Superior labrum anterior posterior (SLAP) injury is a major challenge for orthopedic surgeons, due to the poor healing ability of the injured labrum. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during operation, knotted or knotless anchors, and fixation methods. The authors believe that arthroscopic repair of SLAP lesions is effective for young patients with intact glenoid labrum(<35 years old) or with extensive activity, where single and knotless anchor is preferred. For the older patients(≥35 years old) with degeneration and wear of glenoid labrum, biceps tenodesis is more preferable, and interference screw fixation technique is recommended. As for patients with failed SLAP repair, biceps tenodesis can achieve a high success rate as a revision surgery. By review of the relevant literature in recent years, this paper summarizes the adaptation of different surgical methods of arthroscopic treatment of SLAP injury, intraoperative anchoring techniques, fixation methods and other improved surgical techniques.
Humans ; Adult ; Shoulder Joint/surgery* ; Arthroscopy/methods* ; Tendon Injuries/surgery* ; Shoulder Injuries/surgery* ; Tenodesis/methods*

Arthroplasty, Replacement ; methods ; Clavicle ; injuries ; Fractures, Bone ; surgery ; Humans ; Joint Instability ; surgery ; Shoulder Fractures ; surgery ; Shoulder Injuries ; Shoulder Joint ; surgery

INTRODUCTION: Shortening of the tendon and muscle is recognised as a strong predictor of surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. Hence, we aimed to compare the pre- and postoperative architecture of the supraspinatus. METHODS: We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one month (post-op1), three months (post-op2) and six months (post-op3) in relaxed and contracted states (0º and 60º glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed. RESULTS: The mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. The mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3. CONCLUSION Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.
Humans ; Rotator Cuff/surgery* ; Rotator Cuff Injuries/surgery* ; Shoulder/surgery* ; Shoulder Joint/surgery* ; Tendons

Arthroscopy ; methods ; Humans ; Knee Injuries ; surgery ; Shoulder Joint ; injuries

OBJECTIVETo explore operative method for the treatment of double injuries of superior shoulder suspensory complex (SSSC).

METHODSFrom January 2008 to March 2010,11 patients wiht SSSC injuries were treated, including 9 males and 2 females with an average age of 38 years (ranged from 20 to 47 years). The patients were treated with 4 methods as follows: 4 patients with fractures of neck of scapula combined with homolateral fracture of clavicle were treated with reconstituted plates; 2 patients with fractures of coracoid process or disruption of coracoclavicular ligament combined with the fracture of extremitas acromialis claviculae or acromioclavicular dislocation were treated with clavicular hook plates and cannulated compression screws; 3 patients with injuries of basilar part of acromial process combined with the glenoid cavity and acromioclavicular articulation were treated with reconstuction plates and clavicular hook plates; 2 patients with fractures of acromial process combined with acromioclavicular dislocation and the fracture of lateral third of clavicle were treated with small "T" plates and clavicular hook plates.

RESULTSAmong 11 patients, 9 patients were followed up with an average duration of 9.2 months (ranged from 6 to 12 months). All the fractures were healed without bone nonunion or failure of internal fixators. The average union time was 2.6 months. The profile of articulatio capitis humeri was normal and hibateral articulatio capitis humeri was symmetrical without crispation, descensus, adduct and adtorsion of articulatio capitis humeri or other abnormity. According to the Constant-Murley evaluation system, the score ranged from 69 to 100, with an average of 89.7, which included average pain score of 10 to 15, daily activities score of 14 to 20, myodynamia score of 15 to 25, territory score of 34 to 40.

CONCLUSIONThe double injuries of SSSC should be treated by types to recover the integrity and constancy of SSSC.

Acromioclavicular Joint ; injuries ; Adult ; Female ; Humans ; Male ; Middle Aged ; Shoulder Dislocation ; surgery ; Shoulder Joint ; injuries

Adult ; Humans ; Humeral Head ; injuries ; Male ; Shoulder Fractures ; surgery

Adult ; Clavicle ; injuries ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Scapula ; injuries ; Shoulder Joint ; surgery ; Young Adult

Arthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears, but spontaneous pneumothorax after surgery is very rare. The present case was a 66-year-old female with irreparable rotator cuff tears of the right shoulder, treated with the arthroscopic shoulder superior capsular reconstruction. The general anesthesia and operation went smoothly, but the patient experienced stuffiness in the chest and shortness of breath after recovery from anesthesia. Thoracic CT scans showed spontaneous pneumothorax in the right side, which was successfully treated by the conservative treatments (oxygen therapy) according to multidisciplinary team. Prompt and accurate early-stage diagnosis is necessary in controlling postoperative complications and standardized treatment is the key to relieve the suffering. Spontaneous pneumothorax after arthroscopic shoulder surgery has been rarely reported in previous literatures.
Aged ; Arthroscopy/methods* ; Female ; Humans ; Pneumothorax/surgery* ; Range of Motion, Articular ; Rotator Cuff Injuries/surgery* ; Shoulder ; Shoulder Joint ; Treatment Outcome

OBJECTIVE: To investigate clinical results of reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury. METHODS: From January 2017 to December 12, 12 comminuted fracture or dislocation of proximal humerus elderly patients were diagnosed as rotator cuff injury by preoperative MRI and operative exploration, and treated by reverse total shoulder arthroplasty. Among them, including 7 males and 5 females aged from 65 to 86 years old; 5 patients injured on the left side and 7 patients injured on the right side. Range of motion, postoperative complication were observed, VAS score was used to evaluate pain release and UCLA score was used to assess recovery of shoulder joint. RESULTS: All patients were followed up from 8 to 18 months. At the latest follow-up, shoulder range of motion conditions were as following:forward bend and lifts ranged from 90° to 150°, external rotation ranged from 10°to 30°, internal rotation could reached L₃ level(S₁-L₁), VAS was for 0 to 6 points, UCLA score ranged from 18 to 32 points, 5 patients were good and 7 patients were poor. No infection, prothesis loosening, shoulder stress fracture, injury of vessel and nerve occurred. CONCLUSIONS Reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury has advantages of early recovery of shoulder joint range of motion, less pain and high patients' satisfactory.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Shoulder ; Female ; Fractures, Comminuted ; Humans ; Humerus ; Male ; Range of Motion, Articular ; Rotator Cuff Injuries ; Shoulder ; Shoulder Fractures ; surgery ; Shoulder Joint ; Treatment Outcome

OBJECTIVETo evaluate the mid-term results of arthroscopic repair of full-thickness rotator cuff tears.

METHODSFrom December 2002 to May 2007, 35 patients(35 shoulders) with full-thickness rotator cuff tears underwent arthroscopic treatment. Five patients were lost in the follow-up period, leaving 30 patients available for evaluation. There were 15 male and 15 female patients, the average age was 55.6 years(31-74 years). Three left shoulder and 27 right ones were involved. All the patients underwent subacromial bursectomy and acromioplasty, 19 cases were repaired by suture anchor. Eleven tears were repaired by suture anchor combined with side-to-side suture. Sixteen patients underwent single-row repair and 14 patients underwent dual-row repair. The follow-up was completed on June 2012. The University of California at Los Angeles (UCLA) scoring system was adopted before operation and at the final evaluation.

RESULTSThirty patients were followed up for an average of 78.5 months(range 5-10 years). The average score increased from 14.2 ± 3.1 to 33.6 ± 2.1 (t = -37.154, P = 0.000) . The mean pain score was 2.5 ± 0.9 vs.9.5 ± 1.0(t = -24.466, P = 0.000) for preoperative vs. postoperative, the function score was 4.5 ± 1.5 vs. 9.4 ± 1.1 (t = -18.500, P = 0.000), the mean forward flexion score was 3.3 ± 1.6 vs. 4.9 ± 0.2(t = -5.614, P = 0.000), the mean forward flexion strength was 3.9 ± 0.5 vs. 4.7 ± 0.4 (t = -6.591, P = 0.000). The results were 19 excellent, 11 good. The average scores of single-row group and double-row group were 33.6 ± 1.7 and 33.6 ± 2.6 respectively. All patients were satisfied with the operation.

CONCLUSIONSThis surgery has many advantages such as mini-invasion and rapid recovery. The clinical results of both single-row repair and dual-row repair are satisfactory. The key to the operation lies in accurate tear pattern recognition, enough tendon release and correct suturing method.

Adult ; Aged ; Arthroscopy ; Female ; Humans ; Joint Diseases ; surgery ; Male ; Middle Aged ; Rotator Cuff ; surgery ; Rotator Cuff Injuries ; Shoulder ; surgery ; Shoulder Injuries