Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates.

PURPOSE: To evaluate whether glycemic control affects the integrity of the repaired rotator cuff during the postoperative healing period after arthroscopic double-row suture bridge rotator cuff repair (RCR) METHODS: We retrospectively reviewed patients with diabetes mellitus (DM) who underwent arthroscopic double-row suture bridge RCR at our institution between March 2016 and November 2019. We included the patients who evaluated for serum glycosylated hemoglobin (HbA1c) levels within 1 month before and 3-6 months after surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were categorized into two groups based on comparison between preoperative and postoperative HbA1c values: Group I (increased postoperative HbA1c) and Group D (same or decreased postoperative HbA1c). The correlation between preoperative/postoperative HbA1c, HbA1c increase/same or decrease (during the healing period), and post-RCR integrity was evaluated, including various demographic and radiologic factors. RESULTS: A total of 103 patients were analyzed, group I was 47, and group D was 56, respectively. The retear rate of 51.1% (24/47) in Group I was significantly higher than 14.3% (8/56) in Group D (P < .001). HbA1c levels measured 3-6 months after surgery (mean: 6.9; 95% CI: 6.6-7.3 vs mean: 6.5; 95% CI: 6.3-6.7, P = .034), and the proportion of group I and group D were significantly different (75%/25% vs 32.4%/67.6%, P < .001) between the retear and healing groups. Multivariable logistic regression analysis identified increased HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072-14.086; P < .001). CONCLUSIONS: The glycemic control within 3-6 months after surgery when the healing process of the tendon was in progress had a significant effect on retear rate. In particular, the retear rate was higher when the HbA1c level increased at postoperative 3-6 months compared to before surgery. LEVEL OF EVIDENCE: Retrospective case-control comparative study, Level III.

Perianchor cyst formation in all-suture anchor after rotator cuff repair: an evaluation of anchor insertion angle.

BACKGROUND: Previous studies reported that micromotion after all-suture anchor implantation can lead to perianchor cyst formation (PCF), leading to risk of retear. Modifying anchor insertion angle (AIA) is known to be one of the various ways to increase anchor stability. However, there currently are few studies that assess the correlation between PCF, AIA, and retear. PURPOSE: To find the correlation of PCF and the repaired rotator cuff integrity with AIA after arthroscopic double-row suture-bridge rotator cuff repair (RCR) using an all-suture anchor in the medial row. METHODS: A total of 218 patients who underwent arthroscopic double-row suture-bridge RCR were retrospectively reviewed. All patients underwent RCR using all-suture anchors and polyether ketone anchors in the medial and lateral rows, respectively. Magnetic resonance imaging was conducted 6 months after the surgery to evaluate PCF, AIA, and integrity of the repaired cuff. The all-suture anchor insertion angle in the medial row was measured with reference to the greater tuberosity to assess the relationship between the AIA and PCF. The correlations between PCF, AIA, and post-RCR integrity were evaluated including various demographic and radiologic factors. RESULTS: Perianchor cysts were formed in 93 patients (42.7%). Mediolateral tear size (2.1 ± 1.2 cm vs. 1.7 ± 0.9 cm, P = .034) and AIA (61.9° ± 15.2° vs. 68.4° ± 13.0°, P = .001) were significantly different between patient groups with and without perianchor cysts. Multivariate logistic regression analysis showed that mediolateral tear size (odds ratio [OR] 1.318, 95% confidence interval [CI] 1.008-1.724; P = .043) and AIA (OR 0.967, 95% CI 0.947-0.988; P = .002) were independent risk factors for PCF. In addition, PCF was observed more frequently (69.6% vs. 32.1%, P < .001) and the AIA was lower (59.4° ± 13.7° vs. 67.8° ± 13.8°, P < .001) in the retear group than in the healed group. CONCLUSIONS: Perianchor cysts were formed in approximately 40% of patients who underwent arthroscopic double-row suture-bridge RCR using all-suture anchors. Low AIA and large mediolateral tear size were risk factors for PCF. Moreover, perianchor cyst and AIA were correlated with post-RCR integrity. Therefore, a high AIA must be carefully considered when all-suture anchors are inserted into the medial row when performing RCR.

