Nikola Čičak

Hill-Sachs lesion in recurrent shoulder dislocation: sonographic detection.

In a prospective study 61 patients with recurrent anterior shoulder dislocation were evaluated by sonography, radiography, and surgery to determine the value of sonography in the detection of a HillSachs lesion. The group consisted of 57 male and four female patients with an average age of 27 years. Hill‐Sachs lesion was found in 54 (88%) shoulders of the 61 surgically treated patients. Using surgical findings as the gold standard, we found sonography to be 96% (52 of 54 cases) sensitive, 100% specific (seven of seven cases), and 97% (59 of 61 cases) accurate in the diagnosis of HillSachs lesion. The average size of the lesion measured by sonography was 19.2 mm long, 16.0 mm wide, and 4.1 mm deep. The lesion was of small or medium size (up to 6 mm deep) in 88% of patients. Results of our study show that sonography is a valuable imaging technique in the diagnosis of Hill‐Sachs lesion. It produced only two false‐negative results when compared with surgical findings.

One-stage operation for locked bilateral posterior dislocation of the shoulder

A man of 52 years of age had a grand mal seizure. He presented to our unit three months later with irreducible bilateral posterior dislocation of the shoulder. CT scans revealed large compression defects on the anteromedial aspect of the heads of both humeri. The defect on the right side was of more than 50% of the articular surface, and on the left side of 40%. He was treated by a one-stage operation with a hemiarthroplasty on one side and reconstruction of the head by an osteochondral autograft on the other. Three years later the clinical and radiological results were excellent.

Letter to the editor: Advantages of arthroscopic transosseous suture repair of the rotator cuff without the use of anchors.

To the editor, We read the article by Kuroda et al. [3] with great interest. In the current study, the authors describe a novel arthroscopic transosseous technique without the use of anchors. While we congratulate Kuroda and colleagues for an interesting concept and results, we believe it is necessary to emphasize several points. Matis and colleagues [4] previously described their transsoseus arthroscopical technique without the use of anchors, and Cicak et al. [1] described the technique with the use of anchors, but in transosseous manner. Following the publication of these studies, manufacturers developed a significant number of specially designed devices for arthroscopis transsoseus rotator cuff repair [2, 5]. Those techniques, which are based on the basic principle of transosseous fixation, have different limitations. Kuroda et al. [3] reported that the technique cannot be used in shoulders where the stump of the torn rotator cuff does not emerge across the top of the humeral head under traction. Also, operative time is rather long, ranging from 80 minutes to 176 minutes. This likely will increase the cost of treatment, becoming more expensive than the price of anchors. This technique also is not suitable for women with osteoporosis, it increases the risk for pullout of the sutures. Finally, we believe this technique is only suitable for experienced shoulder surgeons because it is rather complex and time consuming; in particular, it is difficult to penetrate through the skin behind the AC joint with K-wires, especially in the lateral decubitus position. Most of the described limitations (except when there is osteoporotic bone) can be avoided with other techniques even when they are based on same biomechanical principle [1, 2, 4, 5].