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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: Retears after rotator cuff repair (RCR) have been associated with poor clinical results. Meaningful data regarding the role of arthroscopic revision RCR are sparse thus far. Purpose/Hypothesis: To investigate results after arthroscopic revision RCR. We hypothesized that (1) arthroscopic revision RCR would lead to improved outcomes, (2) the clinical results would be dependent on tendon integrity and (3) tear pattern, tendon involvement, and repair technique would influence clinical and structural results. Study Design: Case series; Level of evidence 4. Methods: During a 40-month period, 100 patients who underwent arthroscopic revision RCR were prospectively enrolled in this multicenter study. Outcomes were evaluated preoperatively, at 6 months (6M), and at 24 months (24M) using the Constant score (CS), the Oxford Shoulder Score (OSS), and the Subjective Shoulder Value (SSV). Tendon integrity at 2 years was analyzed using magnetic resonance imaging. A total of 13 patients (13%) were lost to follow-up, and 14 patients (14%) had a symptomatic retear before the 24M follow-up. Results: All clinical scores improved significantly during the study period (CS: preoperative, 44 ± 16; 6M, 58 ± 22; 24M, 69 ± 19 points; OSS: preoperative, 27 ± 8; 6M, 36 ± 11; 24M, 40 ± 9 points; SSV: preoperative, 43% ± 18%; 6M, 66% ± 24%; 24M, 75% ± 22%) ( P < .01). At 2 years, a retear rate of 51.8% (43/83) and a surgical revision rate of 12.6% (11/87) were observed. Mean full-thickness tear size decreased from 5.00 ± 1.61 cm2 to 3.25 ± 1.92 cm2 ( P = .041). Although the Sugaya score improved from 4.5 ± 0.9 to 3.7 ± 1.4 ( P = .043), tendon integrity did not correlate with better outcome scores. Previous open RCR, involvement of the subscapularis, chondral lesions of Outerbridge grade ≥2, and medial cuff failure were correlated with poorer SSV scores at 2 years ( P≤ .047). Patients with traumatic retears had better CS and OSS scores at 2 years ( P≤ .039). Conclusion: Although arthroscopic revision RCR improved shoulder function, retears were frequent but usually smaller. Patients with retears, however, did not necessarily have poorer shoulder function. Patient satisfaction at 2 years was lower when primary open RCR was performed, when a subscapularis tear or osteoarthritis was present, and when the rotator cuff retear was located at the musculotendinous junction. Patients with traumatic retears showed better functional improvement after revision.

To compare the clinical and imaging outcome of arthroscopic transosseous (TO)-equivalent rotator cuff repair (RCR) with anchors with arthroscopic anchorless TO RCR at a minimum of 2 years postoperatively.The study population included patients who underwent RCR using either an anchorless TO technique with a TO suture passing device (group A) and those who were matched for tear size and underwent RCR using suture anchors for repair (group B). The inclusion criterion was an easily reducible rotator cuff tear with a sagittal extension of 2 to 4 cm. After a minimum of 2 years, clinical outcome scores and magnetic resonance imaging were obtained. Tendon quality and footprint integration were evaluated using the Sugaya classification.Seventy patients were included. A total of 45 were in group A and 25 were in group B. Group A had 2 bone tunnels and 4 sutures using an X-box configuration, and group B had a suture bridge construct of 4 anchors. Group A and B had identical anteroposterior tear size and were comparable for age. The Constant score improved from 50 ± 17.4 to 88 ± 8.6 in group A versus 48 ± 14.5 to 87 ± 7.2 in B. The Subjective Shoulder Value rose from 47 ± 19.1 to 95 ± 7.4 in group A vs from 47 ± 19.4 to 95 ± 7.6 in B. Neither the preoperative (Anchorless TO RCR is a valid alternative to suture anchor techniques. Clinical outcome data showed comparable results for both techniques after a follow-up of 2 years. The healing results as observed on magnetic resonance imaging were also equivalent for both groups.Level III, retrospective comparative study.

