ABSTRACTS Conclusion: Arthroscopic debridement provides reliable outcome in low-grade tear of the non-throwing sports athletes and non-sports participants. Arthroscopic debridement alone cannot be justified in the throwing athletes with more than Ellman grade 2 tear. Arthroscopic repair is indicated in these high demanding patients. Return to activity is inferior in throwing athletes as compare with non-throwers or non-sports participants. Paper 148: Interventions for Tears of the Rotator Cuff in Adults (Cochrane Review) CARLOS VICENTE ANDREOLI, SAO PAULO, BRAZIL MOISES COHEN, SAO PAULO, BRAZIL BENNO EJNISMAN, SAO PAULO, BRAZIL, PRESENTER FLAVIO FALOPPA, SAO PAULO, BRAZIL ALBERTO CASTRO POCCHINI, SAO PAULO, BRAZIL GUSTAVO CARA MONTEIRO, SAO PAULO, BRAZIL · University Federal of Sao Paulo, Brazil Background: Tears of the rotator cuff tendons, which surround the joints of the shoulder, are one of the most common causes of pain and disability in the upper extremity. Objectives: To review the efficacy and safety of common interventions for tears of the rotator cuff in adults. Search Strategy: We searched the Cochrane Musculoskeletal Injuries Group specialised trail register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library issue 2, 2002), MEDLINE (1966 to December 2001), EMBASE (1974 to December 2001), Biological Abstracts (1980 to December 2001), LILACS (1982 to December 2001), CINAHL (November 1982 to December 2001), Science Citation Index and reference lists of articles. We also contacted authors and handsearched conference proceedings focusing on shoulder conditions. Selection Criteria: Randomised or quasi-randomised clinical trials involving tears of the rotator cuff were the focus of this review. All trials involving conservative interventions or surgery were included (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, and open or arthroscopic surgery). Data Collection and Analysis: Two reviewers independently assessed suitability for inclusion, methodological quality and extracted data. Dichotomous data were presented as relative risks (RR) and 95% confidence intervals (CI), using the fixed effects model. Main Results: Eight trials involving 455 people were included and 393 patients analysed. Trials were grouped in eight categories of conservative or surgical treatment.
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The median quality score of all trials combined was 16 out of a possible 24 points, with a range of 12-18. In general, included trials differed on diagnostic criteria for rotator cuff tear, there was no uniformity in reported outcome measures, and data which could be summarised were rarely reported. Only results from two studies comparing open repair to arthroscopic debridement could be pooled. There is weak evidence for the superiority of open repair of rotator cuff tears compared with arthroscopic debridement. Reviewers’ Conclusions: There is little evidence to support or refute the efficacy of common interventions for tears of rotator cuff in adults. As well as the need for further well designed clinical trials, uniform methods of defining interventions for rotator cuff tears and validated outcome measures are also essential. Paper 149: Ten Years Follow Up of Longstanding Adductor-related Groin Pain in Athletes PER HOLMICH, COPENHAGEN, DENMARK, PRESENTER PER NYVOLD, DRAGOER, DENMARK INGE-LIS KANSTRUP, HERLEV, DENMARK ANNA ROSTED, COPENHAGEN DENMARK · Dept.Orthop.Surg. Amager University Hospital, Copenhagen Denmark Introduction: Adductor-related groin pain is a frequent problem in athletes with an incidence between 8 % & 18 %. It is known to cause longstanding problems that might even sideline the athlete permanently. Results of a randomised clinical trial (Lancet 1999; 353: 439-443) have shown a specific training programme to be highly effective in the treatment of adductor-related groin pain. Material & Methods: The above mentioned RCT took place between 1991 and 1995 and compared an active physical training programme with a conventional physiotherapy programme without active training. 59 male athletes aged 18 to 50 years participated. The purpose of the present study was to follow up on these 59 athletes 8 to 12 years after they finished the treatment. A questionnaire was filled out by the participants. They were examined by a blinded observer using the same examination technique used in the primary study. The standardised tests have, in another study (BrJSpMed 2004), all been shown to be reproducible. New radiographs and bone scintigrams have been taken to follow the development compared to the primary images. The same outcome measures and subjective global assessment as used in the primary study have been used. Results: 48 participants of the primary study have been examined (80 %). Mean age 40 years, mean follow up 10 years. The athletes have decreased activity level but mainly for other reasons than groin pain. Their activity
