EVALUATION OF SURGICAL TREATMENT OF ROTATOR CUFF ANTEROSUPERIOR TEARS ARTHROSCOPICALLY.

OBJECTIVE: To evaluate the functional result of arthroscopic treatment in anterosuperior rotator cuff tears. METHODS: Fifty-six patients submitted to arthroscopic repair of anterosuperior rotator cuff tears were evaluated. The follow-up time was five year and five months. All the tears were diagnosed by detailed physical and imaging examination. Statistical analysis was used to compare the preoperative and postoperative results of range of motion and the UCLA score, with Wilcoxon signed-rank test, 5% significance level (p≤0.05), the relationship between the subscapularis tear and postoperative results using the Mann-Whitney test, and between the pain length and the UCLA scale using Spearman's correlation. RESULTS: A statistically significant improvement (p<0.001) was found, comparing the range of motion and the UCLA preoperatively and postoperatively. 39% of the cases were classified as excellent, 33.9% as good, 23.7% as regular and 3.4% as bad results. A statistically significant relationship was found between the subscapularis tear type and the functional state, the pain length and the postoperative UCLA scale. Five complications, four reruptures and one adhesive capsulitis were found. CONCLUSIONS: The arthroscopic treatment for anterosuperior tears presented satisfactory results, with 8.5% of complications. Level of Evidence IV, Case series.

OBJETIVO: Avaliar o resultado funcional do tratamento artroscópico das lesões anterossuperiores do manguito rotado. MÉTODOS: Avaliação de 59 pacientes com lesão anterossuperior submetidos a tratamento cirúrgico. O tempo de seguimento foi de 5,5 anos. As lesões foram diagnosticadas por exame físico e de imagem. A análise estatística comparou os resultados pré e pós-operatórios de amplitude de movimento e da escala da UCLA, com teste de pontos sinalizados de Wilcoxon, nível de significância de 5% (p≤0,05), a relação entre a lesão do subescapular e o pós-operatório pela aplicação do teste de Mann-Whitney, e entre o tempo de dor e a escala da UCLA pela correlação de Spearman. RESULTADOS: Houve melhora estatisticamente significativa (p<0,001) comparando-se a amplitude de movimento e a escala da UCLA nos períodos pré e pós-operatórios. 39% dos casos foram classificados como excelentes resultados, 33,9% bons, 23,7% regulares e 3,4% ruins. Houve relação estatisticamente significativa entre o tipo de lesão do subescapular e o resultado funcional, entre o tempo de dor e a escala da UCLA pós-operatória. Registramos cinco complicações, quatro re-rupturas e uma capsulite adesiva. CONCLUSÃO: O tratamento artroscópico das lesões anterossuperiores apresentou resultados satisfatórios, com 8,5% de complicações. Nível de Evidência IV, Série de Casos.

Evaluation of surgical treatment of rotator cuff anterosuperior tears arthroscopically / Avaliação do tratamento cirúrgico das lesões anterossuperiores do manguito rotador por via artroscópica

ABSTRACT Objective: To evaluate the functional result of arthroscopic treatment in anterosuperior rotator cuff tears. Methods: Fifty-six patients submitted to arthroscopic repair of anterosuperior rotator cuff tears were evaluated. The follow-up time was five year and five months. All the tears were diagnosed by detailed physical and imaging examination. Statistical analysis was used to compare the preoperative and postoperative results of range of motion and the UCLA score, with Wilcoxon signed-rank test, 5% significance level (p≤0.05), the relationship between the subscapularis tear and postoperative results using the Mann-Whitney test, and between the pain length and the UCLA scale using Spearman's correlation. Results: A statistically significant improvement (p<0.001) was found, comparing the range of motion and the UCLA preoperatively and postoperatively. 39% of the cases were classified as excellent, 33.9% as good, 23.7% as regular and 3.4% as bad results. A statistically significant relationship was found between the subscapularis tear type and the functional state, the pain length and the postoperative UCLA scale. Five complications, four reruptures and one adhesive capsulitis were found. Conclusions: The arthroscopic treatment for anterosuperior tears presented satisfactory results, with 8.5% of complications. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar o resultado funcional do tratamento artroscópico das lesões anterossuperiores do manguito rotado. Métodos: Avaliação de 59 pacientes com lesão anterossuperior submetidos a tratamento cirúrgico. O tempo de seguimento foi de 5,5 anos. As lesões foram diagnosticadas por exame físico e de imagem. A análise estatística comparou os resultados pré e pós-operatórios de amplitude de movimento e da escala da UCLA, com teste de pontos sinalizados de Wilcoxon, nível de significância de 5% (p≤0,05), a relação entre a lesão do subescapular e o pós-operatório pela aplicação do teste de Mann-Whitney, e entre o tempo de dor e a escala da UCLA pela correlação de Spearman. Resultados: Houve melhora estatisticamente significativa (p<0,001) comparando-se a amplitude de movimento e a escala da UCLA nos períodos pré e pós-operatórios. 39% dos casos foram classificados como excelentes resultados, 33,9% bons, 23,7% regulares e 3,4% ruins. Houve relação estatisticamente significativa entre o tipo de lesão do subescapular e o resultado funcional, entre o tempo de dor e a escala da UCLA pós-operatória. Registramos cinco complicações, quatro re-rupturas e uma capsulite adesiva. Conclusão: O tratamento artroscópico das lesões anterossuperiores apresentou resultados satisfatórios, com 8,5% de complicações. Nível de Evidência IV, Série de Casos.

