Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review.

PURPOSE: To systematically review the literature and determine the rate of radiographic tear progression of nonoperatively treated full-thickness rotator cuff tears. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify all articles related to nonoperatively treated rotator cuff tears. English-language studies of Level I through IV evidence examining chronic, full-thickness rotator cuff tears in adults were included. Partial-thickness tears were excluded. Rotator cuff tears were analyzed according to the presence or absence of symptoms. The primary outcome was radiographic tear progression defined as an increase in tear size of 5 mm or greater on magnetic resonance imaging or ultrasound. RESULTS: Eight studies were included for statistical analysis, and 411 tears were analyzed for progression. No difference in the rate of tear progression was detected between the asymptomatic and symptomatic groups (40.6% at 46.8 months and 34.1% at 37.8 months, respectively; P = .65). Calculation of the number needed to treat showed that for an 8% retear rate at 2-year follow-up, approximately 7 patients with rotator cuff tears would have to undergo operative repair to prevent 1 tear from progressing radiographically. CONCLUSIONS: This study showed that with the data available, asymptomatic and symptomatic rotator cuff tears carry similar rates of tear progression over time. Most of these tears will not progress significantly over short- to intermediate-term follow-up. LEVEL OF EVIDENCE: Level IV, systematic review of Level I through IV evidence.

Tribocorrosion in shoulder arthroplasty humeral component retrievals.

BACKGROUND: Tribocorrosion at the modular taper connections of total hip implants has been associated with trunnionosis and adverse local tissue reactions. Modularity is also widely used in shoulder arthroplasty implants, but little information exists about the potential for tribocorrosion. This study hypothesized that there would be mild or no tribocorrosion in a series of retrieved shoulder implants. METHODS: A total of 28 implants with a mean implantation time of 6.2 ± 6.0 years were evaluated using a validated damage scoring method. Implant tapers on the head and stem were divided into upper (deepest) and lower zones and independently scored for fretting and corrosion damage from 1 (none) to 4 (severe). RESULTS: Corrosion was present on 32% of heads and 38% of stems, whereas fretting was present on 36% of heads and 46% of stems. There was significantly greater (P = .02) corrosion in the lower zone of the retrieved stems (1.4 ± 0.5) than there was in the upper zone (1.1 ± 0.3). Correlation between the head and stem corrosion for lower zone was moderate (r = 0.41; P = .04). DISCUSSION: Tribocorrosion was present on the heads and stems of some of the retrieved shoulder implants examined in this study. The incidence of tribocorrosion in shoulder implants was lower than in reported cases of retrieved hip implants. The greatest damage was in the lower zone of the taper, where the connection may be exposed to the surrounding joint fluid. It remains to be seen whether this leads to any clinical presentation of trunnionosis.

A comparison of normal and osteoarthritic humeral head size and morphology.

BACKGROUND: The purpose of this study was to evaluate and to compare the size and morphologic patterns among normal and osteoarthritic (OA) humeral heads. METHODS: This comparative anatomic imaging study evaluated 150 humeral heads that were separated into 3 cohorts: normal, OA with symmetric glenoid erosion, and OA with asymmetric (type B2) glenoid erosion. Three-dimensional models were created of the humeral head from computed tomography data, and point coordinates were extracted for evaluation. Parameters measured were diameter (sphere fit and circle fit), chord distance (superoinferior and anteroposterior), and humeral head height. RESULTS: The sphere-fit diameter of the humeral head for the entire OA cohort (100 patients; mean diameter, 59 ± 9 mm) was significantly greater (P < .001) than that of the normal cohort (50 patients; mean diameter, 49 ± 5 mm). Similarly, the humeral head circle-fit diameters in the superoinferior and anteroposterior planes were significantly greater (P < .001) in the combined OA cohorts (59 ± 9 mm and 56 ± 10 mm, respectively) compared with the normal cohort (51 ± 5 mm and 47 ± 5 mm, respectively). However, there were no significant differences (P ≥ .099) between the symmetric and asymmetric OA cohorts in sphere-fit or circle-fit diameters. The mean values of humeral head heights were not significantly different (P = .382) between cohorts, 19 ± 2 mm, 18 ± 2 mm, and 18 ± 2 mm for the normal, symmetric, and asymmetric cohorts, respectively. DISCUSSION: Although OA humeral head morphology varies significantly from normal, it does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. Understanding of the morphologic variability of the pathologic humeral head may provide insight into the pathoanatomy of osteoarthritis and the development of various erosion patterns.

Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up.

BACKGROUND: The long-term outcomes following arthroscopic Bankart repair have been rarely reported. Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for well-established modern procedures. The purpose of the study was to evaluate the long-term outcomes following arthroscopic Bankart repair. METHODS: Patients who underwent isolated arthroscopic Bankart repair from 2003 to 2006 were retrospectively reviewed. Recurrent instability, radiographic, and clinical scores (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Rowe scores) were evaluated. Patient factors (ie, age, gender, side, number of instability episodes, contact sports, and bone loss) were analyzed to determine the correlation with outcome measures. RESULTS: Among the 98 patients (102 shoulders), we were able to contact 50 patients (51 shoulders, mean age 27.0 years, mean follow-up 121.2 months). Significant bone loss in glenoid and humerus was arthroscopically observed in 16 (31.4%) and 28 (54.9%) shoulders, respectively. Sixteen shoulders (31.4%) experienced recurrent instability. Recent radiographs were obtained for 38 shoulders, 14 (36.8%) of which showed moderate to severe arthritis. Clinical outcomes at follow-up were 89.3, 10.8, and 76.0 for ASES, SST, and Rowe scores, respectively. Neither recurrent instability nor arthritis was correlated with any patient factors. CONCLUSION: When isolated arthroscopic Bankart repair was used in all patients with shoulder instability regardless of bony defect, postoperative recurrent instability and arthritis rates were unacceptably high. Additional procedures should be chosen after careful consideration of multiple patient factors.