Volumetric evaluation of the rotator cuff musculature in massive rotator cuff tears with pseudoparalysis.

BACKGROUND: If the balance of the rotator cuff force couple is disrupted, pseudoparalysis may occur, but the exact mechanism remains unknown. This study investigated the effect of rotator cuff force couple disruption on active range of motion in massive rotator cuff tear (mRCT) by rotator cuff muscle volume analysis. METHODS: The study included 53 patients with irreparable mRCT: 22 in the nonpseudoparalysis group and 31 in the pseudoparalysis group. The volumes of the subscapularis (SBS), infraspinatus (ISP), and teres minor (TM) muscles were measured using magnetic resonance imaging (MRI), and the ratios of each muscle volume to the anatomic external rotator (aER) volume were calculated. A control group of 25 individuals with normal rotator cuffs was included. RESULTS: Anterior-to-posterior cuff muscle volume ratio (SBS/ISP + TM) was imbalanced in both mRCT groups (1.383 nonpseudoparalysis and 1.302 pseudoparalysis). Between the 2 groups, the ISP/aER ratio (0.277 vs. 0.249) and the inferior SBS/aER ratio (0.426 vs. 0.390) were significantly decreased in the pseudoparalysis group (P= .022 and P= .040, respectively). However, neither the TM/aER ratio (0.357 vs. 0.376) nor the superior SBS/aER ratio (0.452 vs. 0.424) showed a significant difference between the two groups (P= .749 and P= .068, respectively). If the inferior SBS was torn, a high frequency of pseudoparalysis was noted (81.0%, P= .010). CONCLUSION: The disruption of transverse force couple was noted in both irreparable mRCT groups, although no significant difference was found between the nonpseudoparalysis and pseudoparalysis groups. ISP and inferior SBS muscle volumes showed a significant decrease in pseudoparalysis group and, therefore, were considered to greatly influence the loss of active motion in mRCT. The TM did not exert significant effect on the incidence of pseudoparalysis.

Management of an engaging Hill-Sachs lesion: arthroscopic remplissage with Bankart repair versus Latarjet procedure.

PURPOSE: This study compared the clinical outcomes of arthroscopic remplissage with Bankart repair and Latarjet operation in patients with a large engaging Hill-Sachs lesion. METHODS: Thirty-seven shoulders subjected to arthroscopic remplissage with a Bankart repair (group A) and 35 shoulders subjected to a Latarjet operation (group B), for a large engaging Hill-Sachs lesion without significant glenoid bone loss, were retrospectively evaluated. Each group was followed up for a mean more than 2-year period. RESULTS: At the last follow-up, postoperative pain, shoulder mobility, muscle strength, Rowe score, and UCLA score revealed no significant difference between the two groups. The postoperative mean deficit in external rotation at the side (ERs) was 8° ± 23° in group A (P = 0.044). In group B, the mean deficits in ERs, external rotation at 90° of abduction, and internal rotation to the posterior were 10° ± 20°, 7° ± 16°, and 1.9° ± 4°, respectively (P = 0.004, 0.022, and 0.009, respectively). The recurrence rate was 5.4 % (two shoulders) in group A and 5.7 % (two shoulders) in group B (n.s.). The overall complication rate was significantly higher in group B (14.3 %) than in group A (0 %) (P = 0.017). CONCLUSIONS: For recurrent anterior shoulder instability with a large engaging Hill-Sachs lesion, both arthroscopic remplissage with Bankart repair and the Latarjet procedure were safe and reliable techniques with a low recurrence rate. However, the Latarjet group had a significantly higher postoperative complication rate than the remplissage group. LEVEL OF EVIDENCE: Case-control study, Level III.

Anterior shoulder instability with engaging Hill-Sachs defects: a comparison of arthroscopic Bankart repair with and without posterior capsulodesis.

