Paper 47: Arthroscopic Versus Mini-Open Rotator Cuff Repair With Suture Anchor

ABSTRACTS ABSTRACT Purpose: This prospective randomized controlled two trailed study was performed to assess the clinical and radiographic results after needling combined with high energetic shock wave therapy for calcifying tendonitis. Methods: 80 patients at a mean age of 48,4 years (range 32,5 - 67,3 y) with painful calcifying tendonitis were selected to one of two study groups. The treatment of the 40 patients in group I consisted of ultrasonic guided needling followed by high energetic shock wave therapy. The 40 patients of group II received high energy shock wave therapy only. In both groups one treatment session with 2500 impulses of shock waves with an energy flux density of 0,36 mJ/mm2 was applied. Clinical and radiological outcome was assessed with the 100 point Constant shoulder score system and standardized radiographs. The mean follow up period was 4,1 months and no patient was lost to follow up. Results: Both groups improved significantly in the Constant shoulder score (Group I: from 47,1 points before treatment to 76,8 points after treatment and Group II: from 44,2 points to 67,3 points). Radiographs showed in 60,0% of the shoulders of group I disappearance of the calcified deposit and in 32,5% of the shoulders of group II (p ⬍ 0,05). Significant better clinical and radiological results were obtained in group I compared to group II. In 32 patients (80,0%) of group I and in 22 patients (55,0%) of group II arthroscopic removal of the calcium deposit could be avoided (p ⬍ 0,05). No severe side effects were recorded. Conclusion: Ultrasound guided needling in combination with high energy shock wave therapy improves the effectiveness of the shock wave treatment. This new treatment method leads to significantly higher elimination rates of the calcium deposits, better clinical results and reduces the frequency of surgery significantly. Paper 46: Inman Was Right: Verification of Glenohumeral Motion In Vivo PAULA M. LUDEWIG, USA, PRESENTING AUTHOR JONATHAN PATRICK BRAMAN, MD, USA VANDANA PHADKE, USA DANIEL R. HASSETT, USA FRED A. WENTORF, MS, USA ROBERT F. LAPRADE, MD, PHD, USA ABSTRACT Introduction: Since the ground-breaking work of Inman in 1944, most subsequent investigations which have evaluated three-dimensional glenohumeral motion in vivo have used non-invasive techniques. This limits direct evaluation of the humeral and scapular motion. The

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technique of this study allows exact real-time determination of position of these bones. Methods: Nine patients with no history of shoulder problems and a normal shoulder clinical screening exam were consented for this IRB approved study. Using fluoroscopy, 2.5 mm stainless steel pins were inserted into the clavicle, the scapular spine, and the humerus. These were connected to three-dimensional motion sensors and patients moved actively through a range of motion. A thoracic marker was placed on the skin over the sternum for reference. Humeral motion was described relative to the thorax and glenohumeral motion described for the humerus relative to the scapula. The contribution of glenohumeral elevation was then identified as a percentage of total motion (humerus relative to the thorax). Results: All values are in average⫹/⫺standard deviation. Average age was 30.3 (⫹/⫺ 7.4 ) years. Seven tested shoulders were non-dominant and two were dominant. Active frontal plane abduction averaged a maximum of 138.9 degrees (⫹/⫺ 14.8). This was composed of a glenohumeral contribution of 68% (⫹/⫺ 2) and a scapulothoracic portion of 32% (⫹/⫺ 2). Active forward flexion averaged a maximum of 132.6 degrees (⫹/⫺ 15.7). This was composed of a glenohumeral contribution of 71% (⫹/⫺ 4) and a scapulothoracic portion of 29% (⫹/⫺ 4). Discussion: Since the work of Inman et al., clinicians have accepted the idea that 2/3 or 66.6% of shoulder motion was glenohumeral while 1/3 (33.3%) of it was scapulothoracic. While our analysis did not yield 180 degrees of elevation as theirs did, very similar ratios were reproduced in our data. This important verification of the accepted standard has ramifications for non-operative rehabilitation programs, implant design, as well as prognosis after traumatic injuries to the shoulder girdle. Further analysis of the motion data will enable investigation of the relationships of the osteology during different portions of the motion cycle. Paper 47: Arthroscopic Versus Mini-Open Rotator Cuff Repair With Suture Anchor CHIH-HWA CHEN, MD, TAIWAN, PRESENTING AUTHOR TAI-YUAN CHUANG, MD, TAIWAN KUO-YAO HSU, TAIWAN KUN-CHUENG WANG, TAIWAN WEN-JER CHEN, TAIWAN CHUN-HSIUNG SHIH, TAIWAN ABSTRACT Purpose: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with miniopen rotator cuff repair using suture anchor.

