P Boileau

Anatomical and functional results after arthroscopic Hill-Sachs remplissage.

BACKGROUND Large osseous defects of the posterosuperior aspect of the humeral head can engage the glenoid rim and cause recurrent instability after arthroscopic Bankart repair for glenohumeral dislocation. Filling of the humeral head defect with the posterior aspect of the capsule and the infraspinatus tendon (i.e., Hill-Sachs remplissage) has recently been proposed as an additional arthroscopic procedure. Our hypothesis is that the capsulotenodesis heals in the humeral bone defect without a severe adverse effect on shoulder mobility, allowing return to preinjury sports activity. METHODS Of 459 patients operated on for recurrent traumatic anterior shoulder instability, forty-seven (10.2%) underwent arthroscopic Bankart repair combined with Hill-Sachs remplissage with use of suture anchors. All had a large Hill-Sachs lesion (Calandra grade III), engaging over the glenoid rim, without substantial glenoid bone loss. Nine patients had had prior unsuccessful surgery to address glenohumeral instability (three Bankart and six Bristow-Latarjet procedures). The average age at the time of surgery (and standard deviation) was 29 ± 5.4 years. Postoperatively, comparative shoulder motion was precisely measured with use of digital photographic images. Capsulotenodesis healing was assessed on a computed tomography (CT) arthrogram (n = 38) or magnetic resonance image (MRI) (n = 4). The mean duration of follow-up was twenty-four months. RESULTS Healing of the posterior aspect of the capsule and the infraspinatus tendon into the humeral defect was observed in all forty-two patients who underwent postoperative imaging, and thirty-one (74%) had a remplissage of ≥75%. Compared with the normal (contralateral) side, the mean deficit in external rotation was 8° ± 7° with the arm at the side of the trunk and 9° ± 7° in abduction at the time of the last follow-up. Of forty-one patients involved in sports, thirty-seven (90%) were able to return postoperatively and twenty-eight (68%) returned to the same level of sports, including those involving overhead activities. Ninety-eight percent (forty-six) of the forty-seven patients had a stable shoulder at the time of the last follow-up. CONCLUSIONS Arthroscopic Hill-Sachs remplissage, performed in combination with a Bankart repair, is a potential solution for patients with a large engaging humeral head bone defect but no substantial glenoid bone loss. The posterior capsulotenodesis heals predictably in the humeral defect. The slight restriction in external rotation (approximately 10°) does not significantly affect return to sports, including those involving overhead activities. The procedure, which may also be useful for revision of previous failed glenohumeral instability surgery, is not indicated for patients with glenoid bone deficiency.

Biologically based strategies to augment rotator cuff tears

Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

Intraoperative biologische Augmentation an Sehnen und Enthesen

ZusammenfassungTrotz technischer Weiterentwicklung in der Sehnenrekonstruktionschirurgie besteht postoperativ nach wie vor eine relativ hohe Rerupturrate. Ein Grund dafür ist die Tatsache, dass bei der Sehnenansatz- und Sehnenheilung, bedingt durch eine limitierte Regenerationskapazität, Narbengewebe anstelle von normalem Gewebe gebildet wird. Dieses Narbengewebe ist sowohl in funktioneller als auch struktureller Sicht dem normalen Gewebe unterlegen. Mehrere Strategien zur biologischen Augmentation von Sehnen- und Sehnenansatzläsionen wurden in den letzten Jahren entwickelt und getestet. Dieser Artikel bespricht die klinische Evidenzlage bezüglich der biologischen Augmentation von Sehnen und Enthesen mittels Wachstumsfaktoren in Form von Plättchenkonzentraten, zellbasierten Therapien bzw. biologischen Sehnengrafts.AbstractIn spite of further developments in surgical techniques for tendon and entheses reconstruction procedures, the retearing rate after tendon and tendon-bone repair remains high. The reason is that instead of native tissue, scar tissue with reduced functional and structural quality forms at the reconstruction site. In order to improve tendon and enthesis healing several therapy strategies have been developed for biological improvement of the repair area. This article provides an overview of the current evidence of augmentation techniques for tendon and enthesis reconstruction using growth factors in the form of platelet concentrates, cell-based therapies and biological tendon grafts.