PURPOSE: The purpose of this study was to compare the clinical results of isolated arthroscopic Bankart repair and those of arthroscopic Bankart repair with posterior capsulodesis for anterior shoulder instability with engaging Hill-Sachs lesions. METHODS: Thirty-five shoulders that underwent isolated arthroscopic Bankart repair (Bankart group) and 37 shoulders that underwent arthroscopic Bankart repair with posterior capsulodesis (remplissage group) for anterior shoulder instability with engaging Hill-Sachs lesions were evaluated retrospectively. The mean age at the time of the surgery was 26.1 ± 7.0 years in the Bankart group and 24.8 ± 9.0 years in the remplissage group. RESULTS: At the final follow-up, the Rowe and UCLA scores significantly improved in both the Bankart and remplissage groups (P < 0.001, in both groups). The post-operative mean deficit in external rotation at the side was 3° ± 10° in the Bankart group and 8° ± 23° in the remplissage group (P = n.s. and P = 0.044, respectively). There was no decrease in muscle strength in either group. The recurrence rate was 25.7 % in the Bankart group and 5.4 % in the remplissage group (P = 0.022). CONCLUSIONS: Arthroscopic Bankart repair with posterior capsulodesis demonstrated good clinical outcomes with a low recurrence rate in the treatment for anterior shoulder instability with an engaging Hill-Sachs lesion. Although a limitation in external rotation was observed, there was no significant limitation of any other motion and no decrease in muscle strength after the remplissage procedure. Posterior capsulodesis alone for remplissage should be considered as a surgical technique that can replace the conventional method. LEVEL OF EVIDENCE: Case-control study, Level III.

Resection arthroplasty for periprosthetic infection after total elbow arthroplasty.

BACKGROUND: Periprosthetic infection after total elbow arthroplasty (TEA) is a serious complication that has no clearly defined treatment. The purpose of this study was to report the outcomes of resection arthroplasty for treatment of infection after TEA and the factors influencing the result. METHODS: Ten elbows (9 patients) underwent resection arthroplasty for treatment of infection after TEA. The mean follow-up duration was 52.4 (range, 24-113) months. According to remnant distal humerus bone stock, we divided the elbows into 3 groups: lateral column, medial column, and both columns. RESULTS: The average time to resolution of symptoms of clinical infection and normalization of serologic marker levels was 6.8 (range, 5-12) and 68.5 (range, 20-148) days after resection. The mean Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder, and Hand score changed from 50.0 (range, 40-60) and 46.5 (range, 29-67) preoperatively to 73.5 (range, 55-85) and 53.0 (range, 33-65) at the last follow-up (P < .001 and P < .001, respectively). Although it was insignificant, the both-columns group showed better functional outcomes (Mayo Elbow Performance Score, 80.0; Disabilities of the Arm, Shoulder, and Hand score, 43.7) than the lateral (74.0, 54.6) or medial (62.5, 63.0) column group. The mean satisfaction score was 70.0 (range, 50-80) at the final follow-up. Only 1 case required additional operations to treat recurrent infection. There were no refractory infections, fractures, or permanent nerve lesions. CONCLUSION: Resection arthroplasty can be an acceptable salvage treatment for infection after TEA for low-demand patients. To achieve success, both columns of the distal humerus must be preserved at implant removal.

Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears: is tuberoplasty really applicable?

