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Platelet-rich plasma (PRP) is a revolutionary treatment that harnesses the regenerative power of the body's own platelets to promote healing and tissue regeneration. While PRP therapy has emerged as a promising option for augmenting biologic healing in the shoulder, the complexity of shoulder disorders makes it difficult to draw definitive conclusions about the efficacy of PRP across different conditions and stages of disease. Our comprehensive review of twenty-four studies highlights the current state of PRP therapy in shoulder pathologies, revealing a wide variety of number of patients, control groups and results. Despite these challenges, the regenerative potential of PRP therapy is moderate in some conditions, with numerous studies demonstrating the positive effects. In conclusion, the authors of this study recommend the use of PRP therapy for adhesive capsulitis and rotator cuff repair of medium to large tears. However, they do not recommend the use of PRP for subacromial impingement or rotator cuff tears. It is up to the clinician's discretion to decide whether PRP therapy is appropriate for individual cases. However, there is still insufficient evidence to support the inclusion of PRP therapy in treatment protocols for other shoulder disorders. Therefore, further research is needed to fully explore the potential of PRP therapy in the treatment of various shoulder conditions.

Background: Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair. Purpose: This in vitro investigation aimed to investigate the influence of a comma sign–directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups. Results: The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred ( P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared ( P = .596). Conclusion: The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading. Clinical Relevance: The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.

We describe a reproducible, step-by-step arthroscopic technique for anchorless transosseous rotator cuff repair using an X-box configuration with the Arthrotunneler device. The technique uses 2 bone tunnels and 4 high-strength sutures and is suitable for medium to large tears of the supra- and infraspinatus that would alternatively need a double-row repair with 4 anchors. Biomechanically, results appear to be similar as for anchored transosseous equivalent techniques. Enhanced biological healing and lower material costs are the possible benefits of this appealing arthroscopic approach that mimics the previous gold standard.

When revising failed double-row and suture-bridge rotator cuff repairs medial failures represent a potential feature. In the presence of a compromised healing environment, patch augmentation becomes a logical adjunct from a mechanical and biological point of view. A reproducible step-by-step revision technique is described that reinforces the weak central cuff area with an absorbable synthetic scaffold.

BACKGROUND: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies.METHODS: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least two-thirds agreement.RESULTS: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue).CONCLUSION: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed.

Aim To compare the outcome of patients operated using either suture anchors vs a new anchorless transosseous (TO) technique for rotator cuff (RC) repair. We hypothesize that healing at the footprint (FP) as observed on MRI might be better with the anchorless approach. Background The former gold standard of open TO RC repair can now be mimicked arthroscopically. Since 5 years we use the Arthrotunneler (AT) system with 2 bone tunnels and 4-5 high strength sutures in an X-Box configuration for medium to large tears of supra- and infraspinatus, which would otherwise require a four anchor construct. Our impression was that the TO technique provides excellent outcomes and high healing rates. Methods We compared 2 cohorts: Cohort A prospectively includes 50 consecutive patients operated since 12/13 with the AT-device (Tornier, Wright); cohort B entails a retrospective series of 35 patients operated earlier. Included were non-retracted tears with a sagittal extension of 2.5 to 4 cm. Group A was operated without, group B with 4 anchors (Speed-bridge, Arthrex). Groups A and B were comparable in regards to age, sex and tear size. After a minimum of 2 years clinical outcome scores and a native MRI were obtained. Tendon quality and FP integration were evaluated using the Sugaya classification by an independent radiologist. Statistics: ANOVA and Wilcoxon test. Results Excluding 9 patients who declined, FU data are available from 44 patients in group A and 32 in B. Constant Score improved from 49 to 89P in group A vs. 46 to 86P in B (p = 0.66). The SSV rose from 45 to 95 % in group A vs from 44 to 93 % in B (p = 0.84). MRI showed no retears in group A vs 3 retears (= 9 %) in B. Comparing the Sugaya types we observed a significant (p = 0.002) shift to the more favorable Sugaya types I and II (normal & near normal) with 82 % in group A vs 50 % in B. Conclusions The study confirms that anchorless TO RC repair is a good alternative to established suture anchor techniques. The technique can easily be learned by the experienced arthroscopist. Clinical outcome data show equivalent results for both techniques. With EUR 700 vs 1100 material costs are lower for the anchorless technique. The healing results as observed on MRI are superior, maybe due to enhanced blood flow at the FP provided by the bone tunnels.

Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.