Evaluation of surgical treatment of patients with shoulder instability / Avaliação do tratamento cirúrgico artroscópico em pacientes com instabilidade do ombro

ABSTRACT Objective: To evaluate the results of arthroscopic surgery in patients with traumatic anterior shoulder dislocation. Methods: This retrospective study analyzed 76 patients with a mean age of 28 and mean postoperative follow-up period of 62 months. Evaluation consisted of physical examination, and X-rays; results were classified according to the UCLA and Rowe scales. Results: Patients showed decrease of range of motion in all planes, except elevation and lateral rotation with 90º abduction. According to the Rowe score, significant postoperative improvement was found compared with preoperative evaluations, with 89.4% of satisfactory results. According to the UCLA score, good or excellent results were observed in 97.4% of the cases. We found a 6.5% rate of recurrence. Conclusion: Arthroscopic treatment for traumatic anterior shoulder dislocation is effective, as long as indications are used. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar os resultados da cirurgia artroscópica em pacientes com instabilidade traumática anterior do ombro. Métodos: Realizamos um estudo retrospectivo de 76 pacientes, com média etária de 28 anos e tempo médio de seguimento pós-operatório de 62 meses. A avaliação foi feita por meio de exame físico, radiográfico e classificação de resultados segundo as escalas funcionais da UCLA e Rowe. Resultados: Os pacientes apresentaram perda de amplitude de movimento em todos os planos, exceto elevação e rotação lateral em abdução de 90º. Na avaliação da escala de Rowe, observamos, em média, melhora estatisticamente significante dos resultados pós-operatórios comparadas às avaliações pré-operatórias, com 89,4% de resultados satisfatórios. Pela escala UCLA, observamos resultados satisfatórios em 97,4% dos casos. Encontramos um índice de recidiva de 6,5%. Conclusão: A cirurgia artroscópica para o tratamento da instabilidade traumática anterior do ombro é um método eficaz, desde que se respeitem as indicações. Nível de Evidência IV, Série de Casos.

Terrible triad of the elbow: functional results of surgical treatment / Tríade terrível do cotovelo: resultados funcionais do tratamento cirúrgico

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar os resultados funcionais e radiográficos dos pacientes que sofreram lesões do tipo tríade terrível do cotovelo (TTC) e foram tratados cirurgicamente. Métodos: Foram avaliados retrospectivamente 20 pacientes, um caso com lesão bilateral (21 cotovelos), que foram tratados cirurgicamente no período de janeiro de 2004 a julho de 2014. Os resultados funcionais do tratamento foram avaliados pela medida da restauração do arco de movimento (ADM) do cotovelo, de acordo com os escores DASH (Disabilities of the Arm, Shoulder and Hand) e MEPS (Mayo Elbow Performance Score). Além da presença de complicações, avaliou-se osteoartrose e ossificação heterotópica (OH). Resultados: Oito cotovelos (38%) foram submetidos a novo procedimento cirúrgico; observou-se OH em oito cotovelos (38%) e apenas um caso (4%) de artrose grave (tipo IV de Broberg-Morrey). Apesar disso, foram obtidos bons resultados funcionais, DASH de 14,27 e MEPS de 84. E o ADM médio de flexão-extensão foi de 101o (20o e 140o) e de pronação-supinação, 112,85o (0o até 180o). Conclusão: Quando se realiza tratamento sistematizado nas lesões do tipo TTC, mesmo com suas variações, pode-se obter um ADM funcional e escore funcional entre bom e excelente. Nível de Evidência IV, Série de Casos.