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ABSTRACTS

Methods: Sixty-four shoulders (60 patients) were included in the analysis; 28 in the arthroscopic group and 36 in the mini-open group. Average follow-up for all patients was 34 months, with a minimum of 12 months. The arthroscopic group (N⫽28) included 8 small tears (⬍ 1 cm), 14 medium-size tears (1 to 3 cm), and 6 large tears (3 to 5 cm). The mini-open group (N⫽36) included 3 small tears, 19 medium tears, and 14 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. Three of the arthroscopic and 9 of the mini-open patients underwent coplaning of the acromioclavicular joint. Suture anchors were the primary method for all the patients, with an average of 1.5 anchors per case for arthroscopic group and 2.3 for mini-open group. Results: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 90.2 and for the mini-open group was 88.7. One patients (4%) in the arthroscopic group developed shoulder stiffness, whereas 3 patients in the mini-open group developed the condition (8%). No anchor-related complications were noted. Shoulders in the arthroscopic group showed greater range of motion at 3 months postoperatively and slightly better motion at final follow-up. However, final motion revealed no statistically significant difference. Conclusions: Alrthroscopic cuff repair provides comparable outcomes and complication rates to mini-open repair. The lower incidence of shoulder stiffness favors the arthroscopic technique. A trend for better early motion was also noted in the arthroscopic group.

Constant and Visual Analog Pain (VAS) scores. Preoperatively, patients presented with pain which they characterized as severe and debilitating, reporting significant limitations of ADLs, particularly those requiring overhead use of the affected extremity. All patients had failed conservative treatment and were experiencing worsening pain and progressive loss of motion prior to surgery. Postoperatively, all subjects underwent a standard physical therapy program. Postoperative assessments were conducted at 4 - 7 days, 6 weeks, 3, 6, 12, 18 and 24 months. Statistical analysis of the data was performed in order to determine significant differences between preoperative and postoperative scores. Summary of Methods: No significant complications were experienced. Postoperatively, all patients reported significant pain relief. VAS scores improved from 4.36 preoperatively to 1.00 three months postoperatively. Physical examination revealed significant improvements in functional outcomes as well. Forward flexion improved from a mean of 107.2 degrees preoperatively to 155 degrees postoperatively. Abduction improved from a mean of 38.8 degrees preoperatively to 48.1 degrees postoperatively. Good to excellent results were also observed in the WOOS and Constant scoring systems. Conclusion: Those patients disabled by pain and whom have failed conservative treatment may benefit from partial humeral head resurfacing arthroplasty. Partial humeral head resurfacing arthroplasty in patients diagnosed with avascular necrosis yields a successful outcome, with patients experiencing excellent pain relief and improved range of motion. Furthermore, satisfactory results may be obtained without the use of excessively large humeral heads; rather, preservation of bone stock is maintained.

Paper 48: Experience with Partial Humeral Head Resurfacing Arthroplasty in Patients Diagnosed with Avascular Necrosis JOHN WILLIAM URIBE, MD, USA, PRESENTING AUTHOR ANGIE BOTTO-VAN BEMDEN, PHD, USA JOHN E. ZVIJAC, MD, USA

Paper 49: Arthroscopic Rotator Cuff Repair In Patients Younger Than Fifty Years Of Age JOSEPH PHILIP BURNS, MD, USA, PRESENTING AUTHOR STEPHEN J. SNYDER, MD, USA

ABSTRACT Purpose: To evaluate the postoperative outcomes of partial humeral head resurfacing arthroplasty for avascular necrosis. Description of Methods: This is a prospective series of eight patients diagnosed with avascular necrosis who underwent partial humeral head resurfacing arthroplasty. Their mean age was 58.8 years. Preoperative and postoperative standardized evaluations included history, physical examination, radiographs, and clinical scoring systems. Clinical scoring systems included the Western Ontario Osteoarthritis of the Shoulder index (WOOS),

ABSTRACT Between 1994 and 2002, fifty-two patients (fifty-six shoulders) younger than fifty years of age underwent all-arthroscopic repair of a rotator cuff tear. With a minimum three-year follow-up (average 69 months, range 37”161 months), thirty-seven of these patients (forty-one shoulders) were available for retrospective evaluation. Postoperative function was assessed by means of a UCLA scoring system, range of motion measurements, strength exam and VAS pain score. Tears were categorized into four groups by type and size: partial undersurface tears and complete tears that were