Scott D. Pennington

Clinical success of biceps tenodesis with and without release of the transverse humeral ligament.

BACKGROUND Multiple methods for biceps tenodesis exist, but long-term studies have demonstrated high failure rates. We hypothesized that tenodesis techniques that do not release the biceps sheath are associated with a higher surgical revision rate than those that do. METHODS A retrospective study was conducted of 127 biceps surgeries over a 2-year period. The mean follow-up post surgery was 22 months (range, 6-59). Clinical failure was defined as ongoing pain localized in the biceps groove, severe enough to warrant revision surgery. RESULTS When all techniques that released the biceps sheath (6.8%, 4/59) were compared to those that did not release the biceps sheath (20.6%, 14/68), a statistically significant difference was found, P = .026 (chi-square). Proximal arthroscopic techniques were revised at a significantly higher rate than distal tenodesis techniques (P = .005). CONCLUSION Biceps tenodesis techniques which do not release the biceps sheath or remove the tendon from the sheath have increased revision rates, compared to techniques that do. This may be supportive evidence for the theory that residual pain generating elements in the biceps groove is a cause of failure of proximal tenodesis methods.

Shoulder Arthroplasty for Fracture: Restoration of the ???Gothic Arch???

Shoulder arthroplasty for fracture remains a technically challenging procedure, often with unpredictable clinical outcomes in the reported literature. Consequently, the appropriate management of certain 3- and 4-part fractures and fracture-dislocations of the proximal humerus remains controversial. However, recent advances in our understanding of the intraoperative technical pitfalls with shoulder fracture arthroplasty have created the potential for more reproducible functional results. Restoration of the “gothic arch” of the shoulder girdle combined with anatomic tuberosity reconstruction can make this operative procedure reproducible.

Management of Os Acromiale

ABSTRACT Os acromiales occur with an incidence between 7% and 8%. They can result in dynamic impingement on the rotator cuff and be symptomatic. Although symptomatic pre-acromions can be excised, the excision of larger os acromiales may result in poor deltoid biomechanics and functional loss. The authors favor arthroscopic examination to determine os stability followed by open reduction of a meso-acromion or meta-acromion with bone grafting and internal fixation using 4.0-mm cannulated screws and 18-gauge wire. The earlier experience of nonunion has largely been avoided by abandoning K-wire fixation for cannulated screws. We have achieved union in 13 of the 15 cases of os acromiales treated in this manner. Complications are nearly always related to symptomatic prominent hardware that can be ameliorated by staged hardware removal after healing of the bone grafted os acromiale.

Shoulder arthroplasty in patients with dwarfism: a report of 2 cases

Some skeletal dysplasias are characterized by abnormalities in the development and remodeling of cartilage and bone and may herald the early onset of osteoarthritis. The cumulative effects of abnormal cartilage synthesis, increased cartilage fibrosis, and weight bearing on an abnormal joint leads to progressive degeneration of the articular surface and loss of articular congruency. This is probably the reason why many osteochondrodysplasias evolve to osteoarthritis in early adulthood. While total knee and total hip replacements in patients with dwarfism has been well reported, to our knowledge there are no reports of shoulder arthroplasty in such patients with pain and functional limitations. In fact, only 1 case of shoulder arthroplasty in patients with dwarfism has been mentioned in the literature, but the rationale and specifications of its treatment were not addressed. It is well established that the most significant problem related to dwarfism is not so much their short stature, but rather the medical problems complicating their general health. Although quality literature lacks regarding the health and social consequences in the adult individual with skeletal dysplasia, one cannot understate the importance of a good functioning upper limb, especially for overhead activities and personal hygiene. We report our experience with 2 such cases where a custom designed shoulder hemiarthroplasty was

Arthroscopic Ulnohumeral Arthroplasty for Degenerative Arthritis of the Elbow in Patients Under the Age of 50

Symptomatic primary degenerative arthritis of the elbow in young, active patients remains a rare but formidable problem in elbow reconstruction as neither total elbow replacement nor arthrodesis are ideal treatment solutions. The primary goals in treating these patients are restoration of motion and pain relief. We present here our rationale, indications, technique, and result of all-arthroscopic ulnohumeral arthroplasty in patients under 50 years of age.