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2013年1月28日江苏徐州骨科运动创伤、关节镜Journal club预告
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Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637, USA.
Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuffwith retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particulararthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.
2、Clin Sports Med. 2012 Oct;31(4):633-44. doi: 10.1016/j.csm.2012.07.002.
Arthroscopic rotator cuff repair: techniques in 2012.Orthopaedic and Sports Medicine Clinic of Kansas City, 3651 College Boulevard, Leawood, KS 66211, USA.
Techniques for arthroscopic partial-thickness and full-thickness RTC repairs continue to advance. When selecting an RTC repair technique, it is important to identify the tear pattern and adhere to the fundamentals of tendon mobilization and footprint preparation. Partial RTC tears greater than 50% in thickness can be reproducibly repaired with tear completion or transtendinous techniques with good clinical outcomes. Based on the available literature, small, less than 1-cm RTC tears can effectively be repaired with single-row techniques. Tears sized 1 cm to 3 cm can be repaired with either single-row, double-row, or transosseous-equivalent techniques based on surgeon comfort, tendon quality, and tissue mobility. Tears greater than 3 cm have shown superior results when transosseous-equivalent techniques are used. Further clinical studies are needed to definitively conclude the ideal RTC repair technique.
3、HSS J. 2011 Oct;7(3):208-12. Epub 2011 Sep 13.
Technique for margin convergence in rotator cuff repair.Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Summit Medical Group, 95 Madison Avenue, Morristown, NJ 07960 USA.
The purpose of the present study is to describe the technique of margin convergence for U-shaped rotator cuff tears and report the clinical outcomes and ultrasonography with a minimum of 2 years follow-up. Three hundred eleven patients with a rotator cuff tear were prospectively enrolled in a registry at one institution. Inclusion criteria included any patient undergoing arthroscopic margin convergence for a rotator cuff tear. Exclusion criteria included open or mini-open rotator cuff repairs or suture anchor fixation to the cuff insertion without margin convergence. The outcome measurements included physical examination, manual muscle testing, the American Shoulder and Elbow Surgeons (ASES) score, and ultrasonography. Nineteen patients met the study criteria and 13 were available for 2-year follow-up (68.4%). The mean age of this cohort was 62.2 ± 7.5 years with a mean pre-operative rotator cuff tear size of 4.0 ± 1.6 cm. The ASES score increased significantly from 50.0 ± 17.7 before surgery to 83.3 ± 19.5 at 2 years (P = 0.01). The active forward elevation also improved from 156.2 ± 11.9° before surgery to 168.0 ± 12.1 at 2 years (P = 0.03). The active external rotation 54.4 ± 14.5 at baseline and improved to 57.1 ± 19.1 at 2 years (P = 0.04). The strength also increased significantly from 6.7 ± 6.4 to 10.6 ± 4.9 lb at 1 year (P = 0.048). The post-operative ultrasound demonstrated that 46.2% of rotator cuff tears were healed at 2 years. In conclusion, margin convergence is a useful technique for U-shaped tears that are difficult to mobilize.
4、J Pediatr Orthop B. 2012 Jun 4. [Epub ahead of print]
Rotator cuff injuries in adolescent athletes.aKeck School of Medicine, Children's Orthopaedic Center, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California bChildren's Hospital Philadelphia, Philadelphia, Pennsylvania, USA.
The cause of rotator cuff injuries in the young athlete has been described as an overuse injury related to internal impingement. Abduction coupled with external rotation is believed to impinge on the rotator cuff, specifically the supraspinatus, and lead to undersurface tears that can progress to full-thickness tears. This impingement is believed to be worsened with increased range of motion and instability in overhead athletes. A retrospective review of seven patients diagnosed with rotator cuff injuries was performed to better understand this shoulder injury pattern. The type of sport played, a history of trauma, diagnosis, treatment method, and outcome were noted. Six patients were male and one was a female. Baseball was the primary sport for four patients, basketball for one, gymnastics for one, and wrestling for one. The following injury patterns were observed: two patients tore their subscapularis tendon, two sustained avulsion fractures of their lesser tuberosity, one tore his rotator interval, one tore his supraspinatus, and one avulsed his greater tuberosity. Only four patients recalled a specific traumatic event. Three patients were treated with arthroscopic rotator cuff repair, three with miniopen repair, and one was treated with rehabilitation. Six of the seven patients returned to their preinjury level of sport after treatment.Rotator cuff tears are rare in the adolescent age group. The injury patterns suggest that acute trauma likely accounts for many rotator cuff tears and their equivalents in the young patient. Adolescents with rotator cuff tears reliably return to sports after treatment. The possibility of rotator cuff tears in skeletally immature athletes should be considered. The prognosis is very good once this injury is identified and treated.