BACKGROUND: Tuberoplasty is a therapeutic option for irreparable massive rotator cuff tear (RCT). However, no study has reported long-term outcomes after arthroscopic tuberoplasty. METHODS: We evaluated 16 patients who underwent arthroscopic tuberoplasty for symptomatic irreparable massive RCT without pseudoparalysis. Patients were a mean age of 64 years (range, 43-80 years) at the time of the operation, and the mean duration of follow-up was 98 months (range, 84-126 months). RESULTS: At the last follow-up, the visual analog scale score for pain during motion had decreased to 2.3 from a preoperative mean of 6.9 (P < .001). The mean University of California at Los Angeles and Constant scores improved from 10.3 and 37.9 preoperatively to 27.2 and 59.2, respectively, at the last follow-up (P < .001 for both). The best University of California at Los Angeles (UCLA) and Constant scores during the follow-up duration were 28.3 and 60.3, respectively, at 5 years. The mean acromiohumeral interval changed from 5 mm preoperatively to 4 mm at the last follow-up. The rate of continuity in the inferior scapulohumeral line decreased significantly from 69% (11 shoulders) preoperatively to 19% (3 shoulders) at the last follow-up (P = .011). Only 1 patient underwent revision surgery. CONCLUSIONS: Arthroscopic tuberoplasty yielded satisfactory outcomes during a mean 8-year follow-up period. Although superior migration of the humeral head progressed with time, the clinical outcomes were not affected. Arthroscopic tuberoplasty is a good option for relieving pain and improving functionality in nonpseudoparalytic patients with painful irreparable massive RCT.

Effects of humeral component retroversion on functional outcomes in reverse total shoulder arthroplasty for cuff tear arthropathy.

BACKGROUND: The currently recommended 0° to 30° humeral component retroversion angle for reverse total shoulder arthroplasty (RTSA) is based on expert opinion rather than anatomical or clinical evidence. METHODS: Sixty-two patients who underwent RTSA for cuff tear arthropathy were reviewed retrospectively. The humeral component was inserted with 20° retroversion in 30 patients (group A) and with 0° retroversion in 32 (group B). The mean age at the time of operation was 66.2 years and 68.9 years, and the mean follow-up period was 43.3 months and 38.4 months in groups A and B, respectively. RESULTS: At the last follow-up, external rotation at the side was 47.2° ± 8.4° in group A and 43.9° ± 7.0° in group B, whereas internal rotation to the posterior was L3 and L2, respectively (P = .102 and P = .092). The ranges of motion between the 2 groups at the last follow-up were not significantly different. Most daily movements related to activities of daily living showed no significant differences between the 2 groups, with the exception of back washing/back doing up bra (1.5 ± 1.2 in group A vs 2.1 ± 0.8 in group B of 3 points, P = .026). CONCLUSIONS: Range of motion after RTSA did not significantly differ between 20° and 0° humeral component retroversion angle. Most daily movements did not differ between the 2 groups, but patients in the 0° retroversion angle group scored better on activities related to internal rotation.

Filling Index Score of Remplissage (FISOR): a useful measurement tool to evaluate structural outcome after remplissage.

BACKGROUND: The purpose of this study was to evaluate and to grade the extent of filling into the Hill-Sachs lesion quantitatively by use of magnetic resonance arthrography after an arthroscopic remplissage procedure. METHODS: The current study enrolled 23 patients who underwent arthroscopic Bankart repair with a remplissage procedure for a large or engaging Hill-Sachs lesion confirmed by arthroscopic findings. The postoperative filling index was classified into 5 categories by axial and sagittal views of T2-weighted images on magnetic resonance arthrography: complete filling (4 points); partial filling with minor defect (3 points); partial filling with major defect (2 points); minimal filling with significant free fluid level (1 point); and filling failure with dehiscence (0 point). Filling Index Score of Remplissage (FISOR) was also calculated from the total sum of points in the axial and sagittal planes and classified into 5 grades. RESULTS: The FISOR was 8 points in 13 patients, 7 points in 2 patients, 6 points in 3 patients, 5 points in 1 patient, 4 points in 1 patient, 3 points in 1 patient, 2 points in 1 patient, and 0 point in 1 patient. According to the FISOR grades, these results were recorded as excellent in 15 patients (65.2%), good in 4 patients (17.4%), fair in 2 patients (8.7%), poor in 1 patient (4.3%), and no evidence of filling in 1 patient (4.3%). CONCLUSION: The FISOR would be a useful measurement tool for the evaluation of structural outcomes after the remplissage procedure.