Objectif La neuropathie par compression du nerf suprascapulaire peut engendrer une paralysie et une atrophie des muscles supra- et infraepineux. La decompression arthroscopique du nerf donne d’excellents resultats. L’objectif consiste a determiner la recuperation des muscles supra- et infraepineux sur le plan electrophysiologique et radiologique apres decompression dans les atteintes chroniques. Patients et methode Entre janvier 2010 et mars 2016, 21 patients ont ete traites pour une neuropathie chronique du nerf suprascapulaire avec importante atrophie des muscles supra- et infraepineux. En preoperatoire, tous les cas presentaient des douleurs dorsales a l’epaule ainsi qu’une faiblesse a la rotation externe. La decompression arthroscopique du nerf suprascapulaire a ete effectuee dans 14 cas par evacuation de kystes para-glenoidiens associee a une fixation du bourrelet glenoidien et dans 7 cas par dissection du ligament transverse de l’echancrure coracoidienne. Tous les patients ont ete evalues par une IRM et un examen neurophysiologique en preoperatoire ainsi qu’a 12 mois postoperatoires et a chaque annee suivante a l’aide du Simple Shoulder Test. Les images d’IRM ont ete analysees de facon anonyme par deux co-auteurs et les parametres ont ete correles. Resultats Au total, 21 patients ont pu etre inclus avec un recul moyen de 54 mois (R : 28–96). La comparaison des images par IRM montre une augmentation significative (p > 0,01) des volumes des muscles supra- et infraepineux respectivement. Aucun cas de degenerescence graisseuse n’est decele. L’examen neurologique a 1 annee postoperatoire revele une nette amelioration de la vitesse de conduction nerveuse (ENG) et de la force musculaire (EMG). La rotation externe moyenne s’est amelioree de facon non significative (p > 0,05) avec 9° (SD : 8°) en RE1 et 14° (SD : 11°) en RE2. Conclusions Les resultats electrophysiologiques et radiologiques sont excellents apres decompression du nerf suprascapulaire dans les cas de compression chronique. Une recuperation du volume musculaire est observee dans tous les cas et meme apres une atrophie preoperatoire severe des muscles supra- et infraepineux.

Arthroscopic rotator cuff reconstruction (ARCR) is a challenging operative procedure in the treatment of symptomatic cuff tears. The literature does not consistently report on surgical complications after this procedure.

The proximal humerus is a well-known site of predilection for the solitary osteochondroma-the most common benign bone tumor. Subscapularis tears were underreported in the pre-arthroscopic era. Literature about rotator cuff impairment caused by osteochondromas is almost non-existent. We will present the case of a young man, who had a complete non-traumatic subscapularis tear, where the tendon had been peeled off the lesser tuberosity by an osteochondroma. Diagnostic features such as MRI and arthroscopy are emphasized. The patient was successfully treated by open resection of the tumor and reattachment of the tendon with suture anchors.

The standard technique for repairing partial-thickness tears of the supraspinatus tendon includes completion of the lesion to a full-thickness tear. Partial articular-side supraspinatus tendon avulsions (PASTA) form a subgroup deserving special consideration. We present a transtendon suture technique that is able to preserve the intact tendon fibers and to achieve firm attachment of the tendon to the humeral footprint using 1 double-loaded bone anchor. The surgical technique is described in detail, and pitfalls and complications are noted. The clinical results of the first 22 consecutive patients are reported, showing an increase in the UCLA score from 17.1 to 31.2 points and a patient satisfaction rate of 91%.

Introduction Confronted with a failed rotator cuff (RC) repair or a massive tear with compromised tissue quality patch augmentation becomes a logical adjunct from a mechanical and biological point of view. We hypothesize that augmentation of the repair with a novel bioabsorbable scaffold might improve healing rates with few complications and reasonable added costs. Methods A consecutive series of 54 patients was prospectively included since 3/14. The case series includes 38 revision cases (typically medial failures) and 16 primary repairs in massive tears. The operation is technically demanding but reproducible and includes 12 steps (video). The cuff is repaired with a standard suture bridge construct using 1–2 medial and 2 lateral anchors; no additional anchors are needed for patch augmentation. The proposed scaffold (BioFiber, Tornier) consists of biosynthetic fibers woven into a lattice structure and fully absorbing in the Krebs cycle over 18 months. Results Until now 14 patients have completed 24 mo FU including constant score (CS), subjective shoulder value (SSV) and a native MRI. The CS rose from 46 to 85 points, the SSV from 43 to 89%. MR scans showed an intact repair in 12 cases, typically Sugaya type III (intact but thinnend cuff). 2 retears were observed (14%). In this series of 54, one shoulder was revised for infection, one shoulder received a reversed prosthesis and two more were sucessfully revised because of a symptomatic gap formation at the posterior edge of the patch. Reversal of pseudoparesis in massive tears was achieved in 10 cases. The added costs of patch augmention were about 600 Euros, added operation time after the learnig curve less than 30. Patch integration has been observed at repeat arthroscopy. Conclusion We report a learnable technique for patch augmentation in the revision setting and for massive RC tears. Implant costs are reasonable; the material has been succesfully used in abdominal wall hernias and cosmetic breast surgery. The scaffold is made from fully absorbable synthetic fibres degrading without known toxicity and containing no DNA residues. It has good mechanical and biological properties. The preliminary results suggest an improved outcome and higher healing rates in these critical situations.

