Purpose To investigate whether subscapularis integrity and compensatory teres, minor hypertrophy is associated with maintaining relatively good function and tolerable pain levels during non-operative treatment. Methods This study included 108 patients with irreparable, massive rotator cuf tears involving at least two tendons and stage III or IV muscle hypotrophy and fatty iniltration on oblique sagittal magnetic resonance imaging, in which even a partial repair does not seem feasible. All supraspinatus and infraspinatus muscles were grade IV; if the subscapularis was involved, only stage III or IV was included. Patients were divided into two groups: group A consisted of 67 patients with both an intact subscapularis and teres minor hypertrophy; group B consisted of 41 patients lacking either one or both. The Visual Analogue Scale pain score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles shoulder score, and active range of motion (ROM) were assessed. Results During the follow-up period, failure of non-operative treatment was found in 29 (43%) patients in group A and 28 (68%) in group B (p = 0.012). Conversion to surgery was noted in 26 (39%) patients in group A and 27 (66%) in group B (p = 0.006). Among the remaining nonsurgical patients, there were no signiicant diferences in clinical outcomes between the groups except ROM in internal rotation at inal follow-up. Conclusions Although conservative treatment was not always successful in patients with irreparable, massive cuf tears, patients with both an intact subscapularis tendon, and teres minor hypertrophy experienced signiicantly lower incidences of failure and conversion to surgery, since force couple is maintained in the setting of minimal arthritis. Level of evidence III.

Background To elucidate the effect of anterolateral bowing on the fracture height of atypical femoral fractures (AFFs), we separated the AFFs into 2 groups according to the presence of anterolateral femoral bowing (straight group and bowing group) and analyzed the fracture height. The aims of this study were to evaluate the clinical and radiological features of AFFs in the straight group and bowing group, and to determine which factors were associated with the fracture height of AFFs in the total cohort and each subgroup. Methods Ninety-nine patients with AFFs were included in this study (43 patients in the bowing group and 56 patients in the straight group). Clinical and radiological characteristics were compared between the groups. Multivariable linear regression analysis was performed to determine the effect of factors on fracture height. Results Patients in the straight group were younger, heavier, and taller, and had a higher bone mineral density, smaller anterior and lateral bowing angles, and more proximal fracture height than those in the bowing group. Multivariable analysis showed that the presence of anterolateral bowing itself and height were associated with fracture height in the total cohort. In the subgroup analysis, the lateral bowing angle in the straight group and the estimated apex height in the bowing group were associated with fracture height. The lateral bowing angle was not significantly associated with fracture height in the total cohort and the bowing group. Conclusions The presence of anterolateral bowing and the level of the apex of the bowed femur were important factors for the fracture height of AFFs.

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