$46
J. Shoulder Elbow Surg. March/April 1996
Abstracts
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ARTHROSCOPIC SURGERY FOR CHRONIC IMPINGEMENT SYNDROME. K.Yanaga, M.Kurokawa, MD, & Y.Hirasawa, MD, Dept. of Orthop. Surg., Kyoto Prefectural Univ. of medicine, Kyoto, Japan. The purpose of this study was to clarify the indication of arthroscopic surgery for chronic impingement syndrome. Forty cases(age 15-86, mean 49) with chronic impingement were operated arthroscopicafly. Using Synder's arthroscopic classification, 27 shoulders with incomplete rotator cuff tear(RCT) were classified into Synder A or B. Seven had complete RCTs (Synder CI,C2 & C3).Six were massive RCTs(Synder C4). ASD was made on 20 shoulders and CA dissection was made on seven in Synder A and B RCTs. ASD was also made on seven shoulders with Synder C1 ,C2 and C3 RCT. in six Synder C4 RCTs, three were operated on with ASD and the others were with debridement. Clinical results were evaluated using the shoulder rating score of the Japanese Orthopaedic Association(JOA score).ln Synder A and B RCTs, grade 1 (mean 94.3 pts.) and grade 2(92.4 pts.) showed excellent or good results with postoperative score in ASD, but two cases of grade 3(73.7 pts,) were judged in poor. Six cases of Synder C2 and C3 RCTs(87.3 pts.) showed excellent or good results. Both ASD and debridement(67.0 & 60.0 pts.) were fair or poor results in Synder C4 RCTs. In conclusior], ASD achieved good results in case of Synder grade ; and grade 2 RCTs. Both ASD and debddement were unfavorable for Synder C4 RCT. The results of ASD depended on the sizes of the RCT.
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SUBACROMIAL D E C O M P R E S S I O N FOR IMPINGEMENT SYNDROki OF ]-HE SHOULDER: 4- and tO-YEARS-FOLLOW-UP IN CDkiPARI$ON. J. Ludwig. kiD. Chl Plalki. MD. H. NonseidJansen. kiD. A. Hedlmann. kid 9 R.H. Wittenberg. kiD. Dept. of Orthopaedic=. Univ. o! Bochum. Germany The impingement syndrome of the shoulder, described by NEER in 1972 means an impingement of the rotator cuff on the coracoaclomial ligament and the anterior acromion. Besides degenerative deseases {e_g. rotator cuff tearJ it is one occasion for shoulder pain. If conservative treatment fails, surgical treatment with resection of the coracoaclomial ligament. an optional anterior acromioplasty and in eases of calcifying tendiniti: removal of calcium deposits has become a standard procedure_
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To get more information about medium-term and long-term results of subacromial decompression patients, who had beer= operated on between (]1/1980 and 05/1585 (n=140 with 150 operated shoulders] were investigated 4 years [average 46.9 monthJ and 10 years [135 month] after ~urgical treatment The total number mat 112 Patients with 120 operated shoulders. None o| these patients got an anterior acromiopiasty. Valuation of the results ensued from a score which included functional disturbance, pain. intensity of pain and patients comment on result of surgical treatment. CONSTANT-Score was not used in ~be medium-term results but in the same way as our own score for valuation o| the long-term results. The medium-term results revealed after assessment of 70 male and 50
female shoulders with an ratio of 78 right to 42 lets shoulders 81.7 excellent, 10.8 ~ good. 3.3 ~ fair and 4.2 9 poor result~r Even patients with ooor results had at least more mobility of the opelated shoulder. Resullt el the long-term investigation {50 patients[, are similar to the medium term results [ GZ.O :~ excellent. 1G.0 ~; good. 14~0 ~; fair and 8.0 ~; poe, lesolts[. Valuation with CONSTANT-Score showed GS.0 excellent. 12.0 :r good. 12.0 :r fair and 10 9 poor results_ The subacromial decompression with more than 90 ~; excellent and good results after four and 76 9 after ten years is an adequate treatment of impingement syndromes when conservative treatment has failed.
ARTHROSCOPIC SUB-ACROMIAL DECOMPRESSION-A REVIEW OF 582 CASES. J F de Beer~ M A de Beer, I R 8 Wilson, Leeuwendal Medi-Clinic, Cape Town, South Africa. The purpose of this study was to assess the results of arthroscopic sub-acromial decompression (ASAD). A retrospective study done by independent observers was conducted on 582 cases of ASAD performed by the senior authors from 1991to1994. The follow-up was from 6 months to 4'~ years. 59% of the patients were men and the age range was from 21 - 74 years with a mean of 51 years. A precision technique has been developed:The acromioclavicular joint is always viewed and used for orientation. With the scope in the posterior portal the anterior end of the acromionis shortened to the line of the anterior aspect of the AC joint, with the acromionizerin the lateral portal. Switching the scope tolatera]~ instrument to posterior the shape of the acromion is then changed to a flat, Type I, starting the slope from the line of the posterior aspect of the AC joint. Viewing from lateral portal, instrument in anterior portal, the anterior edge of the acromion is then p e r f e c t e d . The r e s u l t s were evaluated according to the American Shoulder and Elbow Surgeons s c o r i n g system. Good and Excellent : 88% Fair : 5% Poor : 7% Complications : Nil In spite of reservations as to the success of this technique by some authors~ our experience is that thls is a very s u c c e s s f u l procedure i n the hands o f experienced shoulder arthroscopic surgeons. In fact, it has become preferable to open acramiaplasty.
COMPARISON OF THE RESULTS OF THE NEER ACROMIOPLASTY A N D MODIFIED A C R O M I O P L A S T Y
G~]ven O. *, BOltJkba,}l B. ~, Karahan M. *, Atik ~.~, Aykm ~.~ *MarmaraUnlv.Schoolof MedicineDepartmentof Orthopedics& Traumatology,Istanbul.Turkey ~Gazi UnivSchoolof MedicineDepartmentof Orthopedics& Traumatol~gy,Ankara,Turkey Acremioplasty was performed in 77 (47 F / 30 M) patients with the diagnosis of impingement syndrome. In 50 of these patients classical Neer acromioplasty was performed.(Group I) Modified acremioplasty which was described by Rockwood was performed in the remaining 27 patients, (Group II) The postoperative results of each group were evaluated.(Table-I) Mean follow-up time was 23.2(8-46) months in Group I, while the mean follow-up time was 24,8 (10-42) in group II. There was no significant difference in age between two groups. The results were evaluated by both the Constant scoring system and the scoring system which is described by C.H Rockwo~l, Results : Group I Group II Excellent 36 (%72) 19(%70,3) Good 10 (%20) 6 (%22,2) Poor 4 (%8) 2 (%7.5) Table 1; Postoperativeresults accerdingto the Rockwood scoring system. Group I Group II Preoperative 32 (12-45) 35 (15-40) Postoperative 85 (69-98) 91 (76-98) Table 2: Comparative results according to the Constant scoring system. Results of the preoperative and the postoperative Rockwood scoring system in each group was evaluated by the Stuart-Maxwell test.(p>0,O5) Results of the Constant scodng system in each group was evaluated with the Student's paired t-test. (p>0,05) Conclusion: Neither Neer method nor modified Rockwood acremioplasty does not change the final outcome. Both methods provide adequate decompression.