Clinical outcome and repair integrity after rotator cuff repair in patients older than 70 years versus patients younger than 70 years.

PURPOSE: The purpose of this study was to evaluate and compare the clinical and structural outcomes of rotator cuff repairs in patients older than 70 years and those younger than 70 years and to analyze a correlation between patient factors and retear rate. METHODS: Two hundred thirty-eight patients between the ages of 60 and 79 who underwent rotator cuff repair between 2006 and 2011 and were available for postoperative magnetic resonance imaging (MRI) evaluation at least 6 months after surgery were enrolled in this study. They were divided into 2 groups, one group (n = 191) included patients aged between 60 and 69 years, and the other group (n = 47) included patients aged between 70 and 79 years. The mean follow-up period was 14.6 months (range, 12-63 months) and 13.2 months (range, 12-62 months) for patients in their 60s and 70s, respectively. RESULTS: The mean visual analog scale (VAS), University of California Los Angeles (UCLA), and Constant scores significantly improved from 5.4, 18.1, and 57.4 preoperatively to 1.0, 31.2, and 75.0 at the final follow-up, respectively (P < .001), in the 60s group and from 5.9, 17.0, and 53.6 to 1.3, 30.1, and 72.7, respectively (P < .001), in the 70s group. There were no significant differences between the 2 groups (P > .05). Instead, intraoperative tear size was correlated with the clinical scores with Pearson correlation coefficients of -0.161 and -0.211 for patients in their 60s and 70s, respectively. There were 76 (39.8%) retears among patients in their 60s and 24 (51.1%) retears among patients in their 70s, with no significant difference between the 2 groups (P = .161). The retear rate increased significantly with increasing preoperative tear size (P < .001; odds ratio [OR], 7.1 in large tears; P < .0001; OR, 17.2 in massive tears). Age and sex were not significantly correlated with the retear rate. CONCLUSIONS: Both patients in their 60s and 70s showed significant improvement in clinical outcomes after rotator cuff repair, without a significant difference between the 2 populations. The retear rate increased significantly with increasing intraoperative tear size but not with increasing age. LEVEL OF EVIDENCE: Level III, case-control study.

Clinical effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a randomized controlled trial.

BACKGROUND: Bee venom acupuncture (BVA) has been used in the treatment of adhesive capsulitis (AC) in the clinical field. This study aimed to investigate whether the addition of BVA to physiotherapy (PT) would be more effective in the management of AC, and whether BVA would have a dose-dependent effect. MATERIALS AND METHODS: Sixty-eight patients diagnosed with AC were recruited into 3 groups; BV 1 (1:10,000 BVA plus PT), BV 2 (1:30,000 BVA plus PT), and group 3 (normal saline (NS) injection, as a control, plus PT). PT was composed of 15 minutes of transcutaneous electrical nerve stimulation (TENS), transcutaneous infrared thermotherapy (TDP), and manual PT. Treatments were given in 16 sessions within 2 months. Shoulder pain and disability index (SPADI), pain visual analogue scale (VAS), and 3) active/passive range of motion (ROM) were measured before treatment and at 2, 4, 8, and 12 weeks after the treatment. RESULTS: All 3 groups showed statistically significant improvements in SPADI, pain VAS scores, and active/passive ROM. The BV 1 group showed significantly better outcomes in SPADI at 8 and 12 weeks, in pain VAS (at rest) at 8 weeks, and in pain VAS (during exercise) at 12 weeks than the NS group. No significant differences were found in active/passive ROM among all the groups. CONCLUSION: BVA in combination with PT can be more effective in improving pain and function than PT alone in AC. However, the effectiveness of BVA was not shown in a dose-dependent manner.

Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises.

PURPOSE: To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. METHODS: Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. RESULTS: Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). CONCLUSIONS: Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. LEVEL OF EVIDENCE: Level II, randomized controlled trial.

Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears.