Posterior shoulder instability is rare, appears in varying clinical patterns and can be the main symptom in patients with instability in more than one direction. The purpose was to analyze and categorize our patients and to report on the results of operative treatment by arthroscopy. A consecutive series of 32 shoulders in 31 patients from a 7-year period was chosen for retrospective clinical evaluation with VAS for pain, Rowe Score, Constant Score and Simple Shoulder Test. Follow-up rate was 100 %, the mean FU period was 28 months (range 13–58). Allocation based on clinical and intraoperative criteria resulted in the 4 groups A to D characterized by an increasing traumatic impact. Patients received a posterior Bankart repair with bone anchors in 21 or capsular plication to the intact labrum in 11 cases. The clinical outcome scores were generally good and all showed a trend towards better results from A to D, but without significance. Pain on VAS pre- and postoperatively showed a significant (p

The case of a 22-year-old man with synovial chondromatosis (SC) of the shoulder joint is described. A literature review confirmed that SC of the glenohumeral joint is very rare and that the etiology of the disease is still unknown. The diagnosis is often delayed, and the preferred form of management remains controversial. We consider magnetic resonance imaging (MRI) a valuable tool in detecting SC at an early phase and estimating the intrasynovial extent of the disease. Shoulder arthroscopy today represents an elegant treatment option for removing the chondromas and performing a partial synovectomy. It might, however, be insufficent in cases of involvement of the bicipital tendon sheath and other recesses of the joint.

This study was performed to review and compare the outcome of a consecutive series of 96 rotator cuff repairs performed with an open versus arthroscopic technique. The arthroscopic repairs include the beginning of the learning curve.Case series.In a 24-month period from 1999 to 2001, 95 patients underwent a cuff repair with bony reattachment by 1 surgeon; 4 patients had surgery on both shoulders. We present subjective outcome data from 96 of 99 operated shoulders by the use of a visual analog scale (VAS), the Simple Shoulder Test (SST), and the question of overall patient satisfaction. Thirty shoulders undergoing surgery before February 2000 had open cuff repair (12 classic open, 18 mini-open) and 66 shoulders undergoing surgery after February 2000 had an arthroscopic cuff repair with suture anchors. All but 3 shoulders had the supraspinatus/infraspinatus tendon refixed, 32% had a subscapularis reattachment, and 21% an additional SLAP repair.Groups A (30 shoulders, open repair) and B (66 shoulders, arthroscopic repair) were comparable concerning tear size, cause of the tear, professional shoulder strain, and preoperative pain intensity. At follow-up evaluation (15-40 months after surgery), group B had significantly better pain relief on the VAS (P.05), more yes answers in the SST (9.7 vs. 8.7, not significant), and a higher patient satisfaction rate of 92.4% versus 80% (not significant). From the 12 questions of the SST, all but 1 showed a higher percentage of yes answers in group B; for 3 questions concerning mobility the difference was significant (P.07). There was no correlation between tear size and outcome in the SST.Arthroscopic cuff repair yielded equal or better results than open repair, even at the beginning of the learning curve. Patients with an arthroscopic repair had a significantly better decrease in pain and a better functional result concerning mobility. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might even benefit more than small ones.Level IV.

Analysis of 100 consecutive femoral fractures admitted to our institution revealed an incidence of about 1 fracture per 2,000 children per year. Epidemiologic data may help to promote prevention. Initial treatment was performed by many doctors, thus rendering guidelines to safe and cost-effective management indispensable. In the last decade, growing concern to reduce hospital stays and costs led to new approaches that replaced traction as a therapeutic principle. Today, we consider immediate spica casting a good option for the group 0-5 years old, whereas in the age group 5-12 years old elastic stable intramedullary nailing (ESIN) produces reliably good results. Minor complications were common and could be avoided partially, but they did not affect the good final outcome.