Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable ext...Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.展开更多
AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 mal...AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.展开更多
目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β...目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β,IL-1β)炎性通路对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用及机制。方法构建30只大鼠肩关节慢性巨大肩袖撕裂模型,并根据姜黄素给入的剂量不同将30只大鼠模型分为3组,即普通膳食组、姜黄素混合膳食低剂量组、姜黄素混合膳食高剂量组,每组各有大鼠模型10只。对30只大鼠肩关节慢性巨大肩袖撕裂模型分别进行药物干预后,获取3组大鼠模型在第2、3、4周的肩关节固定脱钙组织切片,分别检测3组大鼠模型的脂肪浸软程度,并对大鼠巨大肩袖撕裂肌肉组织中NLRP3、IL-1β指标进行检测,探讨姜黄素对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用。结果相比于普通膳食组,姜黄素混合膳食低剂量组和高剂量组的炎症因子水平均明显下降,且姜黄素混合膳食高剂量组下降的具有明显的特征性,差异有统计学意义(P<0.05)。结论根据托法理论的治疗原则,利用姜黄素治疗巨大肩袖撕裂能够有效地干预该疾病的脂肪浸润,这主要是由于姜黄素治疗能够通过对NLRP3炎症小体进行有效地抑制,减少IL-1β的生成,从而能够有效地减轻骨骼肌炎性损伤,能够通过NLRP3/IL-1β炎性通路抑制骨骼肌干细胞的脂肪分化,减少慢性过程中肌肉的脂肪浸润,从而改善肩袖肌腱肌肉的生物活力。展开更多
The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodi...The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodialysis for the past 20 years. The patient experienced bilateral knee pain and swelling and was unable to bear weight. Physical examination revealed bilateral quadriceps tendon defect above the patella and loss of active extension. Although plain radiographs of both knees showed no fracture or widening of the joint space, an inferiorly positioned patella was observed. Ultrasonography of the knees revealed a quadriceps tendon defect at the upper edge of each patella, while MR imaging revealed a tear in each quadriceps tendon from the superior poles of the patella. The patient then underwent surgical correction wherein the tendons were repaired using sutures passed through drill holes in the patella. The knees were immobilized with splints for 4 wk before starting physiotherapy. The patient subsequently regained full functional activity within 1 year.展开更多
Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the ...Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.展开更多
AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis...AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases(> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured.RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging(MRI)(at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly(2 tailed P value = 0.0036).CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.展开更多
Rotator cuff tears(RCTs) occur more commonly with advanced age,with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs.Irreparable postero-superior cu...Rotator cuff tears(RCTs) occur more commonly with advanced age,with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs.Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population,and the incidence of irreparable RCTs in young patients is still unknown.Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs,such as rotator cuff debridement,partial rotator cuff repair,biceps tenotomy/tenodesis,rotator cuff grafting,latissimus dorsi tendon transfer,and reverse shoulder arthroplasty.After being thoroughly investigated in open surgery,arthroscopic techniques for latissimus dorsi tendon transfer have been recently described.They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.展开更多
文摘Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.
文摘AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.
文摘目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β,IL-1β)炎性通路对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用及机制。方法构建30只大鼠肩关节慢性巨大肩袖撕裂模型,并根据姜黄素给入的剂量不同将30只大鼠模型分为3组,即普通膳食组、姜黄素混合膳食低剂量组、姜黄素混合膳食高剂量组,每组各有大鼠模型10只。对30只大鼠肩关节慢性巨大肩袖撕裂模型分别进行药物干预后,获取3组大鼠模型在第2、3、4周的肩关节固定脱钙组织切片,分别检测3组大鼠模型的脂肪浸软程度,并对大鼠巨大肩袖撕裂肌肉组织中NLRP3、IL-1β指标进行检测,探讨姜黄素对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用。结果相比于普通膳食组,姜黄素混合膳食低剂量组和高剂量组的炎症因子水平均明显下降,且姜黄素混合膳食高剂量组下降的具有明显的特征性,差异有统计学意义(P<0.05)。结论根据托法理论的治疗原则,利用姜黄素治疗巨大肩袖撕裂能够有效地干预该疾病的脂肪浸润,这主要是由于姜黄素治疗能够通过对NLRP3炎症小体进行有效地抑制,减少IL-1β的生成,从而能够有效地减轻骨骼肌炎性损伤,能够通过NLRP3/IL-1β炎性通路抑制骨骼肌干细胞的脂肪分化,减少慢性过程中肌肉的脂肪浸润,从而改善肩袖肌腱肌肉的生物活力。
文摘The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodialysis for the past 20 years. The patient experienced bilateral knee pain and swelling and was unable to bear weight. Physical examination revealed bilateral quadriceps tendon defect above the patella and loss of active extension. Although plain radiographs of both knees showed no fracture or widening of the joint space, an inferiorly positioned patella was observed. Ultrasonography of the knees revealed a quadriceps tendon defect at the upper edge of each patella, while MR imaging revealed a tear in each quadriceps tendon from the superior poles of the patella. The patient then underwent surgical correction wherein the tendons were repaired using sutures passed through drill holes in the patella. The knees were immobilized with splints for 4 wk before starting physiotherapy. The patient subsequently regained full functional activity within 1 year.
文摘Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.
文摘AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases(> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured.RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging(MRI)(at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly(2 tailed P value = 0.0036).CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.
文摘Rotator cuff tears(RCTs) occur more commonly with advanced age,with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs.Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population,and the incidence of irreparable RCTs in young patients is still unknown.Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs,such as rotator cuff debridement,partial rotator cuff repair,biceps tenotomy/tenodesis,rotator cuff grafting,latissimus dorsi tendon transfer,and reverse shoulder arthroplasty.After being thoroughly investigated in open surgery,arthroscopic techniques for latissimus dorsi tendon transfer have been recently described.They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.
