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Background: Arthroscopic needling of a rotator cuff calcification is a highly reliable operation in terms of pain relief and return of function. However, during the needling process, a cuff defect is created. Little is known about the evolution of this defect., Methods: We conducted a prospective, randomized controlled clinical trial to investigate the evolution of the aforementioned defect and the role of platelet-rich plasma (PRP) augmentation in this healing process. Patients were randomized to either group 1 (PRP, n = 20) or group 2 (no PRP [control group], n = 20). Patients in group 1 received a perioperative PRP infiltration at the rotator cuff defect, whereas the control group did not. Patients were assessed clinically preoperatively and postoperatively at 6 weeks, 3 and 6 months, and 1 year. The Constant score, Simple Shoulder Test, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) were used as outcome measures. The evolution of the cuff defect was evaluated on sonography at 3 and 6 months and with magnetic resonance imaging after 1 year., Results: All patients improved significantly after surgery (P < .05). There was no difference in clinical outcome or rotator cuff healing between groups. We observed a high rate of persistent rotator cuff defects after 1 year in both groups. The presence of residual cuff defects did not influence the clinical outcome., Conclusion: Arthroscopic needling is an operation with a predictive, good clinical outcome. We found a high rate of persistent rotator cuff defects after 1 year. This study could not identify any beneficial effect of the addition of PRP on rotator cuff healing., Level of Evidence: Level II; Randomized Controlled Trial; Treatment Study., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Hypothesis: Arthroscopic augmentation of the anterior glenoid using a free bone graft through the rotator interval is possible without compromising the fixation and position of the graft, Material and Methods: In 7 cadavers arthroscopic augmentation of the anterior glenoid was performed. A preshaped, free graft was introduced and fixated with 1 central screw without desinsertion or split of the subscapularis tendon. Postoperatively, the orientation and position of the screw and position of the graft in the vertical and horizontal plane were analyzed on computer tomography (CT) scan. Macroscopic dissection was performed to assess damage to the conjoined and subscapularis tendon and surrounding neurovascular structures and to verify the position of the graft., Results: Postoperative CT scans showed no intra-articular perforation of the screw. The mean inclination angle in the axial plane was 21,2° (range, 9-48°). Postoperative dissection showed no damage to surrounding neurovascular structures. Fraying occurred at the lateral border of the conjoined tendon in 3 specimens, at the upper border of the subscapularis in 5 cases, but no tears were noted. In the vertical plane, the augmentation block was correctly (subequatorial) positioned in 5 cases; 2 blocks were at the level of the equator. In the horizontal plane, the augmentation block was flush with the articular surface in 5 cases and too medial in 2 cases (<5 mm)., Conclusion: This study showed that it is technically possible to perform a bone block procedure arthroscopically through the rotator interval without compromising the position and fixation of the graft and fixation screw., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

The aim of this retrospective study was to assess the mid- and long-term functional and radiological results following latissimus dorsi transfer for symptomatic irreparable tears of the supra- and infraspinatus tendons (postero-superior cuff tears). Twenty-six shoulders with an irreparable posterosuperior rotator cuff tear were assessed preoperatively and after latissimus dorsi transfer, using the Constant score and standard radiographs to determine the degree of osteoarthritis and to measure the acromio-humeral distance. After a minimal follow-up of one year (range: 13 to 124 months) we observed a significant increase in Constant score from 39 to 60 points at the time of the last follow-up (p < 0.00001). Eighty-five percent of the patients were satisfied or very satisfied with the result and would undergo the same surgery again. An increase in the grade of gleno-humeral osteoarthritis was noted in 38.5% of the operated shoulders, and this was associated with a lower Constant score. We noted a decrease in acromio-humeral distance, indicating further proximalisation of the humeral head, but this was not significant (p = 0.049).

The purpose of this study was to determine the attitude of the members of the Flemish Elbow and Shoulder Surgeons Society (FLESSS) towards full-thickness tears of the rotator cuff and their treatment in their daily practice. A survey form was sent to 123 shoulder surgeons between January and March 2008. Seventy-three responses were returned, a 60% response rate. For 40% of the respondents, arthro-CT was the gold standard diagnostic method for assessment, 36% preferred arthro-MRI. Arthroscopic, mini-open and open cuff repair were preferred by 64%, 19% and 16% of the responders respectively. Fewer years in practice, a higher volume of shoulder operations and a higher volume of rotator cuff repairs were significantly correlated with a higher percentage of arthroscopic repairs (p > or = 0.001). With respect to the type of fixation, 91% preferred screw-type anchors, and of these 81% were metal anchors. Our results show that all-arthroscopic techniques are becoming the gold standard for the repair of full-thickness tears of the rotator cuff in Flanders.

