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Early Clinical Results of Arthroscopic Latissimus Dorsi Transfer For Irreparable Cuff Tears (SS-24)
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ABSTRACTS
Introduction: Symptomatic sternoclavicular joint disorders refractory to non-operative treatment are not common. Traditionally surgical intervention has required an open approach but carries the risks of damage to underlying mediastinal structures, damage to the sternoclavicular and costo-clavicular ligaments with subsequent joint instability and unsightly scarring. An arthroscopic approach could potentially decrease these risks. Methods: Patients & Technique: We undertook an arthroscopic approach to the sternoclavicular joint for the surgical treatment of 25 patients. These included 2 diagnostic osteochondral biopsies, 3 diagnostic synovial biopsies and joint lavage, 2 excisions of bony loose fragments, 4 sternoclavicular menisectomies and 14 excisions of the medial end of the clavicle and degenerate intra-articular disc. All patients underwent pre-operative MRI scanning to visualise the anatomy of the sternoclavicular joint and establish the proximity and any possible anatomical variation of the vessels posterior to the mediastinum. At surgery the patients were positioned supine with a sand-bag between the shoulder blades. A 2.7mm 300 arthroscope and 3mm instruments were used. An initial viewing portal was established using a longitudinal incision in the line of and just inferior to sternoclavicular joint. A second superior working portal was then created in the soft spot at the medial end of the clavicle leaving the anterior sterno-clavicular ligament intact. Having obtained satisfactory visualisation within the joint the posterior capsule was then identified allowing for intra-articular biopsy and excision of soft-tissue or bone to be undertaken safely. Results: Results: None of the patients had any complications following surgery. The 6 patients who underwent excision of loose fragments or menisectomy had a complete resolution of symptoms. All of the medial clavicle excision patients obtained initial subjective symptomatic relief but in 3 this has not been sustained. Conclusion: Conclusion: This series demonstrates that an arthroscopic approach to the sternoclavicular joint is technically possible and safe. This could lead to a lowering of the threshold for the operative management of a limited number of sternoclavicular disorders.
Introduction: Latissimus dorsi (LD) transfer for irreparable posterosuperior cuff tears has been described as successful in many studies. Insufficient tendon thickness and open exposure may explain some unsatisfying results. Our purpose was to evaluate an arthroscopic assisted technique of the LD transfer and tunnel fixation as a prospective multicenter study presenting clinical, magnetic resonance imaging (MRI) and electromyographic (EMG) results Methods: Inclusion criteria was an irreparable posterosuperior cuff tear. Exclusion criteria were eccentric omarthrosis, deltoïd palsy, irreparable subscapularis tear. All patients were pre- and post-operatively evaluated with Constant score and single shoulder value (SSV) score and had pre-operative MRI or CT scan. Patients were asked to have a one year postoperative MRI and EMG Results: Forty-nine patients met the criteria for inclusion. Mean age was 59,4 (31-73). 26 patients had previous surgeries (1 to 6 procedures). Mean preoperative Constant score was 36,8 (14-58), preoperative SSV score was 26,6 % (5-50). No patient was lost to follow-up. Mean follow-up was 21,2 months (12-42). Mean postoperative Constant score was 63,6 (35-81), mean postoperative SSV score was 68,6 % (25-90. Factors that had no influence on the clinical results: age , gender, type of work, preoperative mobility zone of fixation of the tendon on the greater tuberosity. Factors that had adverse effects: preoperative surgery, worker’s compensation. Forty-four patients had a one year postoperative MRI, 41 had an intact transfer, 3 had a ruptured tendon. Six patients had a one year postoperative EMG. LD muscle was electrically active during combined external rotation and abduction Conclusion: This is the first multicenter prospective study describing the early clinical results of the arthroscopic assisted transfer and bone tunnel fixation of the LD tendon. Our preliminary results reinforce previously described improved biomechanical properties of bone tunnel fixation rather than anchor fixation technique. Our clinical and MRI results are promising and are comparable to anchor fixation techniques. EMG results are encouraging but need to be obtained in more patients.
Early Clinical Results of Arthroscopic Latissimus Dorsi Transfer For Irreparable Cuff Tears (SS-24) VIVIAN K. CHANG, M.D., PRESENTING AUTHOR JEAN GRIMBERG, M.D. JEAN KANY, M.D. PHILIPPE VALENTI, M.D. LOUIS-DENIS DURANTHON, M.D. JEROME GARRET, M.D.
Arthroscopic Basic Task Performance in Shoulder Simulator Model Correlates with Clinical Arthroscopy Experience (SS-25) KEVIN D. MARTIN, D.O., PRESENTING AUTHOR ANDREW SCHOENFELD, M.D. KENNETH CAMERON, PH.D. BRETT D. OWENS, M.D. PHILIP BELMONT, M.D.
