Coracoclavicular Space Widening on Radiographs After Arthroscopic Stabilization With Suspensory Fixation Does Not Affect Athletic Performance.

PURPOSE: To evaluate the effect of the coracoclavicular distance widening in athletes after arthroscopic acromioclavicular (AC) stabilization using a suspensory button fixation device in terms of function, athletic performance, or isokinetic assessment. METHODS: Sixty-eight athletes with a minimum 6-month follow-up after AC stabilization using suspensory button fixation were allocated in 2 groups, the widening group and non-widening group, according to the measured coracoclavicular distance after 6 months from the operation. The assessment was done every 6 months by Subjective Patient Outcome for Return to Sports (SPORTS) score, Athletic Shoulder Outcome Scoring System (ASOSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score (CMS), and the coracoclavicular distance. Isokinetic testing was performed at 24 months postoperatively to evaluate shoulder abduction and external rotation strength. RESULTS: No statistically significant differences were found between the 2 groups in terms of the DASH, ASOSS, SPORTS, and the CMS, in addition to the isokinetic testing (P > .05). A statistically significant improvement in both groups over the follow-up stage was identified in the DASH, ASOSS, SPORTS, and the CMS (P < .05). CONCLUSIONS: Coracoclavicular distance widening following arthroscopic suspensory button fixation for AC joint dislocation did not affect function, athletic performance, or isokinetic evaluation in athletes. LEVEL OF EVIDENCE: III; nonrandomized, comparative trial.

The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption.

RATIONALE AND OBJECTIVES: The bright rim sign (BRS) was used as a reliable indicator of anterior talofibular ligament (ATFL) disruption beside other well-known diagnostic criteria. Although this sign can improve accuracy of conventional magnetic resonance imaging (MRI) in diagnosis of ATFL disruption, it was not adequately discussed in the literature. This study aimed to confirm the added diagnostic value of BRS to conventional MRI assessment of ATFL disruption. MATERIALS AND METHODS: A prospective study included 62 patients (47 males and 15 females; mean age, 36.9 ± 12.1 years; range, 17-52 years) with clinically suspected ATFL disruption. All patients underwent MRI and arthroscopy of ankle. MRI images were evaluated for the presence of ligament disruption sign (LDS) and BRS. The patients were classified into 3 groups: group 1 included patients with acute lateral ankle ligament sprain; group 2 included patients with chronic ankle instability; and group 3 included patients with recurring ankle sprain. The diagnostic value of the BRS was evaluated using arthroscopy as reference standard. RESULTS: The diagnostic value of both signs together increased overall sensitivity in detecting ATFL disruption to 86.7% compared to 60% when considering LDS alone (p < 0.0001). In group 1 and 3, the sensitivity increased when both signs were considered together compared to LDS alone (p = 0.004 and 0.025, respectively). In group 2, there was a trend toward significance in sensitivity when both signs were considered compared to LDS alone (p = 0.08). CONCLUSION: BRS is a very helpful diagnostic sign in assessment of ATFL disruption when considered conjointly with the LDS.

Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain.

BACKGROUND: Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. METHODS AND RESULTS: A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). CONCLUSION: Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.

Rehabilitation Posture Does Not Affect the Outcome of Arthroscopically Treated Acromioclavicular Dislocation.

PURPOSE: To assess the effect of the patient's posture (erect or supine) during rehabilitation sessions on pain, function, and the coracoclavicular (CC) distance after arthroscopic treatment of acromioclavicular joint dislocation. METHODS: Sixty patients with acute type III or V acromioclavicular dislocation injuries were randomly allocated into 2 groups according to their posture during the rehabilitation phase: supine rehabilitation group (SRG) or erect rehabilitation group (ERG). Arthroscopic stabilization with a suspensory fixation device was used in all patients. The visual analog scale (VAS) score was assessed on the first postoperative day and at 1, 3, and 6 months postoperatively. The Constant-Murley score (CMS) was recorded preoperatively and at 3, 6, 12, and 24 months postoperatively. The CC distance was assessed preoperatively; on the first postoperative day; and at 6, 12, and 24 months postoperatively. RESULTS: No significant differences were found between the 2 groups in terms of the VAS score, CMS, and CC distance changes. A significant improvement over the follow-up phase was identified in the VAS score and CMS in both groups. The CC distance in both groups was significantly reduced from preoperatively (29.34 mm in the ERG and 28.65 mm in the SRG) to the first postoperative day (10.44 mm and 10.11 mm, respectively). However, a statistically significant re-widening of the CC distance (P < .001) occurred within the first 6 months after surgery (13.55 mm in the ERG and 13.50 mm in the SRG) and at 12 months (15.51 mm and 15.80 mm, respectively). CONCLUSIONS: The patient's posture during early postoperative rehabilitation does not affect the CC distance changes. LEVEL OF EVIDENCE: Level I, randomized prospective comparative study.

