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Background: To investigate whether arthroscopic partial repair with the additional use of a biodegradable subacromial spacer would be proven better treatment for irreparable massive rotator cuff tears (MRCT) compared to single arthroscopic partial repair. Methods: A matched-pairs case–control study of 32 patients suffering from irreparable MRCT who underwent an arthroscopic partial repair with (Group B: 16 patients) or without (Group A: 16 patients) InSpace Balloon (ISB®; Orthospace, Caesarea, Israel) implantation was conducted. For the clinical and functional assessment of the patients, the visual analog scale, Constant score, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Range of Motion (RoM), and patients' satisfaction were obtained. Results: The two groups were matched in all baseline demographic and clinical characteristics (n.s.). All mean final quantitative postoperative clinical and functional scores of group A (partial repair and ISB) and group B (single partial repair), as well as active RoM, were significantly improved (t test) in comparison with the mean preoperative values (p < 0.05). No significant differences were observed between the two groups in relation to the two success rate criteria (ASES minimal clinically important difference or MCID > 17, Constant score MCID > 10.4), as well as pain relief and RoM 12 months after surgery. Conclusion: Arthroscopic partial repair, either with or without ISB implantation, resulted in significantly improved clinical and functional short-term outcomes for the treatment of MRCT. Patients who were treated with combined partial repair and ISB implantation had a potential propensity toward better functional outcomes and higher patient satisfaction compared to the single-partial-repair-treated group. However, given that these differences were not significant, we feel that further studies are required to clarify the potential therapeutic value of ISB implantation in the treatment of irreparable MRCT. Level of Evidence: Level III. Clinical Trials' registry: German Clinical Trials Register (WHO International Clinical Trials Registry Platform). ID number: DRKS00014725. Date of registration: 07/05/2018. [ABSTRACT FROM AUTHOR]

Recently, hybrid glenoid components have been developed, consisting of cementless highly porous metal central peg, monoblock keel or cage along with cemented backside polyethylene surface. The aims of this study were twofold: (1) to determine the revision and complication rates of hybrid glenoid components, consisting of porous metal pegs or coatings attached to the polyethylene, for aseptic loosening in TSA and (2) to evaluate the rate of radiolucent lines in patients who underwent TSA with hybrid glenoid components consisting of porous metal pegs or coatings attached to the polyethylene. The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "hybrid" OR "bone-ingrowth" OR "bone ingrowth" AND "TSA" OR "total" AND "shoulder" AND "arthroplasty" OR "replacement". Five articles were included for analysis (470 operated shoulders, mean follow-up: 47.5 months). The overall weighted mean modified methodology Coleman score was 51.2/100, indicating a moderate level of overall methodological quality. The survival rate of hybrid glenoid components was 97.4% (458 out of 470 cases), while the rate of glenoid-related complications was 2.8% (13 cases). Finally, there were 54 cases (out of 313 reported; 17.3%) with glenoid radiolucency (none of them required revision). TSA with hybrid fixation glenoid components was associated with high survivorship and low rate of glenoid component-related complications at 4 years mean follow-up. In addition, there was limited evidence to show that the short- to mid-term outcome of TSA using hybrid glenoid components is not inferior to the outcome of cemented all-polyethylene glenoid components. [ABSTRACT FROM AUTHOR]

Several clinical studies have compared the clinical and functional outcomes of arthroscopic anatomic complete repair and arthroscopic partial repair for massive rotator cuff tears (MRCTs). To our knowledge, no systematic review of these comparative trials has been published yet. A systematic analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. Six studies were eligible for analysis, and they were level III case–control studies. There were 223 cases of complete repair and 208 cases of partial repair (mean age range 59–67 years, mean follow-up range 24–45 months). All studies reported significant postoperative improvement in the reported subjective scores and range of motion in both groups. Complete repair was associated with at least equal or better functional outcomes compared to the partial repair. The rate of complications requiring reoperation in the complete and partial repair cohorts was 1.3% and 3.4%, respectively. Although the overall rate of radiographic integrity of the complete and partial repair cohorts was 61.1% and 26.7%, respectively, we found no clinical relevance in this finding. There is moderate-to-good quality evidence to support that both arthroscopic complete and partial repairs of MRCTs are associated with satisfactory functional outcomes and low rate of complications requiring reoperation. Complete repair is associated with at least equal or better functional outcomes compared to the partial repair and, therefore, it should remain the first line of treatment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether a non-anatomic arthroscopic repair of massive rotator cuff tear (RCT) produces satisfactory clinical outcomes comparable to those of an anatomic complete arthroscopic repair. Methods: A retrospective case-control study (prospectively collected data, mean follow-up: 32.7 months ± 29.5; range 12–80 months) was conducted with patients with massive RCT who underwent either an anatomic complete arthroscopic repair (group A: 34 patients) or a non-anatomic arthroscopic repair (partial repair or medialized repair, group B: 30 patients). The rate of success was calculated primarily by the number of patients per group who achieved a minimal clinically important difference between the preoperative and postoperative values of (a) the American Shoulder and Elbow Surgeons Shoulder Score, (b) the constant score and (c) secondarily, the visual analogue scale (VAS-pain). Active range of motion (shoulder forward flexion, abduction, external rotation in 0° and 90° abduction), muscle strength and external rotation lag sign were also assessed. Results: No significant statistical differences amongst groups were found concerning the baseline demographic and clinical characteristics. All postoperative clinical and functional scores were significantly improved in both groups (p < 0.001). According to our primary and secondary success rate criteria, both treatments were found to be successful, whereas there was no significant difference amongst them. Conclusions: Non-anatomic arthroscopic repair of massive RCT illustrated satisfactory outcomes, which are not significantly different from those reported after an anatomic complete arthroscopic repair. [ABSTRACT FROM AUTHOR]

