Paper #211 Rotator cuff repair in spinal cord injury patients

ABSTRACTS Anatomic: 48% of pts were found to have a defect in the RCR at some point post-op. Defects were seen in 50% pts at T#1 , 45% at T#2, and 43% at T#3. Majority of RC defects were classified as Type 1 B. Average defect size at each time point was 1 x1 cm2. 33% of asymptomatic controls were found to have a defect consistent with RCT, 7.6x7.1 mm. Discussion/Conclusion: Outcomes tools demonstrate consistently worse short-term result with ARCR compared to MORCR and ORCR. Whether or not poor short-term results are a function of surgical learning curve or whether result is dependent on number of suture anchors and subsequent suture strands crossing the repair is unclear. Paper #211 Rotator Cuff Repair In Spinal Cord Injury Patients. John E. Zvijac, Presenter, UHZ Sports Medicine Institute, Coral Gables, FL, USA, Keith Sheldon Hechtman, Coral Gables, FL, USA, John William Uribe, Coral Gables, FL, USA, Matthias Rolf Schurhoff, Coral Gables, FL, USA, Jeremy Blair Green, Coral Gables, FL, USA Previous studies on the effect of rotator cuff tears on wheelchair bound patients concentrated on non-surgical treatment. We conducted a retrospective review to determine the effectiveness of surgical intervention of rotator cuff tears in spinal cord injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging, underwent rotator cuff repair. Two of eight shoulders were revisions. The patients were evaluated postoperatively using the American Shoulder and Elbow Surgeons’ Scoring System. These results were compared to preoperative functional assessment. Patients were given a subjective questionnaire to assess their overall experience. Postoperative range of motion improved in six of eight shoulders. Strength was increased in six of eight shoulders. Patients reported satisfaction with the results in seven of eight shoulders, and all five patients would recommend the procedure to other spinal cord injury patients. At recent follow-up seven out of eight shoulders returned to their pre-injury level of function. Surgery for spinal cord injury patients with rotator cuff tears can improve the their functional capability and autonomy while reducing their pain. Compliance with the demanding postoperative rehabilitation is essential, therefore proper patient selection is crucial for optimal results. Paper #212 Glenohumeral Joint Kinematics During Anterior And Posterior Drawer Tests: Effects Of Intra-clinician Repeatability. Volker Musahl, Presenter,

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Musculoskeletal Research Center, Department of Ort, Pittsburgh, PA, USA, Susan Moore, Pittsburgh, PA, USA, Patrick McMahon, Pittsburgh, PA, USA, Richard Debski, Pittsburgh, PA, USA Objectives: Clinical exams translate the humerus with respect to the scapula and are utilized to diagnose glenohumeral joint instability. The objective of this study was to assess the repeatability of simulated anterior and posterior (a-p) drawer tests, and to determine intra-clinician repeatability in cadaveric shoulders with simulated rotator cuff (RC) forces. Therefore, a clinical exam was performed with and without orientation feedback. Methods: Eight fresh-frozen human cadaveric shoulder specimens (50 ⫾ 6 yrs) were dissected free of all soft tissue except the RC tendons and the glenohumeral joint capsule. The scapula was mounted to a Plexiglas fixture and 13.3 N was applied to the RC tendons to simulate passive muscle tension. Translation of the humerus with respect to the scapula was recorded using a 6-degree of freedom (DOF) magnetic tracking device (The Bird, Ascension Technologies, Inc.). Sensors were rigidly fixed to the scapula and humerus and anatomical landmarks were digitized for description of joint motion. The starting position, which was determined using feedback from the magnetic tracking device, was defined with the humeral head centered in the glenoid cavity at 0° of external rotation with the humerus 60° abducted and aligned in the coronal plane of the scapula. The clinician performed an a-p drawer test at 0°, 30°, and 60° of external rotation by applying a manual maximum anterior/posterior load. For each specimen, the a-p drawer test was subsequently performed five times. Once in the starting position, the a-p drawer test was performed first without feedback from the technician and then with feedback. Feedback was defined as, orienting the clinician for all rotational positions of the shoulder during the entire test. Statistical comparisons were made using a repeated measures ANOVA to compare the feedback exam to the non-feedback exam. Results: The repeatability for the recorded kinematics of the a-p drawer test in the anterior direction was 1.7 mm for the feedback test and 3.3 mm for the nonfeedback test. There was a significant difference (p ⬍ 0.05) between the feedback and non-feedback tests for 30° and 60° of external rotation. For the posterior drawer test, the repeatability was 1.9 mm and 6.0 mm for the feedback and non-feedback tests, respectively. There were no significant differences (p ⬎ 0.05) between the feedback and non-feedback tests for all tested external rotations. The repeatability for the abduction angle was 4.4° and for external rotations 4.1°, as compared to 3.7°