PURPOSE: The purpose of this study was to evaluate the clinical and radiologic results of arthroscopic tuberoplasty for symptomatic irreparable massive rotator cuff tears. METHODS: This study enrolled 32 patients (32 shoulders) who underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears and were followed up for at least 24 months. The mean patient age at the time of surgery was 62.4 years (range, 43 to 76 years), and the mean duration of follow-up was 40 months (range, 24 to 63 months). The Constant score and the University of California, Los Angeles score were used for clinical evaluation. The acromiohumeral interval and inferior scapulohumeral line continuity were used for radiologic evaluation. RESULTS: Twenty-six shoulders underwent arthroscopic tuberoplasty with concomitant acromioplasty, and 6 shoulders had only arthroscopic tuberoplasty. The Constant score increased from a preoperative mean of 47.6 points to 70.4 points at the last follow-up (P < .001). The University of California, Los Angeles score also improved from a preoperative mean of 15.4 points to 27.1 points at the last follow-up (P < .001), with 3 shoulders (9%) rated as excellent, 23 (72%) as good, and 6 (19%) as poor. The active range of forward flexion improved from 115.9° to 142.7° (P = .024). The final outcomes were not statistically affected by sex, age, preoperative mobility, and existence of a lesion of the long head of the biceps tendon. However, preoperative acromiohumeral interval and inferior scapulohumeral line continuity were statistically correlated with the final results (P < .001 and P = .047, respectively). CONCLUSIONS: Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility.

Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability.

PURPOSE: This study aims to compare the associated lesions, clinical results, and postoperative recurrence rates in patients with ALPSA lesions (ALPSA group) versus those with Bankart lesions or Perthes lesions (Bankart group) in arthroscopic capsulolabral repair for anterior shoulder instability. METHODS: Two hundred and twenty-two patients (227 shoulders) who had been followed for a minimum of 1 year were enrolled for this study. Mean age at the time of first dislocation was 19.5 ± 4.8 years. Mean age at the time of operation was 23.3 ± 4.6 years. One hundred and seventy-four shoulders were included in the Bankart group and fifty-three shoulders in the ALPSA group. RESULTS: The mean preoperative number of dislocations was significantly higher in the ALPSA group with 12.3 ± 6.2 times than in the Bankart group with 6.9 ± 5.7 times. No statistically significant differences were found in final clinical results except postoperative loss of external rotation (P < 0.01) between the two groups. The ALPSA group had significantly higher rates of the lesion extended to the superior part of the 2 o'clock position (P < 0.01), synovitis (P < 0.01), glenoid erosion (P < 0.01), large Hill-Sachs lesions (P < 0.01), and engaging Hill-Sachs lesions (P = 0.03). The recurrence rate was 15.1% in the ALPSA group, more than twice the rate in the Bankart group with 7.4% (P = n.s.). The size and engagement of Hill-Sachs were significantly associated with redislocation (P < 0.01, P = 0.02). CONCLUSIONS: Compared with the Bankart group, the ALPSA group showed a significantly higher number of preoperative dislocations, an associated larger-sized Hill-Sachs lesion, and a higher tendency to develop into an engaging Hill-Sachs lesion. In addition, the ALPSA group presented a higher tendency to redislocate and significant postoperative loss of external rotation after capsulolabral repair.

Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear.

BACKGROUND: To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. METHODS: Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. RESULTS: There were 402 female patients (79%) with mean age of 55 years (range, 31-87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0-35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1-10) and 47 (range, 8-95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05). CONCLUSIONS: This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.

Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: does the initial radiologic aspect affect the final results?