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.

The subscapularis muscle and its tendon are of major importance in the kinematics of the glenohumeral joint. Therefore, a diligent repair of subscapularis tears is essential. We describe our reliable standardized arthroscopic suture bridge technique to repair subscapularis tears under intra- and extraarticular visualization and with preservation of the “comma sign.” This technique provides excellent exposure of the subscapularis tendon, allows its complete release in the subcoracoid space and ensures a safe and stable repair., Technique Video Video 1 Arthroscopic suture-bridge repair of the subscapularis tendon—“inside and outside the box” with preservation of the comma sign. Video sequences are taken from the right shoulder of a patient in the beach-chair position. The arthroscopic video clips are taken from the posterior (intra-articular), suprabicipital (extra-articular), and posterolateral (subacromial) viewing portals. A case of a subscapularis tear with luxation of long head of biceps and tear of the anterior rotator cable is shown. The 12 steps of suture bridge repair of the Subscapularis as specified in Table 1 are illustrated subsequently.

Background: Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. Purpose: To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions—(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction—using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. Results: The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N ( P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N ( P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group ( P≤ .029). Conclusion: While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. Clinical Relevance: DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.

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.

Instabilitaten sind eine haufige Ursache von Schulterbeschwerden bei jungen sportlichen Patienten und stellen den behandelnden Arzt oft vor eine diagnostische Herausforderung. Im Vergleich zur wesentlich ofter auftretenden ventralen Instabilitat wird die dorsale Schulterinstabilitat wenig beachtet. Sie wird daher vielfach ubersehen oder falsch behandelt.

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.

Die arthroskopische Rotatorenmanschettennaht (RMN) befindet sich auf dem Siegeszug zum „Goldstandard“ in der operativen Behandlung der Rotatorenmanschette (RM). In unserer Klinik, in der wir bereits seit dem Jahr 2000 alle RMN ausschlieslich arthroskopisch durchfuhren, haben wir immer wieder Falle mit unbefriedigendem Verlauf gesehen, als deren Ursache meist eine (partielle) Reruptur diagnostiziert wurde. Das ist der Grund, weswegen wir – bei aller Begeisterung fur die Arthroskopie – hier die Frage aufwerfen mochten: Was tun, wenn die Manschette nicht heilt?

Purpose Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure. Methods A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured. Results The distance of the inferior glenoid rim to the axillary nerve averaged 13.6 mm (5.8–27.0 mm, ±5.1 mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1 mm (0.6–21.3 mm, ±6.5 mm). The distance of the glenoid centre to the suprascapular nerve passing point under the transverse scapular ligament measured 28.4 mm (18.9–35.1 mm, ±3.8 mm) in the mediolateral direction and 10.8 mm (−4.8 to 25.3 mm, ±6.1 mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6 mm (11.1–24.9 mm, ±3.4 mm) in the mediolateral direction and −11.8 mm posterior (−19.3 to −4.7 mm, ±4.7 mm) in the anteroposterior direction. Conclusions Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11 mm and to the suprascapular notch of 19 mm.

Etwa 5% der Patienten in der Schulterpraxis berichten uber ratselhafte Schulterbeschwerden, die ohne ausere Ursache oder nach einem Bagatellereignis aufgetreten sind. Die zunehmend massiven Schmerzen qualen die Betroffenen vor allem auch nachts. Erst spater fallt den Patienten auf, dass sie ihre Schulter nicht mehr gut bewegen konnen und ihnen viele alltagliche Verrichtungen wie das Schliesen des Bustenhalters oder das Ziehen des Parktickets und auch die Korperpflege zunehmend Muhe bereiten — das Krankheitsbild der Frozen Shoulder ist voll entwickelt.

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.