EVALUATION OF SURGICAL TREATMENT OF PATIENTS WITH SHOULDER INSTABILITY.

OBJECTIVE: To evaluate the results of arthroscopic surgery in patients with traumatic anterior shoulder dislocation. METHODS: This retrospective study analyzed 76 patients with a mean age of 28 and mean postoperative follow-up period of 62 months. Evaluation consisted of physical examination, and X-rays; results were classified according to the UCLA and Rowe scales. RESULTS: Patients showed decrease of range of motion in all planes, except elevation and lateral rotation with 90º abduction. According to the Rowe score, significant postoperative improvement was found compared with preoperative evaluations, with 89.4% of satisfactory results. According to the UCLA score, good or excellent results were observed in 97.4% of the cases. We found a 6.5% rate of recurrence. CONCLUSION: Arthroscopic treatment for traumatic anterior shoulder dislocation is effective, as long as indications are used. Level of Evidence IV, Case Series.

OBJETIVO: Avaliar os resultados da cirurgia artroscópica em pacientes com instabilidade traumática anterior do ombro. MÉTODOS: Realizamos um estudo retrospectivo de 76 pacientes, com média etária de 28 anos e tempo médio de seguimento pós-operatório de 62 meses. A avaliação foi feita por meio de exame físico, radiográfico e classificação de resultados segundo as escalas funcionais da UCLA e Rowe. RESULTADOS: Os pacientes apresentaram perda de amplitude de movimento em todos os planos, exceto elevação e rotação lateral em abdução de 90º. Na avaliação da escala de Rowe, observamos, em média, melhora estatisticamente significante dos resultados pós-operatórios comparadas às avaliações pré-operatórias, com 89,4% de resultados satisfatórios. Pela escala UCLA, observamos resultados satisfatórios em 97,4% dos casos. Encontramos um índice de recidiva de 6,5%. CONCLUSÃO: A cirurgia artroscópica para o tratamento da instabilidade traumática anterior do ombro é um método eficaz, desde que se respeitem as indicações. Nível de Evidência IV, Série de Casos.

TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT.

OBJECTIVE: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). METHODS: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. RESULTS: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). CONCLUSION: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

OBJETIVO: Avaliar os resultados funcionais e radiográficos dos pacientes que sofreram lesões do tipo tríade terrível do cotovelo (TTC) e foram tratados cirurgicamente. MÉTODOS: Foram avaliados retrospectivamente 20 pacientes, um caso com lesão bilateral (21 cotovelos), que foram tratados cirurgicamente no período de janeiro de 2004 a julho de 2014. Os resultados funcionais do tratamento foram avaliados pela medida da restauração do arco de movimento (ADM) do cotovelo, de acordo com os escores DASH (Disabilities of the Arm, Shoulder and Hand) e MEPS (Mayo Elbow Performance Score). Além da presença de complicações, avaliou-se osteoartrose e ossificação heterotópica (OH). RESULTADOS: Oito cotovelos (38%) foram submetidos a novo procedimento cirúrgico; observou-se OH em oito cotovelos (38%) e apenas um caso (4%) de artrose grave (tipo IV de Broberg-Morrey). Apesar disso, foram obtidos bons resultados funcionais, DASH de 14,27 e MEPS de 84. E o ADM médio de flexão-extensão foi de 101o (20o e 140o) e de pronação-supinação, 112,85o (0o até 180o). CONCLUSÃO: Quando se realiza tratamento sistematizado nas lesões do tipo TTC, mesmo com suas variações, pode-se obter um ADM funcional e escore funcional entre bom e excelente. Nível de Evidência IV, Série de Casos.

Axillary nerve position in the anterosuperior approach of the shoulder: a cadaveric study.

