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
Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon follow...Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.展开更多
目的验证Hug-up试验用于诊断单独冈上肌腱损伤的价值,为临床治疗提供可靠依据。方法选取因肩关节疼痛及功能障碍初次进行肩关节镜手术治疗的患者,术前进行4项冈上肌腱损伤诊断方法:Job试验、落臂试验(Drop arm sign)、Hug-up试验及改良H...目的验证Hug-up试验用于诊断单独冈上肌腱损伤的价值,为临床治疗提供可靠依据。方法选取因肩关节疼痛及功能障碍初次进行肩关节镜手术治疗的患者,术前进行4项冈上肌腱损伤诊断方法:Job试验、落臂试验(Drop arm sign)、Hug-up试验及改良Hup-up试验,并进行关节镜检查验证。术中镜下对单纯冈上肌腱损伤的患者进行记录并分型。结果116例患者进行肩关节镜下手术治疗,其中40例存在单独冈上肌腱撕裂。其中,改良Hug-up试验的敏感度75.92%,特异性64.32%,具有较高的敏感性,但由于后关节囊及冈下肌及小圆肌亦处于高张力状态,所以特异性会受到一定影响。结论改良Hug-up试验对单纯冈上肌损伤有较高的敏感性及特异性,可以作为该损伤的筛选试验运用于临床,对冈上肌腱损伤的诊断和鉴别诊断有较好的临床意义。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.
基金This paper is supported by Zhejiang Medical and Health Science and Technology Project(2019RC309)Taizhou Science and technology plan project(1701ky49).
文摘Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.
文摘目的验证Hug-up试验用于诊断单独冈上肌腱损伤的价值,为临床治疗提供可靠依据。方法选取因肩关节疼痛及功能障碍初次进行肩关节镜手术治疗的患者,术前进行4项冈上肌腱损伤诊断方法:Job试验、落臂试验(Drop arm sign)、Hug-up试验及改良Hup-up试验,并进行关节镜检查验证。术中镜下对单纯冈上肌腱损伤的患者进行记录并分型。结果116例患者进行肩关节镜下手术治疗,其中40例存在单独冈上肌腱撕裂。其中,改良Hug-up试验的敏感度75.92%,特异性64.32%,具有较高的敏感性,但由于后关节囊及冈下肌及小圆肌亦处于高张力状态,所以特异性会受到一定影响。结论改良Hug-up试验对单纯冈上肌损伤有较高的敏感性及特异性,可以作为该损伤的筛选试验运用于临床,对冈上肌腱损伤的诊断和鉴别诊断有较好的临床意义。
