No abstract

This article reports the authors' experience with single-row arthroscopic revision rotator cuff repairs and analyzes the variables associated with a poorer long-term outcome. A retrospective review was performed of patients who had undergone an all-arthroscopic, single-row revision rotator cuff repair for pain with a documented re-tear over a 13-year period. After exclusionary criterion was applied, 32 shoulders in 30 patients were available for follow-up. A thorough shoulder examination was performed to record postoperative motion and functional outcomes, including the University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) pain score, and was compared with the patient's preoperative data. Analysis of variables, including patient demographics, surgical history, and functional outcomes, was performed to determine whether there was any association with a UCLA score less than 28 or an ASES score less than 65. At final follow-up, 20 men and 10 women had a mean age of 69.3 years (range, 55.1-84.1) at a mean follow-up of 70.3 months after final revision surgery. Mean UCLA score improved from 15.5 ± 3.9 preoperatively to 29.8 ± 4.6 postoperatively (P<.001); mean modified ASES score improved from 53.4 ± 12.5 preoperatively to 86.7 ± 12.7 postoperatively (P<.001); and mean VAS pain score improved from 4.6 ± 1.1 preoperatively to .91 ± 1.1 postoperatively (P<.001). A poorer functional outcome (defined as a UCLA score greater than 28) was found in 25% of patients. This was associated with female gender, age older than 70 years, dominant-arm revision, and preoperative external rotation less than 35°. In addition, preoperative active range of motion in forward flexion less than 140° (P=.039) and active range of motion in external rotation less than 35° (P=.025) were also associated with poorer ASES scores (<65). The authors believe that patients can have reliable improvements in shoulder pain and function after a revision procedure using a single-row arthroscopic technique and that patient factors can lead to poorer results with this technique.

Shoulder injuries in the throwing athlete are becoming more frequent. Sports specialization at a younger age, playing multiple seasons, increased awareness of injury and injury prevention, advances in diagnosis, and surgical treatment all play a part in the increase in diagnosis of these injuries. Understanding the biomechanics of throwing and pathologies that are encountered in the throwing athlete can aid the clinician in successful diagnosis and nonoperative/operative treatment of the throwing athlete. This article discusses the relevant anatomy, biomechanics, and pathoanatomy of the throwing shoulder. Additionally, understanding the kinetic chain can assist in the nonoperative rehabilitation of the injured shoulder. Surgical reconstruction is indicated when nonoperative efforts have been exhausted and is directed based on the extent of the pathology to the capsuloligamentous structures, labrum, and rotator cuff.

No abstract

There appears to be a physiologic deepening of the superior labrum sulcus with age, which becomes significant after the age of 40. These findings can contribute to whether the superior labrum is considered abnormal when assessed radiographically. The differentiation of normal age-related changes in the shoulder, from those of a type 2 SLAP tear can reduce the rates of unnecessary SLAP-2 repairs. This is the first reported series to use the BLC system; we believe it provides a common nomenclature to allow clear communication between specialists.