OBJECTIVE: To determine the distance between the axillary nerve and the antero-lateral (AL) edge of the acromion, its anatomical variability and relationship to humeral length and body height. METHODS: Twenty-two shoulders were dissected. The anterosuperior (AS) approach was used; the deltoid was detached from the acromion and the distance between the AL portion and the axillary nerve was measured and submitted to statistical analysis. RESULTS: The distance varied from 4.3 to 6.4 cm (average 5.32 ± 0.60 cm). The axillary nerve distance increased as the humeral size (p<0.05) and the height of each cadaver increased. However, the correlation with the specimens height was not significant (p=0.24). CONCLUSIONS: The distance between the acromion and the axillary nerve on the AS approach was 5.32 ± 0.60 cm in both shoulders, and increasing the humeral length there is also an increase in the axillary nerve distance. Level of Evidence IV, Case Series - Anatomic Study.

Axillary nerve position in the anterosuperior approach of the shoulder: a cadaveric study

Objective: To determine the distance between the axillary nerve and the antero-lateral (AL) edge of the acromion, its anatomical variability and relationship to humeral length and body height. Methods: Twenty-two shoulders were dissected. The anterosuperior (AS) approach was used; the deltoid was detached from the acromion and the distance between the AL portion and the axillary nerve was measured and submitted to statistical analysis. Results: The distance varied from 4.3 to 6.4 cm (average 5.32 ± 0.60 cm). The axillary nerve distance increased as the humeral size (p<0.05) and the height of each cadaver increased. However, the correlation with the specimens height was not significant (p=0.24). Conclusions: The distance between the acromion and the axillary nerve on the AS approach was 5.32 ± 0.60 cm in both shoulders, and increasing the humeral length there is also an increase in the axillary nerve distance. Level of Evidence IV, Case Series - Anatomic Study.

Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001), 3º of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results. .

Evaluation of the Clinical-functional Results from Repairing Extensive Rotator Cuff Injury with Inclusion of the Tendon of the Long Head of the Biceps.

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33o (p < 0.001), 3o of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

Correlation of coracoid thickness and glenoid width: an anatomic morphometric analysis.

BACKGROUND: The coracoid has been widely used as a graft to reconstruct anterior glenoid bone defects, as described by the Latarjet and Bristow procedures, with successful results. Nevertheless, at the present, there are no studies correlating the size of the coracoid graft and its relation to the glenoid. PURPOSE: To assess the mediolateral (M-L) and anteroposterior (A-P) thickness of the coracoid process as well as the widest anterior-to-posterior glenoid distance (glenoid width) and to analyze the correlation between these measurements, while comparing these with the A-P coracoid process thickness. STUDY DESIGN: Descriptive laboratory study. METHODS: Sixty-one unpaired, adult human cadaveric scapulae were evaluated. Three examiners performed 3 independent measurements of the largest M-L thickness of the coracoid process and also the widest anterior-to-posterior distance of the glenoid. The A-P coracoid process thickness was also measured to compare for correlations with M-L coracoid thickness. RESULTS: The glenoid width was 26.38 ± 2.69 mm (range, 20.03-32.35 mm), and the M-L coracoid thickness was 14.51 ± 1.90 mm (range, 9.60-19.31 mm). Calculating the ratio between the M-L thickness of the coracoid and glenoid width, we observed that the coracoid represented 43% to 70% of the glenoid width (54% on average). The A-P coracoid process thickness was 8.37 ± 0.93 mm (range, 6.61-9.76 mm), representing 31% of the glenoid width on average. CONCLUSION: A strong positive and statistically significant relationship between the coracoid process M-L thickness and the anterior-to-posterior glenoid width exists; the coracoid represents, on average, 54% of the glenoid width. CLINICAL RELEVANCE: Most cases of glenoid bone loss in recurrent shoulder dislocation can be reconstructed with the coracoid process to re-establish its anatomy.

ARTHROSCOPIC REPAIR OF SMALL AND MEDIUM TEARS OF THE SUPRASPINATUS MUSCLE TENDON: EVALUATION OF THE CLINICAL AND FUNCTIONAL OUTCOMES AFTER TWO YEARS OF FOLLOW-UP.

OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136°, lateral rotation of 58° and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156° with an average gain of 20°, and the average final lateral rotation was 57° with an average gain of 9°. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Reparação artroscópica de lesões pequenas e médias do tendão do músculo supraespinal: avaliação dos resultados clínico-funcionais após dois anos de seguimento / Arthroscopic repair of the small and medium tears of the supraspinatus muscle tendon: evaluation of the clinical and functional outcomes after two years of follow-up

OBJETIVO: Avaliar os resultados clínico-funcionais das reparações artroscópicas de lesões pequenas e médias do tendão do músculo supraespinal. MÉTODOS: Foram avaliados, retrospectivamente, 129 casos de lesões isoladas pequenas ou médias do tendão do músculo supraespinal. O tempo médio de dor foi de 29 meses. A amplitude articular média era de 136º de elevação ativa, 48º de rotação lateral, rotação medial no nível T12 e a escala funcional pré-operatória da UCLA foi, em média, de 17 pontos. Em todos os casos foi possível o reparo completo da lesão. RESULTADOS: A pontuação pela escala funcional da UCLA no período pós-operatório foi, em média, de 32 pontos. O tempo médio de seguimento foi de 39 meses. Setenta e cinco casos (58%) tiveram resultados excelentes e 42 (32%), bons. A elevação ativa final teve a média de 156º, com ganho médio de 20º, e a rotação lateral final foi, em média, de 57º, com ganho médio de 9º, ambos estatisticamente significativos (P < 0,05). Os pacientes submetidos à tenotomia da cabeça longa do bíceps (CLB), com ou sem tenodese, não apresentaram resultado funcional estatisticamente inferior àqueles que foram submetidos somente à descompressão e reparo da lesão (P = 1,00). Quatorze casos (10,8%) apresentaram complicações no período pós-operatório. Seis casos (4,6%) desenvolveram capsulite adesiva e quatro (3,1%) tiveram rerruptura do tendão comprovada por ressonância magnética. CONCLUSÕES: O reparo artroscópico das lesões pequenas e médias do tendão do músculo supraespinal proporcionou melhora clínico-funcional com bons e excelentes resultados em 90% dos casos.

OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136º, lateral rotation of 58º and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156º with an average gain of 20º, and the average final lateral rotation was 57º with an average gain of 9º. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Resultados da cirurgia de latarjet no tratamento da instabilidade anterior traumática do ombro associada à erosão óssea da cavidade glenoidal - seguimento mínimo de um ano / Results from latarjet surgery for treating traumatic anterior shoulder instability associated with bone erosion in the glenoid cavity, after minimum follow-up of one year

OBJETIVO: Avaliar o resultado da cirurgia de Latarjet para pacientes com luxação recidivante anterior do ombro com perda óssea maior que 25 por cento da cavidade glenoidal. MÉTODO: Avaliamos 26 pacientes submetidos à cirurgia de Latarjet. O tempo médio de seguimento foi de 38 meses e a média etária, de 28 anos. Os pacientes foram avaliados quanto à amplitude de movimento e pelas escalas de Rowe e UCLA, no período pré-operatório como no período pós-operatório, radiografias do ombro para avaliar a presença de artrose, posição e consolidação do enxerto e posicionamento dos parafusos. A análise estatística foi utilizada para avaliar se haveria relação entre o número de episódios de luxação, presença de artrose, correlação entre artrose e limitação da rotação lateral. Comparar a diferença entre o arco de movimento do lado operado com o não acometido e avaliação funcional pré e pós-operatória das escalas de UCLA e Rowe. RESULTADOS: A elevação e rotação lateral foram estatisticamente inferiores do lado operado. A escala de UCLA e a de Rowe mostrou uma melhora estatisticamente significante dos resultados clínico-funcionais (P < 0,001 em ambas). Houve relação entre o número de episódios de luxação e a presença de artrose, mas não pudemos confirmar que os casos mais graves de artrose foram os que mais luxaram pela amostra ser pequena. CONCLUSÃO: A cirurgia de Latarjet é um método eficaz para casos graves de erosão da borda da cavidade glenoidal.

OBJECTIVE: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25 percent. METHODS: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. RESULTS: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. CONCLUSION: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin.

RESULTS FROM LATARJET SURGERY FOR TREATING TRAUMATIC ANTERIOR SHOULDER INSTABILITY ASSOCIATED WITH BONE EROSION IN THE GLENOID CAVITY, AFTER MINIMUM FOLLOW-UP OF ONE YEAR.

OBJECTIVE: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25%. METHODS: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. RESULTS: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. CONCLUSION: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin.

Tratamento cirúrgico das fraturas supra e intercondilianas do úmero / Surgical treatment of supra and intercondilar humeral fractures

Introdução: As fraturas supra e intercondilianas do úmero, em adultos, são lesões complexas e de difícil tratamento, pelas características anatômicas locais e pela grande fragmentação óssea que geralmente ocorre. Objetivo: Avaliar o resultado funcional do tratamento cirúrgico dessas fraturas em adultos. Método: No período de junho de 1999 a agosto de 2005, 22 pacientes (22 cotovelos) com idade entre 20 e 70 anos, com fraturas supra e intercondilianas do úmero, foram submetidos a tratamento cirúrgico mediante redução aberta e fixação interna rígida, com placas e parafusos de 3,5 mm, por via de acesso posterior. Resultados: De acordo com o critério de Jupter et al, obtivemos 68,2% de resultados classificados como satisfatórios e, como complicações do tratamento, um paciente (4,5%) apresentou neuropraxia ulnar, que regrediu espontaneamente e outros dois (9%) que apresentavam dor no olécrano, causada pelo material de síntese. Após a retirada desse material de síntese referiram melhora. Conclusões: O tratamento cirúrgico para as fraturas supra e intercondilianas do úmero mostrou ser um método eficaz com 68,2% de resultados classificados como satisfatórios neste estudo.

Introduction: The supracondylar and intercondylar humerus fractures are complex injuries of difficult treatment because of the local anatomic features and the bone fragmentation that generally occurs. Objective: To access the functional outcome of surgical treatment of these fractures in adults. Method: From June 1999 to August 2005, 22 patients (22 elbows) ranging from 20 to 70 years old who had supracondylar and intercondylar humerus fractures were submitted to surgical treatment by posterior approach with open reduction and internal fixation with 3,5 mm screws and plates. Results: According to Jupiter’s criteria, we found satisfactory results in 68.2% of the patients. One patient (4,5%) presented ulnar neuropraxia with spontaneous subsidence, and two patients (9%) who had pain caused by the tension band on the olecranon needed to have it removed and then were satisfied with the result. Conclusions: In this study, the surgical treatment for the supracondylar and intercondylar humerus fractures led to an acceptable rate of satisfactory outcomes (68,2%).

Instabilidade do cotovelo causada por fratura sagital do processo coronoide / Instability of the elbow caused by sagittal fracture of the coronoid process

Introdução: Descrever um padrão diferente de fratura do processo coronoide associada à instabilidade do cotovelo tratada com sucesso em nosso serviço. Relato do caso: Um paciente de 27 anos, do sexo masculino e destro, havia sofrido luxação do cotovelo. Procurou nosso hospital com uma queixa de dor e instabilidade à extensão do cotovelo, apresentando instabilidade em varo-valgo e queixa de luxação eminente do cotovelo quando este atingia -30º de extensão. No exame radiográfico, observou-se uma fratura anteromedial do processo coronoide. Submetido ao tratamento cirúrgico fixando-se a fratura, reparando-se o ligamento colateral medial, imobilizado-se com uma tala gessada por dez dias e, depois, iniciando-se o programa de reabilitação. Após 21 meses de seguimento, o paciente mantinha 135º de flexão e 0º de extensão, 80º de pronação e 90º de supinação; força muscular grau V e sem instabilidade no exame físico. As radiografias de controle demonstraram consolidação completa sem ossificação heterotópica. Discussão: Apesar de ser um tipo raro de fratura do processo coronoide, é importante que seja devidamente diagnosticado pelo ortopedista para que se realize o tratamento adequado e se evite a instabilidade crônica. O presente caso foi tratado com sucesso por meio de redução aberta e fixação interna, sem nenhuma queixa de instabilidade após 21 meses de seguimento.

