Background: Acromioclavicular joint separations are very common lesions, with the majority falling into Rockwood classification type
I and II. It is generally agreed that conservative treatment of ...these injuries leads to good functional results, although
there are some studies that suggest these injuries are associated with a high incidence of persistent symptoms.
Hypothesis: Type I and II acromioclavicular joint disruption significantly impairs long-term shoulder function.
Study Design: Case series; Level of evidence, 4.
Methods : The shoulder function of 23 patients who were treated for type I or II acromioclavicular joint disruption was evaluated
at a mean of 10.2 years after injury. The objective and subjective measures of the injured shoulder were assessed using Constant,
University of CaliforniaâLos Angeles Shoulder Scale, and Simple Shoulder Test scores and were compared with results of the
uninjured shoulder.
Results: At an average follow-up of 10.2 years, 12 of 23 patients (52%) reported at least occasional acromioclavicular joint symptoms.
The average Constant score for the injured shoulder was 70.5 and 86.8 for the uninjured shoulder ( P < .001). The average University of CaliforniaâLos Angeles Shoulder Scale score for the injured shoulder was 24.1 and 29.2
for the uninjured shoulder ( P < .001). The average Simple Shoulder Test value for the injured shoulder was 9.7 and 10.9 for the uninjured shoulder ( P < .002). The extent of acromioclavicular joint disruption and acromioclavicular joint width did not have any statistically
significant influence on the shoulder functional scores.
Conclusion: Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after
injury.
Keywords:
acromioclavicular joint
shoulder
ultrasound
injury
functional outcome
Background To overcome the mismatch between a stiff stem and the more elastic bone, the concept of isoelasticity was introduced in the 1970s. This concept was based on the assumption that the implant ...and the bone should deform as one unit to avoid stress shielding. The Robert Mathys (RM) cementless total hip replacement (THR) was one of the earliest isoelastic designs.
Patients and methods From 1984 to 1987, we performed 149 total hip replacements in 135 patients (92 women, mean age 47 (21-72) years) using third-gen-eration Mathys isoelastic polyacetal stem with stain-less-steel heads and polyethylene cementless acetabular cups. 11 patients died before revision or before the examination for this study, and 14 were lost to follow-up. Average follow-up time for the remaining 110 patients was 15 (14-17) years.
Results To date, 69 hips (64 patients) have been revised, 5 due to infection. The 10-year survival rate for any reason was 70% (66-74). In the 46 remaining patients (53 hips), the average HHS was 80 (39-100) points. 13 of these were regarded as radiographic failures, with an average HHS of 75 points.
Interpretation The performance of this prosthesis was unacceptably poor. Higher debris production and poor primary fixation are believed to be the main reason for the high failure rate.
Background
The management of massive, irreparable rotator cuff tears (RCT) is challenging and associated with high failure rates. There are no current consensus or definitive guidelines concerning ...the optimal surgical treatment for this devastating condition. This study was designed to confirm the long-term safety and efficacy of the biodegradable inflatable InSpace™ system in patients with massive reparable or irreparable RCTs.
Methods
In this open-label, single arm, prospective study, subjects with massive RCT underwent subacromial implantation with the biodegradable spacer. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Total Constant Score (TCS).
Results
Twenty-four patients were treated and assessed. Four patients had partial tears, and in three of them RC repair was performed. These patients were not included in the efficacy analyses. Of the participating subjects who reached the 5-year follow-up, 84.6% of the patients showed a clinically significant improvement of at least 15 points in their score, while 61.54% showed at least 25 points of improvement. Only 10% of the treated patients showed no improvement or worsening in the shoulder score comparing to their baseline. An overall improvement in the total CS commencing at 3 months and sustained by 6 months through to 5 years of follow-up (
P
< 0.0001) was demonstrated.
Conclusions
We conclude that in this initial cohort, arthroscopic implantation of InSpace™ system represented an effective alternative to the existing arthroscopic procedures in patients with painful massive RCT refractory to conservative management. Further randomized controlled trials comparing the clinical and functional outcomes after implantation of the InSpace™ device are warranted.
Purpose
The purposes of this prospective non-randomized study were to confirm the feasibility of the biodegradable sub-acromial spacer (InSpace™) implantation in patients with massive irreparable ...rotator cuff tear and to determine the safety profile and functional results 3 years post-implantation.
Methods
Twenty patients were implanted with the InSpace™ device and assessed up to 3 years of post-implantation. Improvement in shoulder function was assessed using Constant score, while ease of use of the system was recorded by surgeons as were device-related adverse events.
Results
Twenty patients were available for assessment. Implantation was performed arthroscopically in all patients, and a range of deployment time was 2–20 min. The mean total Constant score increased from 33.4 to 65.4 points at 3 years. There was an improvement of 6.4 points in subjective pain score which commenced at 1 week post-operatively and was sustained until 3 years of follow-up. Also activities of daily living and motions commenced improvement by 9.4 and 7.7 points, respectively. Improvement in power was only evident at 18 months of follow-up but was sustained at 3 years.
Conclusions
Arthroscopic deployment of a co-polymer biodegradable spacer (balloon) into the sub-acromial space for an irreparable rotator cuff tear was found to be low-risk and simple procedure associated with improvement in shoulder function and low rate of complications.
Level of evidence
IV; therapeutic case series
Background To overcome the mismatch between a stiff stem and the more elastic bone, the concept of isoelasticity was introduced in the 1970s. This concept was based on the assumption that the implant ...and the bone should deform as one unit to avoid stress shielding. The Robert Mathys (RM) cementless total hip replacement (THR) was one of the earliest isoelastic designs.
Patients and methods From 1984 to 1987, we performed 149 total hip replacements in 135 patients (92 women, mean age 47 (21-72) years) using third-gen-eration Mathys isoelastic polyacetal stem with stain-less-steel heads and polyethylene cementless acetabular cups. 11 patients died before revision or before the examination for this study, and 14 were lost to follow-up. Average follow-up time for the remaining 110 patients was 15 (14-17) years.
Results To date, 69 hips (64 patients) have been revised, 5 due to infection. The 10-year survival rate for any reason was 70% (66-74). In the 46 remaining patients (53 hips), the average HHS was 80 (39-100) points. 13 of these were regarded as radiographic failures, with an average HHS of 75 points.
Interpretation The performance of this prosthesis was unacceptably poor. Higher debris production and poor primary fixation are believed to be the main reason for the high failure rate.
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