Unlabelled: Implant failure is a serious complication in reverse shoulder arthroplasty. We determined the incidence of glenosphere disengagement in a cohort of 479 reverse shoulder prostheses (468 Delta III [DePuy International Ltd, Leeds, UK], 11 Aequalis [Tornier, Grenoble, France]). We also determined whether disengagement adversely affected clinical outcomes. The minimum followup was 12 months (mean, 28.6 months; range, 12-72 months). Disengagement of the glenosphere occurred in 16 of 479 shoulders (3.2%). In 13 patients, the disengagement was partial (clear step-off between the baseplate and the glenosphere) and was not associated with a poor functional outcome with this short-term followup. In three patients, the disengagement led to a fracture of the central screw, leading to a complete disengagement of the glenosphere from the baseplate, necessitating revision in two; the third refused revision. Partial disengagement was seen in five of 11 Aequalis prostheses (45.4%) and eight of 468 Delta III prostheses (1.7%). The three total disengagements with central screw breakage all occurred in Delta III prostheses. We believe differences in the type of locking screws may explain the differences observed between the two types of reverse prostheses., Level of Evidence: Level III, retrospective study. See the Guidelines for Authors for a complete description of levels of evidence.

In this study, we assessed the functional results after arthroscopic excision of rotator cuff calcifications. Sixty-one shoulders in 57 patients with chronic calcifying tendinitis of the rotator cuff were treated with arthroscopic excision, subacromial bursa debridement and shaving. In patients with fraying or roughness of the coracoacromial ligament, an acromioplasty was also performed. Patients were evaluated after a mean follow-up of 15 months. The modified Constant score and DASH score significantly improved from 33.4 to 66.8 and from 49.7 to 17.3 respectively. Performing an acromioplasty did not influence the final outcome. Frozen shoulder was a frequent complication (18%) without significant effect on the final DASH or Constant score. The presence of residual calcifications after arthroscopic needling did not influence the final outcome. We therefore believe that the presence of residual calcifications can be accepted if this is deemed necessary to preserve the integrity of the tendon.

In this retrospective study, a latissimus dorsi transfer as first described by Gerber in 1988 was performed in 12 patients with massive, irreparable rotator cuff tears. Their average age was 59 years and the preliminary results are reported here after an average follow-up of 39 months. In 50% of the patients there was no pain and 41% had mild to moderate pain at follow-up. Functional Constant scoring was excellent in 42%, good in 8%, moderate in 42% and poor in 8%. Active range of motion in the shoulder improved significantly in external rotation and abduction. Abduction force as measured with Atlantech and Cybex systems showed weak results. In two patients these tests could not be performed due to lack of force, in 9 patients abduction force was much weaker than on the contralateral side and in one patient the operated arm was stronger than the other side. We conclude that in most patients good pain relief and functional improvement can be achieved after latissimus dorsi transfer for irreparable rotator cuff tear. A good active range of motion can be expected but a lack of force persists. However, it remains difficult to conclude for which patients this surgery can be predictably successful.

Rotator cuff tear arthropathy (RCTA) is characterized by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study is to investigate the quantitative characteristics of this migration and its association with glenoid erosions and prearthropathy scapular anatomy. We quantified HHM and prearthropathy scapular anatomy of 64 RCTA patients with statistical shape modeling‐based techniques. Glenoid erosion was classified according to Sirveaux et al. A cutoff value for confirming HHM was 5 mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with a mean subluxation distance (SLD) of 3 mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9 mm, SLD in the anteroposterior plane of −1 mm (SD ± 4 mm), SLD in the superoinferior plane of 7 mm (SD ± 3 mm), and subluxation angle (SLA) of −5° (SD ± 40°). Analysis with Fisher's exact test showed a clear association between HHM and glenoid erosions (p = 0.002). Multivariate regression analysis of Group 2 showed that prearthropathy lateral acromial angle combined with critical shoulder angle (p = 0.004) explained 21% of the observed variability in SLD. The prearthropathy glenoid version explained 23% of the variability in SLA (p = 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the prearthropathy scapular anatomy and the magnitude and direction of HHM. [ABSTRACT FROM AUTHOR]