Introduction: hip fractures in elderly patients have been associated with high morbidity and mortality rate and are dependent on the presence of associated comorbidities. SARS-CoV-2 disease (Covid-19) is nowadays considered to be an independent risk factor increasing mortality rates. The aim of our report was to analyse the management of a vaccinated versus a non-vaccinated elderly patient that were both diagnosed positive to SARS-CoV-2 after having sustained an intracapsular neck of femur fracture. Methods: Two patients (Patient A 91 and Patient B 88 years old, both female) were referred to our hospital after sustaining an intracapsular neck of femur hip fracture as a result of low energy trauma. Both patients tested positive for Covid-19 during their preoperative screening tests. Patient A had not been vaccinated against Covid-19 in contrast to patient B who had completed the 2 dose regimen of the Pfizer-BioNTech COVID-19 vaccine. Patient A presented on arrival Leukopenia (WBC: 1.2 µc/l, Neutrophils 0.4 mcL ) and Thrombocytopenia (PLT 70.000 ). The Procalcitonin, C-Reactive Protein and Ferritin levels long as Arterial blood Gases were measured in both patients on arrival. Patient A required administration of Granulocyte colony stimulating factor and platelet transfusion prior to surgery. Results: Both patients underwent uncemented hip hemiarthroplasty. Patient A was operated 5 days after hospital admission as optimization of the patient's Covid-19 related Leukopenia and Thrombocytopenia was required and Patient B was operated within 24 hours after hospital admission. Patient A required transfusion of 4 blood Units (bleeding related to Thrombocytopenia) compared to 2 blood units that were administered in Patient B. Patient A developed Covid 19 related Pneumonia and Lung disease on the 6th postoperative day (PO2 SO2 ) and required high flow nasal cannula therapy for 7 days followed by oxygen therapy for 8 days delaying her mobilization and hospital discharge. Patient A was discharged on the 29th post-operative day and Patient B was discharged on the 6th post-operative day. Conclusion: Covid 19 related complications in elderly hip fracture patients are challenging and require multidisciplinary approach and hospital resources. However, Vaccination against covid-19 seems to prevent Covid related complications and can improve the outcome. Large series studies and further research is required to support our thesis. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the effects of dietary factors (calcium, proteins, alcohol, coffee and tea intake), exercise, sunlight exposure and immobilization on bone mineral content (BMC) and bone mineral density (BMD) in young men. Patients and measurements We examined a group of 300 healthy men, aged 18–30. Mean weight was 80-81 kg (53–125 kg range) and height 179 cm (160–195 cm range). Distal BMC (dBMC), distal BMD (dBMD) and ultradistal BMD (udBMD) at the radius were measured by single X-ray absorptiometry (Osteometer DTX). The data concerning lifestyle factors were obtained through a questionnaire. The 300 men were divided in four groups according to calcium intake, four groups taking into account protein and three groups alcohol intake. There also were five groups of exercise level, six groups of sun exposure and two groups of duration of immobilization. Results In the group with the lowest levels of calcium intake (< 400 mg/day), dBMD and udBMD were lower than in the other groups of calcium intake ( P = 0·002). dBMC and udBMD were lower ( P = 0·043 and 0·015, respectively) in subjects with low physical activity (< 2 h/week), whereas dBMC and udBMD were higher ( P<0·0005) in subjects with frequent sun exposure (group labelled ‘very often’). Multiple regression analysis on bone mineral density of the forearm showed that, calcium intake, exercise and sunlight were also independent predictors of bone mass. No significant correlation between the other examined factors and BMD or BMC was detected. Conclusions Calcium intake, exercise level and sun exposure showed a statistically significant correlation with distal BMD and BMC in young adult men. [ABSTRACT FROM AUTHOR]