Introduction: Description of a different pattern of coronoid process fracture related to elbow instability, treated successfully at our institution. Case report: A 27-year-old right-handed male suffered an elbow dislocation and attended our clinic with a complaint of pain, presenting varus and valgus instability and reporting sensation of eminent dislocation with elbow in -30º of extension. The radiographs showed an antero-medial fracture of the coronoid process. Submitted to surgical treatment with fracture fixation and ligament repair, the patient used a splint for ten days and then started the rehabilitation program. After 21 months of follow-up, the patient presented a range of motion of 135º of flexion and 0º of extension, 80º of pronation and 90º of supination; complete muscle strengh and no instability at phisical examination. The postoperative radiographs showed complete fracture consolidation without heterotopic ossification. Discussion: Even tough it is a rare fracture of the coronoid process, it is important to be diagnosed by the orthopedist to provide appropriate treatment and to avoid chronic instability. The case reported was successfully treated with open reduction and internal fixation, with no complaint of instability after 21 months of follow-up.

Avaliação radiográfica das alterações no terço proximal do úmero de 21 jovens jogadores de beisebol / X-ray evaluation of the presence of proximal humerus growth plate changes in 21 young baseball pitchers

Objetivo: Avaliar a prevalência de alterações radiográficas no terço proximal do úmero de 21 jovens arremessadores de beisebol e correlacioná-las aos achados clínicos. Desenho do estudo: Série de casos. Local: Estudo realizado pelo Grupo de Cirurgia do Ombro e Cotovelo da Disciplina do Estudo das Afecções Ortopédicas da Faculdade de Medicina do ABC. Santo André, São Paulo, Brasil. Instituição terciária. Pacientes: Foram estudados 21 adolescentes do sexo masculino arremessadores de beisebol, com idade média de 14,5 anos da Seleção Brasileira de Beisebol. Intervenção: Os pacientes foram submetidos a avaliações radiográficas dos ombros. Resultados: Dos atletas, 14 (66%) apresentaram alterações radiográficas na placa de crescimento do terço proximal do úmero. Destes, em nove atletas (64%) nos quais os observadores encontraram alterações radiográficas não apresentavam queixa de dor. Também se observou que em apenas 11 pacientes havia correlação entre os achados clínicos e radiográficos. Conclusão: Concluímos que alterações radiográficas na placa de crescimento do terço proximal de úmero foram encontradas em 66% dos atletas avaliados e não foi encontrada correlação com a avaliação clínica. A presença de alargamento da placa de crescimento do terço proximal do úmero no ombro dominante de jovens arremessadores de beisebol pode acontecer em atletas assintomáticos. Provavelmente, esse alargamento representará, no futuro, uma maior retroversão do ombro dominante do arremessador.

PROSPECTIVE RANDOMIZED STUDY COMPARING TWO ANESTHETIC METHODS FOR SHOULDER SURGERY.

OBJECTIVE: To evaluate the efficacy of suprascapular nerve block in combination with infusion of anesthetic into the subacromial space, compared with interscalene block. METHODS: Forty-five patients with small or medium-sized isolated supraspinatus tendon lesions who underwent arthroscopic repair were prospectively and comparatively evaluated through random assignation to three groups of 15, each with a different combination of anesthetic methods. The efficacy of postoperative analgesia was measured using the visual analogue scale for pain and the analgesic, anti-inflammatory and opioid drug consumption. Inhalation anesthetic consumption during surgery was also compared between the groups. RESULTS: The statistical analysis did not find any statistically significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. CONCLUSION: Suprascapular nerve block with infusion of anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals in which an electrical nerve stimulating device is unavailable.

ANTERIOR GLENOID RIM EROSION MEASURED BY X-RAY EXAM: A SIMPLE WAY TO PERFORM THE BERNAGEAU PROFILE VIEW.

OBJECTIVE: To analyze whether the Bernageau radiographic view is adequate for studying the anterior glenoid rim and to determine the distance between the posterior and anterior glenoid rims. METHODS: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160° forward flexion and body at 70° to the x-ray chassis, while positioning the x-ray tube at 30° craniocaudally, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. RESULTS: The mean distance was 24.48 mm ± 0.332 mm (left) and 24.82 mm ± 0.316 mm (right). The Anderson-Darling test showed that the measurements had normal distribution, and Pearson's correlation showed significant reproducibility (P < 0.01). The first observer found that 67% of the x-ray images were suitable for evaluating the anterior glenoid rim. The second found that 81% were suitable and the third, 78%. The kappa coefficient showed that the second and third observers had substantial agreement of opinion. CONCLUSION: The Bernageau view provided a suitable x-ray image for studying the anterior glenoid rim and for assessing erosion after comparison with the unaffected side.