HYPOTHESIS: Although conservative treatment is the first option for the treatment of calcific tendinitis, only a few reports have described its results, without documenting the radiologic changes over time of calcific deposits. We hypothesized that conservative treatment for calcific tendinitis of the shoulder would produce good clinical results in most patients and that the initial radiologic appearance of calcific deposits would not affect the final results. MATERIALS AND METHODS: The study enrolled 87 consecutive patients (92 shoulders) who were diagnosed with calcific tendinitis and underwent conservative treatment. The mean age at the time of first visit was 53.2 years. The mean follow-up period was 16.1 months. RESULTS: At the final follow-up, the Constant score increased to 83.64 points from a mean of 76.17 points at initial visit (P < .001). The score on the University of California, Los Angeles (UCLA) Shoulder Rating Scale improved from 23.42 to 29.69 points (P < .001), and there were 7 excellent (8%), 59 good (64%), and 26 poor (28%) results. Eleven shoulders (12%) revealed complete resolution of calcific deposits; 46 (50%) decreased in size; 18 (20%) had no change in size; and 17 (18%) increased in size. DISCUSSION: Most patients in calcific tendinitis require treatment due to very severe shoulder pain, and conservative treatment may take precedence over operative treatment. Radiologic changes of calcific deposits report varying results depending on treatment methods. This study suggested that good radiologic results may be expected without performing special therapies. CONCLUSION: Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. By radiologic type, 46% of the calcific deposits had a tendency to become more cloudy and inhomogeneous than initial findings, and 62% presented complete resolution or decrease in the size.

Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears.

PURPOSE: The purpose of our study was to evaluate the outcome of massive rotator cuff tears repaired by use of an arthroscopic biceps augmentation technique, interpositioning the tenotomized biceps tendon to bridge the gap between the torn edges of the cuff tendon. METHODS: Sixty-eight shoulders with massive rotator cuff tears were included in this study. Arthroscopic rotator cuff repairs with the biceps augmentation technique were performed in 37 patients (group A), whereas 31 patients underwent repair without biceps augmentation (group B). The mean follow-up period was 21 months (range, 14 to 78 months) in group A and 20 months (range, 13 to 63 months) in group B. RESULTS: The mean University of California, Los Angeles score improved from 14.1 points (range, 6 to 21 points) in group A and 13.9 points (range, 7 to 22 points) in group B preoperatively to 32.6 points (range, 22 to 35 points) and 30.3 points (range, 20 to 35 points) postoperatively, respectively (P < .001 and P < .001, respectively). However, the difference between the postoperative scores was not statistically significant (P = .198). At the last follow-up, group A showed better results than group B in forward flexion, external rotation, and internal rotation strength, with statistically significant differences (P = .017, P = .001, and P < .001, respectively). According to the postoperative repair integrity analyzed by use of magnetic resonance imaging, 58.3% of group A cases (14/24) and 26.3% of group B cases (5/19) had complete healing (P = .036). CONCLUSIONS: An arthroscopic augmentation technique using the tenotomized biceps tendon was effective in achieving fewer structural failures, equivalent clinical outcomes, and significant improvement in muscle strength in comparison traditional arthroscopic repairs by avoiding undue tension in cases with massive rotator cuff tear.

Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation.

BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

Shear-Wave and Strain Ultrasound Elastography of the Supraspinatus and Infraspinatus Tendons in Patients with Idiopathic Adhesive Capsulitis of the Shoulder: A Prospective Case-Control Study.

OBJECTIVE: To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. MATERIALS AND METHODS: The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. RESULTS: Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = -0.340-0.239). CONCLUSION: SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.

Injection-induced pyogenic arthritis of the shoulder joint.

This study reports the clinical results of treatment for injection-induced pyogenic arthritis of the shoulder joint. We followed up 13 patients who underwent operation for the treatment of pyogenic glenohumeral arthritis that developed after injections around the shoulder joint. Cultures identified Staphylococcus aureus in 6 patients and methicillin-resistant S aureus (MRSA) in 4. Finally, the University of California, Los Angeles Shoulder Score improved from 12.7 to 28.3 points. Four of the 9 patients with open surgery and 1 of 4 with arthroscopic surgery had good results; however, the other 8 patients reported poor results. Surgeons must be aware of the possibility of pyogenic arthritis when performing injections, especially in patients with underlying medical diseases. For treatment of injection-induced pyogenic arthritis of the shoulder joint, open surgery may be a better option than arthroscopic surgery.