Background: Active range of motion deficit is one of the alleged negative influencing factors of rotator cuff repair. Recently, with the popularity of reverse total shoulder arthroplasty (RTSA), there is a tendency toward performing RTSA in cases of nonarthritic large-to-massive tears with pseudoparalysis.
Hypothesis: Rotator cuff repair in patients with active motion deficit may yield inferior outcome.
Study Design: Cohort study; Level of evidence, 3.
Methods: Among 195 complete repairs of large-to-massive rotator cuff tears, 35 patients experienced painful pseudoparalysis preoperatively. Propensity score matching (1-to-1) was performed between pseudoparalytic and nonpseudoparalytic groups. Finally, 29 patients in each group were matched using the following variables: age, gender, dominance, onset period, aggravation period, number of tendons involved, retraction, operation method (arthroscopic or mini-open), rows of repair (single or double), number of anchors, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. At least 1 year after surgery (mean, 30.5 months), range of motion, visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale (UCLA score) were evaluated. Healing of repaired cuffs was evaluated by computed tomography arthrography.
Results: Range of motion was improved in both groups after rotator cuff repair. Active forward elevation had significantly improved postoperatively in the pseudoparalytic group (P < .001). All functional outcome scores improved at the final follow-up visit compared with preoperative values (all P < .05). Preoperative Constant, ASES, and UCLA scores were significantly inferior in the pseudoparalytic group, but all except the Constant score showed no differences between the 2 groups at the final follow-up (P = .04). Postoperatively, 7 patients (24.1%) in the pseudoparalytic and 1 (3.4%) in the nonpseudoparalytic group showed pseudoparalysis (P = .03). Among 37 patients who underwent postoperative computed tomography arthrography, cuff healing was achieved in 6 of 18 (33.3%) in the pseudoparalytic and 9 of 19 (47.4%) in the nonpseudoparalytic group (P = .385).
Conclusion: Recovery from pseudoparalysis after rotator cuff repair was evident in a large portion of the study group, and postoperative function and cuff healing were not different according to the presence of pseudoparalysis. Considering possible complications and longevity of RTSA, rotator cuff repair should be the first-line treatment option for large-to-massive tears.
Background: Most studies of allograft versus autograft for anterior cruciate ligament reconstruction have been of bone–patellar tendon–bone; outcome reports evaluating anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft are rare.
Purpose: This study was undertaken to compare the clinical outcome of arthroscopic anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft.
Study Design: Randomized controlled trial; Level of evidence, 2.
Methods: Between 2000 and 2004, 208 patients who met the inclusion and exclusion criteria of the study were prospectively randomized into autograft (n = 104) or allograft (n = 104) groups. All hamstring tendon allografts were fresh-frozen and obtained from a single certified tissue bank. All the operations were done by the same surgeon with the same surgical technique. Femoral and tibial fixation was by means of an EndoButton and a bioabsorbable interference screw augmented with a staple, respectively. Patients were evaluated preoperatively and postoperatively. Evaluations included detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing, Harner vertical jump and Daniel 1-legged hop tests, Lysholm score, Tegner score, the International Knee Documentation Committee (IKDC) standard evaluation form, Cincinnati knee score, and radiographs.
Results: Of these patients, 186 (autograft, n = 91; allograft, n = 95) were available for full evaluation. Demographic data were comparable between groups. The mean follow-up was 7.8 years for both groups. There were no statistically significant differences according to the evaluations of the outcome aforementioned between the 2 groups except that patients in the allograft group had a shorter operation time than the autograft group. Seven patients (7.7%) in the autograft group and 8 (8.4%) in the allograft group had a side-to-side difference >5 mm. Eighty-five patients (93.4%) in the autograft group and 86 (90.5%) in the allograft group were normal or nearly normal according to the overall IKDC. According to the subjective IKDC, the average scores were 89 and 90 points, respectively, for the autograft and allograft groups. The mean Lysholm and Tegner scores were 89 points and 7.7 points, respectively, for the autograft group and 90 points and 7.6 points, respectively, for the allograft group. For the Cincinnati knee score, the average scores were 90 and 91 points, respectively, for the autograft and allograft groups.
Conclusion: Both groups of patients achieved almost the same satisfactory outcome at an average of 7.8 years of follow-up. Fresh-frozen hamstring tendon allograft is a reasonable alternative choice to autograft for anterior cruciate ligament reconstruction.
Background: The increase in anterior laxity and slippage is greater with metal interference screw fixation of a hamstring anterior cruciate ligament (ACL) graft than a bone-patellar tendon-bone graft.
Hypothesis: When slippage-resistant fixation is used with a soft tissue graft, early recovery of function does not result in a clinically important increase in anterior laxity and slippage
Study Design: Case series; Level of evidence, 4.
Methods: Nineteen subjects were treated with a single-tunnel, single-looped, tibialis allograft with slippage-resistant, cortical fixation. An examiner, different from the treating surgeon, used stereophotogrammetric analysis to compute the increase in anterior laxity at a 150 N anterior force and slippage between the day of surgery and each monthly follow-up interval, and determined recovery of function and motion.
Results: Anterior laxity did not increase between the day of surgery and 1 year (P = .23). Total slippage plateaued after 1 month, but increased 1.5 mm between the day of surgery and 1 month (P < .05). Extension and flexion plateaued after 2 months (P < .0001 and P < .02, respectively); activity level (Tegner score) plateaued after 3 months (P < .05), function (Lysholm score) plateaued after 4 months (P < .002), and subjective satisfaction (International Knee Documentation Committee score) plateaued after 6 months (P < .02).
Conclusion: Early recovery of function after ACL reconstruction with a soft tissue allograft did not result in a clinically important increase in anterior laxity and slippage at 1 year. We believe the avoidance of an increase in anterior laxity was related to the use of a transtibial technique designed to place the femoral and tibial tunnels without roof and posterior cruciate ligament impingement, the use of cortical fixation devices designed to resist slippage, the use of an aseptically harvested fresh-frozen tibialis allograft that was not irradiated or chemically processed, and the use of a self-administered rehabilitation program designed to encourage an early return of motion and function.
