Champ L. Baker

Arthroscopically assisted rotator cuff repair: Correlation of functional results with integrity of the cuff

Thirty-three patients (35 full-thickness rotator cuff tears) who underwent arthroscopically assisted mini open repair between June 1987 and January 1990 were evaluated for shoulder function and cuff integrity. The study population was composed of 19 women and 14 men with an average age of 63 years (range 35-76) and an average follow-up of 3.7 years (range 2.5-5.1). Functional results were obtained using the UCLA Shoulder Rating Scale. Integrity of the rotator cuff was established by shoulder arthrography at a minimum 2 years postoperatively. UCLA Shoulder Rating Scale showed 86% good/excellent results with 92% patient satisfaction. The shoulder arthrography showed 12 (34%) full-thickness tears, seven (20%) partial tears, and 16 (46%) no tears. The size of the arthrographic defect correlated well with the size of the intraoperative tear. Seventy percent of the large tears had follow-up full-thickness defects and 80% of the small tears had no defect. Eighty percent and 88% good/excellent functional results were achieved in patients with full-thickness defects and no defects, respectively, without significant differences. The size of the tear at the time of the repair is a major determinant of the integrity of the cuff after repair. The integrity of the cuff at follow-up does not determine the functional outcome of the operated shoulder.

Arthroscopic evaluation of acute initial anterior shoulder dislocations

Arthroscopic evaluation of patients with an acute an terior shoulder dislocation was done to identify and classify the intraarticular lesions that might predict re current dislocations. Forty-five shoulders fit the follow ing criteria for inclusion in our study: initial dislocation with no prior history of shoulder problems; confirmation of the dislocation radiographically or reduction by a physician; and arthroscopy within 10 days. The 42 men and 3 women had an average age of 21.2 years (range, 14 to 28 years). Mechanism of injury was a twisting of the arm into forced abduction and external rotation, a fall on the outstretched arm, or a direct blow to the shoulder. Based on this preliminary study of 45 shoulders, we present a classification of the lesions found in the acute shoulder dislocation. Group 1 (six shoulders) had cap sular tears with no labral lesions: these shoulders were stable under anesthesia and had no or minimal hemar throsis. Group 2 (11 shoulders) had capsular tears and partial labral detachments: these shoulders were mildly unstable and had mild to moderate hemarthrosis. Group 3 (28 shoulders) had capsular tears with labral detach ments : these shoulders were grossly unstable and had large hemarthrosis. They had complete capsular/labral detachments. In the past, redislocation rates have been primarily related to age at the time of initial dislocation and, to a lesser degree, the period of immobilization. We have identified the intraarticular lesions in 45 patients with an initial anterior glenohumeral dislocation and classi fied these shoulders into three groups based on the lesions found. By doing so, we can develop a more accurate method of determining which shoulders are prone to recurrent dislocation. We can then adjust the patients treatment to prevent recurrent dislocation.

The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations

We undertook a prospective study using arthroscopy to determine the intraarticular derangement caused by initial anterior shoulder dislocations. Of our 32 patients, 15 (47%) had a grade I, grade II, or grade III Hill-Sachs lesion. The patients were 29 men and 3 women whose ages ranged from 15 to 28 years (mean 22 years). All of the patients studied were United States military personnel or members of their families. None of the patients had had prior injuries of the affected shoulder, and all underwent arthroscopy within 72 h of injury. Few reports describe a Hill-Sachs lesion in a patient following a single anterior dislocation. Early reports of this lesion were based on indirect (radiographic) evidence. Our arthroscopic findings indicate that the incidence of this lesion after one anterior dislocation is higher than previously thought.

Cost effectiveness of anterior cruciate ligament reconstruction in young adults

The cost effectiveness of ligament reconstruction for acute anterior cruciate ligament tears in young adults was compared with the cost effectiveness of nonoperative management. A decision tree was constructed to predict the expected functional outcomes for operative and nonoperative treatment. Outcome probabilities were derived from the surgical and natural history literature. Cost data were based on averaged figures from the senior authors institution. Utility values were determined from a questionnaire administered to 285 local university students. Cost effectiveness was calculated in terms of dollars spent per additional quality adjusted life year provided by the surgical reconstruction for the initial 7 years after an injury. The operative strategy provided 5.10 quality adjusted life years versus 3.49 years for nonoperative treatment, yielding a marginal effectiveness of 1.61 quality adjusted life years. The estimated total costs of the operative and nonoperative strategies were

Operative ankle arthroscopy: Long-term followup

11,768 and

Comparison of Open and Arthroscopically Assisted Rotator Cuff Repairs

2333, respectively, for a marginal cost of

Long-term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

9435. The resulting marginal cost effectiveness ratio was

Arthroscopic Release for Lateral Epicondylitis: A Cadaveric Model

5857 per quality adjusted life year. These data suggest that, when based on functional outcomes, anterior cruciate ligament reconstruction is a cost effective method of treatment for acute tears in young adults. The cost effectiveness ratio predicted compares favorably with those of other health care interventions that aim to improve quality of life.

Arthroscopy of the Elbow

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been per formed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative exami nation and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months). Preoperative diagnoses were synovitis (26), trans chondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Sub jective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71 %). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications in cluded superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%. In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.

Arthroscopic treatment of chronic synovitis of the ankle

Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Re cently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with re gard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were evaluated in 36 patients with a minimum followup of 2 years. The open repair group comprised 20 shoulders with an average followup of 3.3 years; the arthroscopically assisted repair group com prised 17 shoulders with an average followup of 3.2 years. Overall, the open repair group had 80% good- to-excellent results and 88% patient satisfaction, and the arthroscopically assisted repair group had 85% good-to-excellent results and 92% patient satisfaction. Shoulder flexion and abduction strength, the size of the tear repaired, and the functional outcome did not differ significantly between the two groups. In general, how ever, small and moderate-sized tears (<3 cm) had bet ter functional outcome with arthroscopically assisted re pair. The arthroscopically assisted repair group was hospitalized 1.2 days less and returned to previous ac tivity an average of 1 month earlier. In the surgical treat ment of symptomatic complete rotator cuff tears, arthro scopically assisted rotator cuff repair is as effective as open repair.