Open versus modified arthroscopic treatment of acute acromioclavicular dislocation using a single tight rope: randomized comparative study of clinical outcome and cost-effectiveness.

PURPOSE: The purpose of this study was to compare clinical outcome and cost-effectiveness between arthroscopic and open repair using TightRope in acromioclavicular joint dislocation III and IV. PATIENTS AND METHODS: Fifty-two patients with acute acromioclavicular joint dislocation type III and IV were included. Patients were randomly allocated to either of 2 groups: Arthroscopic Repair Group (ARG) and Open Repair Group (ORG). Constant-Murley Score (CMS), visual analog scale (VAS) score, and coracoclavicular (CC) distance were measured preoperatively and 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS: CMS increased from 40.68 for the ARG and 40.70 for the ORG preoperatively to 84.18 and 84.45 after 2 years from operation. VAS score decreased from 60.59 for the ARG and 64.50 for the ORG 1 day after surgery to 18.04 and 17.87 respectively after 6 months. CC distance decreased from 29.27 mm in the ARG and 28.16 mm in the ORG preoperatively to 9.86 mm in the ARG and 10.54 mm in the ORG on postoperative day 1. Rewidening of the CC distance occurred after 6 months (13.27 mm for the ARG and 13.62 mm for the ORG) and 1 year postoperatively (15.77 for the ARG and 15.41 for the ORG) but remained stable at final follow-up. There was a significant difference in surgical time (80.00 minutes in the ARG compared to 52.79 minutes in the ORG) and cost of consumables (US$1729.95 in the ARG compared to US$851.87 in the ORG). CONCLUSION: Open and arthroscopic repair of acute acromioclavicular joint dislocation yielded good clinical results, yet the arthroscopic technique is more expensive and has a longer surgical time.

Does The Type of Shoulder Brace Affect Postoperative Pain and Clinical Outcome After Arthroscopic Rotator Cuff Repair?

PURPOSE: To compare postoperative pain and clinical outcome after arthroscopic rotator cuff repair in patients immobilized with an abduction brace versus patients placed in an antirotation brace. METHODS: One hundred twenty patients (72 women and 48 men) with symptomatic degenerative complete tear of the supraspinatus or infraspinatus tendons were included in the study. Exclusion criteria were history of trauma/traumatic tears, concomitant shoulder pathology, psychological illnesses, and previous shoulder surgery. The Constant-Murley score (CMS) was obtained before surgery and at 3 months, 6 months, and 1 year after surgery. The visual analogue scale (VAS) was done on the day of surgery and at 1 week, 3 weeks, 6 weeks, and 3 months after surgery. Postoperative isokinetic muscle strength evaluation was done for the shoulder external rotator at 1 year. RESULTS: Mean age was 50.4 years for the abduction brace group (ABG) and 50.8 years for the open pouch arm sling group (PASG). The mean level of the VAS score ranged from 75.6 for the ABG and 74.9 for the PASG on the day of the operation to 17.7 and 18.5 at 3 months after surgery. In both groups, the repeated measure analysis of variance showed that there were highly significant changes (P < .001) in the VAS from the day of operation to 3 months after surgery. A significant improvement was detected in both groups in the mean level of the CMS, from 40.9 for the ABG and 41.2 for the PASG before surgery to 84.7 and 84.5 at 1 year after the operation. There was no statistically significant difference between the 2 groups regarding the isokinetic muscle strength, VAS, or the CMS. CONCLUSIONS: Our study did not find a significant difference between abduction brace and antirotation sling in patient-oriented outcome measures or postoperative pain after rotator cuff repair. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Greater Tuberosity Sclerosis: A Radiographic Sign Of Rotator Cuff Tear?

The study had been carried out to investigate the relation of sclerosis of the greater tuberosity to cuff tear, or whether this may signify partial or complete tear.This retrospective study conducted on 425 patients, 250 Females (58.8%) and 175 males (41.2%). Dominant side was affected in 342 Patients (80%). The average age in males was 46 years (24-68 years) and 54.5 years in Females (44-65 years). Greater tuberosity sclerosis had 93.5% sensitivity for rotator cuff tear, 67.5% specificity, 90.4% positive predictive value (PPV), 51.9% negative Predictive value (NPV) and 85.2% accuracy Greater tuberosity sclerosis had both high sensitivity and positive Predictive value for rotator cuff tears ; however, more in-depth evaluation was required to better understand the relation between greater tuberosity sclerosis and rotator cuff tear. Level of evidence III.