Cadaveric studies and commercial pressure have initiated a strong trend towards double-row repair in arthroscopic cuff surgery. The objective of this study was to evaluate if the biomechanical advantages of a double-row supraspinatus tendon repair would result in superior clinical outcome and higher abduction strength. A retrospective study of two groups of 32 single-row and 33 double-row repairs of small to medium cuff tears was performed. The Simple Shoulder Test (SST) and a visual analog scale for pain were used to evaluate the outcome. The participation rate was 100%. A subset of patients was further investigated with the Constant Score (CS) including electronic strength measurement. The double-row repair patients had significantly more (p = 0.01) yes answers in the SST than the single-row group, and pain reduction was slightly better (p = 0.03). No difference was found for the relative CS (p = 0.86) and abduction strength (p = 0.74). Patient satisfaction was 100% for double-row and 97% for single-row repair. Single- and double-row repairs both achieved excellent clinical results. Evidence of superiority of double-row repair is still scarce and has to be balanced against the added complexity of the procedure and higher costs.

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.

We present a simplified and cost-effective method for repair of a type II SLAP lesion that requires only 1 working portal in the rotator interval-the lateral anterosuperior portal (LASP)-which is about 3 cm more lateral than the standard ASP. The rotator cuff tendon or muscle are not violated when using this portal, which provides an unproblematic 30 degrees angle for the drill hole. The biceps root can be firmly reattached anteriorly and posteriorly using 1 double-loaded absorbable bone anchor with a suture eyelet. The first stitch is performed using a straight suture hook to pierce the anterior biceps root from the front. A PDS utility suture helps to shuttle the braided suture in a retrograde manner through the labrum. We then tie a sliding knot seating solidly on top of the labrum. The second stitch is placed with a 45 degrees curved suture hook allowing us to pierce the labrum posteriorly to the biceps from above. Again, a sliding knot will be seated on top of the posterior biceps root, pressing it firmly onto the previously abraded bone. The completed repair looks like a V and produces secure fixation of the biceps, thus eliminating the peel-back phenomenon.

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.

In the Basel study (BS) (1960-73) on cardiovascular and peripheral arterial diseases, a mortality follow-up was completed for the period 1965-80. Of the 4,224 men at risk for these diseases, 531 died. The causes of death were established from the death certificates and classified into 8 groups. For each case 2 age- and sex-matched controls were selected and compared with the corresponding cases with regard to the various variables obtained at the three examinations (1960, 1965, 1971). This report dealth with cancer mortality, plasma lipids, plasma vitamins, alcohol and cigarette consumption, and intake of milk and citrus fruits. The results were all obtained at the second follow-up examination (BS III, 1971-73). Cancer of the lung, stomach, large bowel, and all other sites were treated separately. The average follow-up from BS III until death varied from 3.7 years (other sites) to 4.9 years (cancer of the lung). Of 129 cancer deaths, the highest incidence was found for cancer of the lung (38) followed by stomach (19) and large bowel, (15) and the remainder (57) was for other sites. Plasma lipids did not differ significantly among cases and controls. However, the lowest values were observed in colorectal cancer and gastric carcinoma (mean cholesterol, 213 mg/dl). beta-Carotene was significantly lower in cancer cases of the lung than in controls (14.8 micrograms/dl vs. 23.7; P less than .05). It was also low in gastric cancer cases (13.0 micrograms/dl). Vitamin A was below average only in cases with gastric cancer (difference due to the small number not significant). Vitamin C was consistently lower in cancer cases than in controls. The lowest value was found for cancer of the stomach and corresponded to a below-average consumption of citrus fruits. Vitamin E was low in cancer of the colon. Plasma lipids correlated strongly with vitamin E (tau = 0.5) and to a lesser extent with vitamin A (tau = 0.25). beta-Carotene correlated poorly with beta-lipoproteins (low-density and very low-density lipoproteins) but significantly with total cholesterol. Smoking was inversely related, as was alcohol consumption, to the beta-carotene level. From these results, the conclusion was that vitamins influence carcinogenesis in humans.