Jun Kumagai

Experimental supraspinatus tendon repair of rabbit using fascial patcth autografting

Purpose: There were few investigations about the process of reconstruction of insertion after the fascial patch procedure. The purpose of this paper is to clarify the process of reconstruction of grafted fascia-bone junctions. Material and Methods: The defects were made at supraspinatus insertion to greater tuberosity in 22 white rabbits. They were replaced by autografts of fascia lata. The grafts and bones were removed on 4th day, 1st, 2nd, 3rd, 4th and 8th week after the operation. Sections parallel to the supraspinatus were decalcified at 4~ embedded in paraffin, stained with hematoxylin-eosin, elastica-Masson and toluidine blue. Results: On 4th day, original fibroblasts were not evident in the grafted fascia. Only limited cell reactions were observed. Fibroeartilage cells aplSeared in the bony gutter on 2rid week with gaps to the grafted fascia. On 3rd week, many fibroblasts were observed in the grafted fascia, FibrocaIilage celIs were arranged in a line in connection with the grafted fascia. These tendency were observed more clearly on 4th week mad the cartilage column was almost completed on 8th week. The tide mark, however, was not seen even this stage. Conclusion: The newly formed insertion of grafted fascia to bone is gradually changed into the normal one after the patch procedure. In this series, it takes at least 3 weeks to start the reconstruction of fascia-bone junctions. 39 CAN ARTHROSCOPIC ACROMIOPLASTY BE ENOUGH TO REMOVE ANTEROLATERAL EDGE OF THE ACROMION? N.Suenaga,MD., A.Minami,MD.,H.Kato,MD.,K. Kaneda,MD.,K.Fukuda,MD. Dept.of Orthopaedic Surgery, Hokkaido Univ. Sch.of Med.,Sapporo,OAPAN. PURPOSES: To c la r i f y how much of the anterolateral edge of the acromion can be removed by arthroscopic anterior acromloplasty and to determine the amount of arthroscopically removale bone could be changed by acromial spur or acromial morphology. MATERIALS and METHODS: Fif ty acromions and coracoacromial ligaments were obtained en block from cadavers and from patients with subaeromial impingement syndrome treated by neers anterior acromioplasty. The specimens were sliced along the line of coracoacromial ligament fibers and stained with toluidine blue. The amount of arthroscopically removable bone was determined by measuring the distance from the bursal side of the deltoid muscle to the bursal side of the bony layer of the anterior edge of the acromion. The anteroinferior acromial sPur and acromial morphology obtained from the supraspinatus view, reported by Bigliani, were observed in 26 shoulders. The correlation between the amount of arthroscopicaIIy removable bone and these findings were investigated. RESULTS and CONCLUSIONS: The amount of the anterior edge of the acromion that can be removed was very small (ranged from Imm to 4.8mm;average2.5mm), and was not related to anterior acromial spur or acromial morphology.

MR imaging for the diagnosis of incomplete rotator cuff tears

The diagnostic value of MRI for the incomplete rotator cuff tears is still controversial. We assessed the effectiveness of MRI in surgical cases. Twenty-four cases of incomplete cuff tears including 13 joint sides, 9 bursal sides and 2 intratendinous tears were confirmed at surgery. T1-and T2-weighted images of these patients obtained preoperatively, the oblique coronal and sagittal planes in 1.5T MR system, were compared retrospectively with the surgical findings. In 13 joint side tears, high signal lesions on T2 were present in 8 and slightly increased signal lesions were found in 5. In 9 bursal side tears, high signal lesions were evident in 2, while they were not recognized in 3 cases which were classified as grade 1 lesions of Ozaki. High signal lesions were found in all 2 intratendinous tears. In order to detect incomplete rotator cuff tears on MR imaging, it is necessary that the tears penetrate into the tendons more than half of their depth.