ABSTRACTS
Introduction: Symptomatic sternoclavicular joint disorders refractory to non-operative treatment are not common. Traditionally surgical intervention has required an open approach but carries the risks of damage to underlying mediastinal structures, damage to the sternoclavicular and costo-clavicular ligaments with subsequent joint instability and unsightly scarring. An arthroscopic approach could potentially decrease these risks. Methods: Patients & Technique: We undertook an arthroscopic approach to the sternoclavicular joint for the surgical treatment of 25 patients. These included 2 diagnostic osteochondral biopsies, 3 diagnostic synovial biopsies and joint lavage, 2 excisions of bony loose fragments, 4 sternoclavicular menisectomies and 14 excisions of the medial end of the clavicle and degenerate intra-articular disc. All patients underwent pre-operative MRI scanning to visualise the anatomy of the sternoclavicular joint and establish the proximity and any possible anatomical variation of the vessels posterior to the mediastinum. At surgery the patients were positioned supine with a sand-bag between the shoulder blades. A 2.7mm 300 arthroscope and 3mm instruments were used. An initial viewing portal was established using a longitudinal incision in the line of and just inferior to sternoclavicular joint. A second superior working portal was then created in the soft spot at the medial end of the clavicle leaving the anterior sterno-clavicular ligament intact. Having obtained satisfactory visualisation within the joint the posterior capsule was then identified allowing for intra-articular biopsy and excision of soft-tissue or bone to be undertaken safely. Results: Results: None of the patients had any complications following surgery. The 6 patients who underwent excision of loose fragments or menisectomy had a complete resolution of symptoms. All of the medial clavicle excision patients obtained initial subjective symptomatic relief but in 3 this has not been sustained. Conclusion: Conclusion: This series demonstrates that an arthroscopic approach to the sternoclavicular joint is technically possible and safe. This could lead to a lowering of the threshold for the operative management of a limited number of sternoclavicular disorders.
Introduction: Latissimus dorsi (LD) transfer for irreparable posterosuperior cuff tears has been described as successful in many studies. Insufficient tendon thickness and open exposure may explain some unsatisfying results. Our purpose was to evaluate an arthroscopic assisted technique of the LD transfer and tunnel fixation as a prospective multicenter study presenting clinical, magnetic resonance imaging (MRI) and electromyographic (EMG) results Methods: Inclusion criteria was an irreparable posterosuperior cuff tear. Exclusion criteria were eccentric omarthrosis, deltoïd palsy, irreparable subscapularis tear. All patients were pre- and post-operatively evaluated with Constant score and single shoulder value (SSV) score and had pre-operative MRI or CT scan. Patients were asked to have a one year postoperative MRI and EMG Results: Forty-nine patients met the criteria for inclusion. Mean age was 59,4 (31-73). 26 patients had previous surgeries (1 to 6 procedures). Mean preoperative Constant score was 36,8 (14-58), preoperative SSV score was 26,6 % (5-50). No patient was lost to follow-up. Mean follow-up was 21,2 months (12-42). Mean postoperative Constant score was 63,6 (35-81), mean postoperative SSV score was 68,6 % (25-90. Factors that had no influence on the clinical results: age , gender, type of work, preoperative mobility zone of fixation of the tendon on the greater tuberosity. Factors that had adverse effects: preoperative surgery, worker’s compensation. Forty-four patients had a one year postoperative MRI, 41 had an intact transfer, 3 had a ruptured tendon. Six patients had a one year postoperative EMG. LD muscle was electrically active during combined external rotation and abduction Conclusion: This is the first multicenter prospective study describing the early clinical results of the arthroscopic assisted transfer and bone tunnel fixation of the LD tendon. Our preliminary results reinforce previously described improved biomechanical properties of bone tunnel fixation rather than anchor fixation technique. Our clinical and MRI results are promising and are comparable to anchor fixation techniques. EMG results are encouraging but need to be obtained in more patients.
Early Clinical Results of Arthroscopic Latissimus Dorsi Transfer For Irreparable Cuff Tears (SS-24) VIVIAN K. CHANG, M.D., PRESENTING AUTHOR JEAN GRIMBERG, M.D. JEAN KANY, M.D. PHILIPPE VALENTI, M.D. LOUIS-DENIS DURANTHON, M.D. JEROME GARRET, M.D.
Arthroscopic Basic Task Performance in Shoulder Simulator Model Correlates with Clinical Arthroscopy Experience (SS-25) KEVIN D. MARTIN, D.O., PRESENTING AUTHOR ANDREW SCHOENFELD, M.D. KENNETH CAMERON, PH.D. BRETT D. OWENS, M.D. PHILIP BELMONT, M.D.