5、Int J Sports Phys Ther. 2012 Apr;7(2):197-218.
Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines.To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation ofrotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.
BACKGROUND:If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion.
METHODS:A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities.
RESULTS:There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data.
CONCLUSION:Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation.
6、J Bone Joint Surg Am. 2012 Feb 1;94(3):227-33. doi: 10.2106/JBJS.J.00739.
National trends in rotator cuff repair.Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair.
METHODS:The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities.
RESULTS:The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopicprocedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001).
CONCLUSIONS:The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.
7、Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1003-11. doi: 10.1007/s00167-012-1901-1. Epub 2012 Jan 21.
Rotator cuff: biology and current arthroscopic techniques.Department of Orthopaedic Surgery, Saarland University, 66424 Homburg/Saar, Germany.
The present article summarizes current trends in arthroscopic rotator cuff repairs focusing on the used repair technique, potential influencing factors on the results, and long-term outcome after reconstruction of the rotator cuff. Moreover, different treatment options for the treatment for irreparablerotator cuff ruptures were described, and the results of additional augmentation of the repairs with platelet-rich plasma were critically analyzed. Based on the current literature, double-row repairs did not achieve superior clinical results compared to single-row repairs neither in the clinical results nor in the re-rupture rate. Multiple factors such as age, fatty infiltration, and initial rupture size might influence the results. If the rupture is not repairable, various options were described including cuff debridement, partial repair, tuberoplasty, or tendon transfers. The additional augmentation with platelet-rich plasma did not reveal any significant differences in the healing rate compared to conventional rotator cuff repairs. LEVEL OF EVIDENCE: IV.
8、Int Orthop. 2012 Jan;36(1):95-100. doi: 10.1007/s00264-011-1305-8. Epub 2011 Jun 30.
Anterolateral approach for mini-open rotator cuff repair.Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 194 Dongsan-dong, Joong-gu, Daegu, Korea. oscho5362@dsmc.or.kr
This study was undertaken to introduce an anterolateral approach for mini-open rotator cuff repair and evaluate its clinical outcome and effectiveness.
METHODS:We evaluated 128 consecutive cases that were repaired by mini-open repair using an anterolateral approach. There were 80 men and 48 women, with an average age of 56.2 years. Average follow-up was 25.7 months. There were eight partial-thickness, 26 small, 40 medium, 39 large and 15 massive tears. After arthroscopic glenohumeral examination and subacromial decompression, we made a 3- to 4-cm skin incision from anterolateral edge of the acromion and dissected to the raphe between the anterior and middle deltoid. The torn tendon was repaired with single- or double-row technique using suture anchors. To prevent avulsion of the deltoid from the acromion, additional suturing within the bone tunnel was performed. We retrospectively evaluated clinical outcomes using the American Shoulder and Elbow Surgeon (ASES) scoring system.
RESULTS:The average visual analogue scale (VAS), activity of daily living (ADL) and ASES scores improved, respectively, from 6.6, 12.0 and 36.7 preoperatively to 1.2, 26.6 and 88.2 postoperatively. There were 71 excellent, 39 good, ten fair and eight poor results. There were no statistically significant difference between final ASES scores and age, symptom duration, tear size or preoperative stiffness, but men had significantly higher final ASES scores than women (P = 0.014).
CONCLUSION:Anterolateral approach for mini-open rotator cuff repair produces satisfactory results. It may also provide better visualisation for rotator cuff tears of all sizes.
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