Eugene M. Wolf

Pigmented villonodular synovitis of the shoulder after anterior capsulolabral reconstruction

Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovium affecting joints, bursae, or tendon sheaths. PVNS is further classified into diffuse and localized forms and rarely affects the shoulder. We report a case of nodular synovitis of the shoulder after arthroscopic and open anterior capsulolabral reconstruction. The histopathology and treatment of a nodular form of PVNS of the shoulder is discussed.

Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Recurrent Anterior Shoulder Instability

Although the Bankart lesion is accepted as the primary pathology responsible for recurrent shoulder instability, recognition of other soft-tissue lesions has improved the surgical treatment for this common problem. Whereas humeral avulsion of the glenohumeral ligaments has been acknowledged as a cause of anterior shoulder instability, we have not found any reported cases of glenoid avulsion of the glenohumeral ligaments. We describe 3 cases of recurrent anterior shoulder instability due to glenoid avulsion of the glenohumeral ligaments. The avulsed ligaments were repaired to the labrum and glenoid, restoring the glenohumeral ligament-labral complex.

Arthroscopic biceps tenotomy: Results in patients with symptomatic degeneration of the long head of the biceps brachii tendon. (SS-10)

Degeneration of the long head of the biceps brachii (LHB) tendon is often symptomatic. Significant tendon fraying (>40%) has historically been treated with tenodesis. However, recovery is prolonged and long-term results are often unsatisfactory after tenodesis. We therefore assessed patient outcomes after arthroscopic tenotomy. Methods. We obtained a functional assessment score for patients undergoing tenotomy over a two-year period using a previously published outcomes measurement. Patients were scored with respect to pain, strength, cosmetic deformity, activity, and overall satisfaction. 15 of 16 patients with a mean age of 59 and postoperative follow-up of 15 months were available for this study. Univariate and multivariate statistical analyses were performed. Results. 13 patients (87%) reported good or excellent results, one fair, and one poor. All patients reported a decrease in pain. 12 patients reported strength equivalent to pre-injury levels, two a mild loss, and one severe loss. No patients had a cosmetically displeasing deformity. 10 patients had full return to predisease level, and all reported at least 75% proficiency. All patients returned to their prior occupation. Poor results occurred in both patients under age 50. Patient age was significantly associated with overall outcome (P < .05) in univariate analysis and after controlling for gender, dominance of operative extremity, type of work, and concurrent procedures. Discussion. Tenotomy of the LHB tendon successfully relieved symptoms and allowed early return to activity in patients over age 50. However, results in patients under 50 were not good. Additional studies should focus on determining optimal surgical treatments for younger patients with LHB tendonopathy.