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level, clinical symptoms and findings and their subjective global assessment will be presented. The results will be correlated to the radiographic and bone scintigraphic findings especially related to the pubic bone and symphysis joint. Conclusion: The preliminary results indicate that the benefit of the active physical training programme both regarding activity, clinical findings and subjective global assessment is of long-term value to athletes with adductor- related groin pain. Paper 150: The Role of Allogenic Mesenchymal Stromal Cells in the Repair of Injured Skeletal Muscle KOJI NATSU, HIROSHIMA, JAPAN, PRESENTER MITSUO OCHI, HIROSHIMA, JAPAN YU MOCHIZUKI, HIROSHIMA, JAPAN NOBUO ADACHI, HIROSHIMA, JAPAN HIROKI HACHISUKA, HIROSHIMA, JAPAN HIROMICHI OOMAE, HIROSHIMA, JAPAN SHIN YOKOYA, HIROSHIMA, JAPAN SHONOBU YANADA,HIROSHIMA, JAPAN YUJI YASUNAGA, HIROSHIMA, JAPAN · Hiroshima University, Hiroshima, Japan Purpose: Mesenchymal stem cells have the potential to differentiate into skeletal muscle. The purpose of this study was to confirm how mesenchymal cells would participate in the repair of injured skeletal muscle after grafting to the injured site by using green fluorescent protein (GFP) transgenic cells as donors. Materials and method: Naive Sprague Dawley (SD) rats and GFP transgenic SD rats were used in this study as recipients and donors, respectively. The recipient SD rats were divided into 3 groups. A half stratum laceration was made in the muscle belly of the tibialis anterior of the recipient SD rats in group L. In group F, fibrin glue was grafted to the lacerated site of the recipient SD rats. In group M, bone marrow cells were grafted as follows. Bone marrow cells were harvested from donor GFP transgenic SD rats and cultured on dishes. Adherent cells were gathered, embedded in fibrin glue, and grafted to the lacerated site. Tacrolimus, an immunosuppressive agent, was administered to the rats of all groups every 2 days to prevent an immune reaction. Before sacrifice, the fast-twitch strength and tetanus strength produced by nerve stimulation were measured for functional evaluation. The specimens of the tibialis anterior muscle were stained with hematoxylin and eosin, and they were immunohistochemically stained for histological evaluation. Results: The mean values of the fast-twitch strength in groups M, F, and L were 76.7%, 76.6%, and 80.1% of
the healthy side, respectively, at postoperative day 14. The mean values increased to 89.2%, 80.2%, and 81.6% of the healthy side in groups M, F, and L, respectively, at postoperative day 28. There were no significant differences among the three groups. The mean values of the tetanus strength in groups M, F, and L were 73.7%, 73.4%, and 72.3% of the healthy side, respectively, at postoperative day 14. The mean values increased to 95.5%, 81.5%, and 83.1% of the healthy side in groups M, F, and L, respectively, at postoperative day 28. The mean value in group M was significantly higher than in groups F and L GFP-positive donor derived cells were observed in and around the grafted fibrin glue at postoperative day 14. At postoperative day 28, GFP-positive cells lay in the interstitial area of myofibers, and GFP-positive myofibers were not observed. The specimens of all groups at postoperative day 14 were stained immunohistochemically with anti-vimentin antibody and anti-desmin antibody. The majority of uninuclear cells around the fibrin were vimentin-negative and desmin-negative in group M, but vimentin-positive and desmin-negative in group F. The specimens of group L had only a small number of cells. Mean cross sections of myofibers in the repaired area were measured at postoperative day 28 in all groups. The data in groups M, F, and L were 16.6, 9.2, and 8.67 m2/g, respectively. The data in group M was significantly higher than in groups F and L. Fibrin was observed at postoperative day 14 in groups M and F, but it was degraded and disappeared at postoperative day 28. Discussion: Our results indicated that the grafted bone marrow cells would participate in the repair of injured skeletal muscle by promoting maturation of myofibers histologically and acquisition of muscle power functionally. However, judging by the localization of the GFPpositive cells, the grafted bone marrow cells do not differentiate into or fuse to skeletal myofibers. The inflammatory cells were observed around the grafted cells and fibrin in group M. Therefore, our results indicated that bone marrow cells contributed to regeneration of skeletal muscle with inflammatory cells through mechanisms other than fusion to myofibers after differentiation. Paper 151: Development of the Humeral Retroversion in the Throwing Shoulder of Young Baseball Players YOSHITSUGU TAKEDA, TOKUSHIMA, JAPAN, PRESENTER TETSUYA MATSUURA, TOKUSHIMA, TOKUSHIMA, JAPAN KOJI FUJII, KOMATSUSHIMA, TOKUSHIMA, JAPAN TORU MAEDA, KOMATSUSHIMA, TOKUSHIMA, JAPAN AKIRA NARUSE, KOMATSUSHIMA, TOKUSHIMA, JAPAN