In this study, massive rotator cuff tears were treated using an absorbable collagen-based patch or a non-absorbable synthetic patch. Results demonstrated the efficacy of the use of the synthetic prolene patch especially for elderly patients The treatment of massive rotator cuff tears presents a challenging problem in shoulder surgery. Traditional repair techniques are associated with high rupture rates due to excessive tension on the repair and the presence of degenerated tendon tissue. These factors have led to attempts to reconstruct the rotator cuff with grafts, using synthetic materials or biologic tissues. The purpose of this study was to compare the efficacy of the use of pericardium patch with the use of prolene patch in the repair of extensive rotator cuff tears.Summary Statement
Introduction
The aim is to evaluate the effectiveness of pericardium patch as a tendon augmentation graft in the repair of massive rotator cuff tear. This is prospective study analysis of a consecutive series of 60 patients who underwent open repair of a massive rotator cuff tear with patch between 1999 and 2007. The inclusion criteria were: symptomatic with pain, deficit of elevation, not responsive to the physiotherapy, tear size (massive: 2 or more tendons), minimum follow-up of 2 years since surgery, active and motivated patients. All were assessed preoperatively with plain radiographs (anteroposterior and axillary views), ultrasound and NMR of the shoulder. The study group consistent of 60 patients (39 men and 21 women) with the mean age of was 66 years (range, 46–81). The mean duration of symptoms before repair was 18 months (range 3–48). Patients were assessed with UCLA score, visual analog scale (Vas scale) and ultrasound preoperatively, at 1 year, and at 3 years. The change in UCLA scores, Vas scale were analyzed with the paired Student's test, assuming a normal distribution of the total score. Satisfactory results were achieved in 49 patients: mean preoperative UCLA score improved from 9.3 to 16.9 at final follow-up. For pain, the mean preoperative value of Vas scale was 9,1, postoperative mean value was 4.9. Range of motion and abduction power improved not significantly after surgery, although patients satisfaction levels were high. Imaging studies identified intact patch in 15 patients and patch detachment in 45. No adverse side effects (infection, rejection, allergy) were reported during the study period. The results of our study suggest that patients (appropriately selected) with a massive full-thickness rotator cuff tear can be expected to have a pain relief after repair, but not a significantly improved of functional outcome.
Traumatic and vascular theories have been proposed as the cause of the SO, lack of blood in some critical areas, such as subchondral bone of femoral condyles or tibial plateaus, has been considered the underlying condition of this pathology. ESWT can be suggested as an effective conservative treatment for SO of the knee.
Patients were treated with a cycle of three ESWT performed with 2000 pulses of 0,28 mJ/mm2 with Wolf Piezoson 300 with 6,5 MHz ultrasounds for three times in a month. Clinical evaluation was performed at first and at third month after treatment and a MRI evaluation was performed at fourth month after treatment.
ESWT might have the potential to avoid the need for surgical treatment.
The aim of the study is to evaluate the results obtained in patients older than 70 years who were treated with open surgical repair for massive ruptures of the rotator cuff and the functional outcome. This is a retrospective analysis of a consecutive series of 280 patients who underwent open repair of a massive rotator cuff tear between 1999 and 2003. The inclusion criteria were: age 65 or over, symptomatic with pain, deficit of elevation, not responsive to the physiotherapy, tear size >
= 5 cm, minimum follow-up of 2 y since surgery. All were assessed preoperatively with plain radiographs (anteroposterior and axillary views) and nmr of the shoulder. Patients were assessed with the Costant score, Simple Shoulder test, UCLA score before and after surgery. Pain was assessed by use of a visual analog scale. The mean age of patients was 75b years (range 65–91). There were 41 men and 28 women. The mean duration of symptoms before repair was 18 months (range 1–58). The dominant arm was affected in 54 patients (78%). The change in UCLA scores, SST, Costant score and their subcomponents were analyzed with the paired Student’s test, assuming a normal distribution of the total score. In an exploratory analysis trying to identify preoperative variables that could be associated with a good surgical outcome, a multivariate logistic regression analysis was performed including the following variables: age equal or more than 80 years, sex history, shoulder different affected, UCLA score, SST, costant score and use of formal physical therapy. Satisfactory results were achieved in 250 patients: the mean preoperative UCLA score was 9.3, Costant score 45, and the mean score after surgery was 16.9 and 65 rispectively. The mean preoperative function score was 2.4, after surgery was 8.1. The UCLA preoperative score for active forward flexion averaged 1.3 (30°–90°), and postoperative rating increased to 4.5 points (p=0,0001)corresponding to an active forward flexion between 120° and 150°.
Patients were evaluated clinically and instrumentally before the first application and at one and three months of follow-up. Three disability scales we utilized (NRS, Mcgill Pain Questionnaire e Chronic Pain Grade Questionnaire).
1. A case of essential osteolysis previously reported in this Journal is recalled briefly and its subsequent course is outlined. 2. A successful prosthesis is described which has enabled the patient to lead a relatively normal life.