Aggregating disparate epidemiological evidence: comparing two seminal EMF reviews.

Two seminal reviews (IARC, 2002; CDHS, 2002) of possible health effects from power-frequency EMFs reached partly different conclusions from similar epidemiological evidence. These differences have an impact on precautionary policy. We examine the statistical aggregation of results from individual disparate studies. Without consistent exposure metrics, the advantage of meta-analysis to estimate magnitude of effect is lost. However, counting positive and statistically significant results yields important information. This is not a substitute for meta-analysis, but a fall-back when meaningful meta-analysis is not available. Representative results from 33 independent adult leukemia studies tabled by IARC yielded 23.5 positives (p approximately 0.01) and 9 significant-positives (p<10(-7)). From 43 representative results from CDHS, there were 32 positive (p<0.001) and 14 significant-positives (p<10(-12)). There were no significant-negative results in either list. Results for adult brain cancer gave a similar, but less clear, message. Childhood leukemia EMF studies have been sufficiently comparable to allow selective pooled analysis, which was important in classifying carcinogenicity. Aggregating all the studies suggests that results for childhood leukemia are not stronger, numerically, than those for adult leukemia. CDHS did not note the number of significant-positives, but noted the meta-analytic summary and the number of positives, forming a view about the strength of these findings. IARC shows no evidence of considering the aggregation of results other than subjectively. It considered individual studies but this led to a tendency to fragment and dismiss evidence that is intrinsically highly significant. We make recommendations for future reviews.

Brain Tumours: Rise in Glioblastoma Multiforme Incidence in England 1995-2015 Suggests an Adverse Environmental or Lifestyle Factor.

Objective: To investigate detailed trends in malignant brain tumour incidence over a recent time period. Methods: UK Office of National Statistics (ONS) data covering 81,135 ICD10 C71 brain tumours diagnosed in England (1995-2015) were used to calculate incidence rates (ASR) per 100k person-years, age-standardised to the European Standard Population (ESP-2013). Results: We report a sustained and highly statistically significant ASR rise in glioblastoma multiforme (GBM) across all ages. The ASR for GBM more than doubled from 2.4 to 5.0, with annual case numbers rising from 983 to 2531. Overall, this rise is mostly hidden in the overall data by a reduced incidence of lower-grade tumours. Conclusions: The rise is of importance for clinical resources and brain tumour aetiology. The rise cannot be fully accounted for by promotion of lower-grade tumours, random chance or improvement in diagnostic techniques as it affects specific areas of the brain and only one type of brain tumour. Despite the large variation in case numbers by age, the percentage rise is similar across the age groups, which suggests widespread environmental or lifestyle factors may be responsible. This article reports incidence data trends and does not provide additional evidence for the role of any particular risk factor.

The importance of regulatory data protection or exclusive use and other forms of intellectual property rights in the crop protection industry.

In order for a chemical plant protection product to be authorised for sale a registration dossier has to be assembled to demonstrate safety and efficacy to the satisfaction of government regulators. These studies and tests are protected for a period of 10 years in Europe, North America and some other jurisdictions from the date of first product authorisation so that only the data owner can gain commercial benefit from the data. Subsequent regulatory reviews which require new studies should not result in further periods of regulatory data protection exclusive use for the new data but compensation should be payable to the data generator. © 2016 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Capitellar and Trochlear Fractures.

Fractures of the capitellum and trochlea account for a small proportion of elbow trauma. Clinicians need to be vigilant in their assessment as they are commonly associated with other injuries about the elbow. To optimize outcomes, the goals of management include a stable, anatomic reduction and early range of motion. Closed reduction of noncomminuted fractures may be successful but requires close follow-up. Open reduction and internal fixation is the preferred management of displaced capitellum-trochlear fractures. Elbow stiffness is the most commonly reported complication in operatively treated fractures. Arthroscopic-assisted reduction and internal fixation and arthroplasty are evolving management options.

Neurologic complications of distal biceps tendon repair with 1-incision endobutton fixation.

Functional outcomes of biceps tendon rupture may be optimized with operative treatment. We conducted a retrospective study to determine the neurologic complications of using 1-incision Endobutton fixation to repair distal biceps tendon ruptures. Patients with distal biceps tendon ruptures treated with a 1-incision technique and Endobutton fixation were included. The primary outcome measure was frequency of neurologic complications. All 50 patients in the study were men. Mean age was 45 years. Twenty-one patients (42%) had at least 1 complication. Injury to the lateral antebrachial cutaneous nerve (LACN) was the most common (36%). Mean time to diagnosis was 17 days (range, 0 to 40 days). Posterior interosseous, anterior interosseous, and superficial radial nerve palsies each occurred at a 4% rate. Mean follow-up was 133 days. This study involved the largest cohort of patients with distal biceps tendon rupture repaired with Endobutton fixation using a 1-incision technique. The LACN injury rate (36%) was higher than in other studies using the same technique (0% to 22%). Injury rates for other neural structures near the elbow were comparable to those in the literature.

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure.

PURPOSE: The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA) lesions. PATIENTS AND METHODS: Patients in the senior author's practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8) and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months) postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test). All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram. RESULTS: There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2) and Simple Shoulder Test (4.6±3.2 to 10.1±3.8) scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect. CONCLUSION: Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair.

The use of an intra-articular depth guide in the measurement of partial thickness rotator cuff tears.

Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears.