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Purpose  The purpose of this study was to determine the safety efficacy and outcomes of platelet-rich plasma (PRP) intra-articular injections for early stages of knee osteoarthritis (OA). Methods  Twenty-five patients affected by grade I and II knee primary OA according to the Kellgren-Lawrence scale received a single intra-articular PRP injection. Patients were prospectively evaluated for 6 months. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) scoring scales were used to evaluate clinical outcomes. Wilcoxon signed rank test was used to evaluate significance of improvement of WOMAC, KOOS, and VAS scores. Results  Twenty-one patients completed 6-months follow-up. The median WOMAC score improved from 29.1 points (range: 17.4-60.4; standard deviation [SD] = 13.0) at baseline to 42.41 (range: 24.3-71.2; SD = 12.5) at final follow-up. Improvements in median KOOS and VAS score have been also found, from 37.49 points and 64.2 mm before injection to 59.71 points and 42.8 mm, respectively. All these improvements were statistically significant ( p  < 0.05). No adverse reactions have been observed. Conclusion  Treating knee OA with PRP injection is safe. A single dose of PRP seems to be effective in managing pain and improving quality of life in patients with low-grade knee OA. Level of Evidence  Level IV, therapeutic case series.

Purpose: the purpose of this study was to evaluate whether treating partial-thickness articular-sided tears of the upper subscapularis (SSC) tendon with a dedicated suture anchor would result in an internal rotation strength improvement compared with simple shaving of the SSC tendon and footprint., Methods: twenty-six patients with a limited SSC tendon tear (equal or inferior to the most superior centimeter) in association with a posterosuperior cuff lesion were prospectively randomized to two treatments: repair with a dedicated suture anchor versus shaving of the tendon and footprint. The patients also underwent long head of the biceps (LHB) treatment and posterosuperior cuff tear repair. In each patient the following parameters were measured both preoperatively and at a minimum follow-up of 2.5 years: strength in internal rotation in the bear-hug testing position (using a digital tensiometer), DASH score and Constant scores. MRI assessment of tendon healing was performed at the final follow-up., Results: twenty of the 26 patients (76%) were reviewed after a mean follow-up time of 42 months: 11 patients had undergone SSC tendon repair and nine simple shaving. At final follow-up no significant differences were found between the repaired and shaving group in strength in internal rotation (9.5 ± 3.8 kg versus 10.3±5.4 kg; p=0.7). The DASH score and Constant score also failed to show significant differences between the two groups. Furthermore, no significant difference in SSC tendon healing rate was observed on MRI evaluation., Conclusions: partial-thickness articular-sided tear of the upper SSC tendon in association with a posterosuperior rotator cuff repair and LHB treatment, when limited to the superior centimeter of the SSC tendon, shows a comparable performance in terms of strength in internal rotation either after simple shaving or a tendon-to-bone repair., Level of Evidence: Level II, prospective comparative study.

Purpose: the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency., Methods: a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis., Results: nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%., Conclusions: RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain., Level of Evidence: level IV, systematic review of level I-IV studies.

Purpose: the purpose of this study was to describe a new test for identifying lesions of the long head of the biceps (LHB) and to evaluate its diagnostic performance in comparison with selected traditional clinical tests., Methods: one hundred and nine consecutive candidates for arthroscopic rotator cuff repair were prospectively recruited. The BRF test, which measures biceps resisted flexion strength, was performed with the patient seated (armat the side and elbow flexed at 90°). The patient was asked to maintain maximal resistance for five seconds while strength was assessed with a digital dynamometer. Since the dynamometer expresses a continuous variable in kilograms, the measure was dichotomized using a threshold value (cut-off) value-able to simultaneously maximize the sensitivity and specificity. This cut-off value was derived from receiver operating characteristic (ROC) curve analysis. Speed's test and the O'Brien test were also performed. During arthroscopy the presence of LHB pathology was assessed., Results: biceps resisted flexion strength was significantly higher in patients without associated LHB lesions [median (range): 3 kg (0-9.5 kg) versus 0 kg (0-8.5 kg); p< 0.001]. The cut-off level able to simultaneously maximize the sensitivity and specificity of the test was 1.1kg. The area under the ROC curve was 0.745 (p<0.001) for the dichotomic BRF test (dBRF), 0.562 (p=0.3) for the O'Brien test, and 0.602 (p=0.113) for Speed's test. A significant good level of accuracy was achieved only by the dBRF test. Specificity and the positive predictive value were significantly higher for the dBRF test than for Speed's and O'Brien's tests (p<0.02). Age and the dBRF test were both found to be significant predictors of LHB lesions., Conclusions: the dBRF test showed higher accuracy than traditional clinical tests in diagnosing LHB lesions. This novel test for biceps pathology may be advantageous because it is objective and therefore likely reproducible., Level of Evidence: Level II, Development of diagnostic test on basis of consecutive patients (with universally applied reference "gold" standard).

Purpose: the aim of this study was to compare clinical outcomes of contracted immobile massive rotator cuff tears mobilised through an arthroscopic interval slide technique versus massive mobile cuff tears directly repaired without any mobilisation., Methods: twenty-five patients who underwent arthroscopic repair for massive rotator cuff tears with a minimum of 18 months follow-up were included. The patients were retrospectively divided into two groups. In group 1, a single or double interval slide was performed to achieve adequate tendon mobilisation. In group 2 (control group), massive rotator cuff tears were arthroscopically repaired without any additional release. Patients were evaluated with validated outcomes scores: subjective and objective Constant score, a Visual Analogue Scale (VAS) for pain, and single Assessment Numeric Evaluation (SANE)., Results: the two groups were comparable in terms of age, gender and involvement of the dominant arm. The mean follow-up duration was 31 months in group 1 and 28 months in group 2 (p = 0.4). The two groups showed no significant differences in SANE and VAS results (group 1: SANE 77%, VAS 1.3; group 2: SANE 88%, VAS 1.6), or in total Constant score (group 1: 66.5 ± 11; group 2: 75 ± 14; p = 0.1) and subjective Constant score (Group 1: 31 ± 5; group 2: 30.8 ± 7; p = 0.9). A significant difference was found for the objective Constant score, which was higher in the control group (group 1: 35.5 ± 7; group 2: 44 ± 8; p = 0.009)., Conclusions: Subjective clinical outcomes of arthroscopic repair with or without interval slides did not differ and were satisfactory. Objectively, immobile cuff tears showed inferior results. The use of interval slides might be considered a first step or an alternative to more invasive procedures for low demanding patients., Level of Evidence: Level III, retrospective comparative study.