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Purpose: The purpose of this study was to analyze the outcome of arthroscopic removal of calcifying tendinitis of the rotator cuff, to document the postoperative pain evolution, and to analyze structural changes of the supraspinatus tendon by use of ultrasonography., Methods: Fifty-four of 58 patients with a mean age of 45.4 years (+/-8 years) enrolled in the study were available for follow-up. The calcific deposits were exclusively located in the supraspinatus tendon. Shoulder function was evaluated by using the Constant score. Radiographs were obtained preoperatively, immediately postoperatively, and at 3, 6, 12, and 24 months. The integrity of the rotator cuff was assessed by using ultrasonography., Results: Shoulder function according to the Constant score improved from 32.8 points (+/-19.8) preoperatively to 90.9 (+/-13.0) at 24 months (P < 0.001). The evolution of postoperative pain was very irregular; 31% of the patients were pain free or reached their minimum pain level after 3 months, 17% after 6 months, 20% after 9 months, and 28% after 12 months; 78% of the patients returned to work within 6 weeks, irrespective of their profession. At the final follow-up 92% of the patients were very satisfied with the outcome. Ultrasonography revealed minor structural changes of the supraspinatus tendon in 66% of the patients., Conclusions: The study confirmed previously reported successful results of arthroscopic treatment of calcifying tendinitis of the rotator cuff. Complete intraoperative removal of the deposit did not appear to be essential. Even if most of the patients were able to return to work within 6 weeks, postoperative recovery was prolonged over several months in most of the patients. The clinical relevance of the ultrasonographic changes of the supraspinatus tendon has not yet been determined., Level of Evidence: Level IV, therapeutic case series.

The objective of this prospective study was to determine the prevalence of popliteal cysts and the associated intraarticular lesions in a group of 100 patients scheduled for arthroscopic surgery of the knee and to evaluate the results of arthroscopic treatment for these intraarticular lesions without removal of the cyst. One hundred patients without any knee complaints served as a control group. The diagnosis of a popliteal cyst was made on the basis of ultrasonography. The prevalence of popliteal cysts was 20% in the study group and 0% in the control group. Patients with a popliteal cyst had a significantly higher prevalence of medial meniscal tears (70% versus 19%) and of chondral lesions (85% versus 28%). Tears of the lateral meniscus, however, were more evenly distributed (20% versus 36%). Sixteen of 20 patients with a popliteal cyst were available for a follow-up examination 1 to 3 years after the arthroscopic procedure. Eleven popliteal cysts had persisted. Chondral lesions were the most relevant prognostic factor; all patients with persisting cysts had grade III or grade IV lesions. We conclude that the popliteal cyst is a secondary phenomenon and that treatment should address the underlying intraarticular lesions. In cases of osteoarthritis it may be impossible to treat the chondral lesion successfully in terms of eliminating the effusion.

To perform an open-wedge high-tibial osteotomy (HTO), the medial proximal tibia is frequently exposed by partial distal release of the overlying insertion of the medial collateral ligament (MCL). Biomechanically, any release of the MCL can increase knee laxity when valgus stress is applied. Clinically however, post-surgical valgus instability following HTO with partial MCL release is an uncommon complication. It is known that the open-wedge procedure can re-tention an intact MCL by the width of the base of the wedge. However, this re-tentioning effect is uncertain in small wedge sizes, preexisting medial compartment laxity and in the presence of a partially detached MCL. Considering the good clinical results after HTO, we hypothesized that a partial release of the superficial MCL for HTO does not play a crucial role in stabilizing valgus forces in the human knee. We therefore measured the effect of partial versus complete release of the superficial MCL to determine medial knee laxity represented by the amount of medial joint opening (MJO) under valgus stress in this human cadaver study. In ten knee pairs, the superficial and deep MCL were sectioned in sequence with a standardized abduction force of 15 kp with a Scheuba apparatus applied. In group 1 (5 knee pairs), the superficial MCL was completely sectioned whereas in group 2 (5 knee pairs), sectioning of the superficial MCL was restricted to the anterior border to mimic the surgical exposure for an HTO. To account for the interindividual variability of ligamentous laxity, only increments of MJO within knee pairs were statistically evaluated. Stress radiography did not reveal any significant differences in increments of MJO between knee pair specimens with complete versus partial release of the superficial MCL. We disproved our hypothesis and concluded that the anterior fibers of the superficial MCL do play a crucial role in maintaining valgus stability in this biomechanical setting. Therefore, the release of the superficial MCL for open-wedge HTO should be kept to a minimum to decrease the potential of late valgus instability. This is especially important in patients with small wedge sizes and medial compartment laxity since the anterior MCL fibers are the main contributor to medial joint stability and the re-tentioning effect of the remaining MCL fibers is presumably decreased. [ABSTRACT FROM AUTHOR]