic augmentation, tendon to bone healing and postoperative pain prevention. CONCLUSION: The biceps tendon is a mechanically robust, locally available autograft that can be used in borderline partial articular-sided supraspinatus tendon avulsions in order to biologically augment healing at the tendon-bone interface without any immunogenic reactions or morbidity following harvesting.

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III-indications for different clinical scenarios using the RAND/UCLA appropriateness method.

PURPOSE: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev). METHODS: The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks. Through a two-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1-3 was considered 'inappropriate', 4-6 'uncertain', and 7-9 'appropriate'). RESULTS: The criteria used to define the scenarios were: age (18-35 years vs 36-50 years vs 51-60 years), sports activity and expectation (Tegner 0-3 vs 4-6 vs 7-10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren-Lawrence [KL] grade 0-I-II vs grade III). Based on these variables, a set of 108 clinical scenarios was developed. ACLRev was considered appropriate in 58%, inappropriate in 12% (meaning conservative treatment is indicated), and uncertain in 30%. Experts considered ACLRev appropriate for patients with instability symptoms, aged ≤ 50 years, regardless of sports activity level, meniscus status, and OA grade. Results were much more controversial in patients without instability symptoms, while higher inappropriateness was related to scenarios with older age (51-60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III). CONCLUSION: This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria and provides a useful reference for clinical practice in determining treatment indications. LEVEL OF EVIDENCE: II.

[Efficiency of arthroscopic treatment in the knee osteoarthritis]. / Artroskopine operacija gali atitolinti kelio sanario endoprotezavima.

UNLABELLED: THE AIM OF THE STUDY was to estimate the effectiveness of arthroscopic operations for patients suffering from knee osteoarthritis; to determine if it is possible to decrease pain, increase range of motions and mobility function. MATERIAL AND METHODS: The subjects of the study were patients with grade III and grade IV with knee osteoarthritis (Outerbridge classification), who underwent arthroscopic operations at Kaunas Red Cross Hospital in 1993-2000. They were followed after arthroscopic operations: debridement, partial synovectomy, meniscus resection and elimination of free bodies. Two hundred eighteen patients were examined by questionnaire; 137 (62.8%) were females and 81 (37.2%) were males. The age range was from 19 till 77 years (average 53.09 years). Follow-up was 1-8 years (average 2.56 years). We estimated knee score and function score pre-op and 0.5 year, 1 year, 3 years and more than 3 years post-op. RESULTS: Six months post-op 58.3% of patients were satisfied, 41.7% had no changes or even worsened. One year post-op 77.5% of patients were satisfied; 3 years post-op 64 patients were followed, 78.1% were satisfied; more than 3 years post-op 45 patients were followed, 82.2% were satisfied. The results six months post-op are as following: 33.9% very good, 38.1% good, 22.9% satisfactory and 5.1% bad. One year post-op the very good and good results increased. Only 64 patients were followed-up three years post-op; 64.1% had very good results and 25.0% had good results, satisfactory and bad results were in the range of 10.9%. The shorter time till arthroscopic intervention and performing arthroscopic debridement gave positive influence on good and very good results. Instability due to ACL rupture, big osteophytes, subchondral sclerosis, valgus deformation and grade III-IV patellofemoral cartilage changes gave worse results. Synovectomy had no influence on the results. CONCLUSIONS: Arthroscopy is a minimally invasive palliative intervention for the patients with the knee osteoarthritis.

[Knee joint evaluation after anterior cruciate ligament plasty]. / Kelio sanario bukles vertinimas po priekinio kryzminio raiscio plastikos.

AIM OF THE STUDY: To make certain how the patients themselves evaluate the state of their knee joint and check-up the state objectively after 3, 6, 12 months period after the anterior cruciate ligament reconstruction. MATERIALS AND METHODS: In 1996-2001 there were performed 78 anterior cruciate ligament reconstruction operations. Twenty one patient was chosen. The patients were questioned according to subjective IKDC (International Knee Documentation Committee) form, 12 months after the anterior cruciate ligament reconstruction. To have an objective evaluation, the patients had to come to the control check-up in 3, 6 and 12 months after the operation. During the clinical check-up the objective IKDC form was being used. RESULTS: According to subjective IKDC formula: for six patients (29%) the results were very good; for seven patients (33%)--good; for seven patients (33%)--satisfactory; for one patient (5%)--bad. The objective data showed that the state of the knee joint before the operation was bad or satisfactory. Now to 90% of the patients the state of the knee joint is very good; 10% evaluate it as good. For all patients (100%) the instability of the knee joint disappeared. CONCLUSIONS: For all questioned patients the instability of the knee joint after the anterior cruciate ligament reconstruction disappeared; 95% patients are satisfied with the results of the operation.