We treated 12 shoulders in ten patients with irreparable rotator-cuff tears by transfer of the latissimus dorsi. There were nine men and one woman. Their average age was 64.0 years and the average follow-up was 35.6 months (26 to 42).The results were excellent in four shoulders, good in four, fair in one, and poor in three. Active forward flexion improved from a preoperative average of 99°t o a postoperative average of 135°. Osteoarthritic changes appeared in five shoulders and proximal migration of the humeral head progressed in six. EMG revealed that nine of the 12 transferred muscles showed activity which was synergistic with the supraspinatus on external rotation with abduction.We conclude that latissimus dorsi transfer can be effective in restoring shoulder function after massive irreparable tears of the rotator cuff.

These results imply that preservation of the ACL remnant tissue may improve graft healing after ACL reconstruction.

Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, = 43) or without (Group N, = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (-0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) ( = 0.019), as well as in the Group N patients ( = 0.019). The degree of synovial coverage of the anteromedial ( = 0.0064) and posterolateral ( = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal ( = 0.049), middle, and distal ( = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.

Knee joint distraction (KJD) is a new application of an established technique to regenerate native cartilage using an external fixator. The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether KJD is beneficial for knee osteoarthritis and how results compare with established treatments. Studies assessing the outcomes of KJD were retrieved, with three studies (one cohort and two randomized controlled trials), 62 knees, meeting the inclusion criteria. The primary outcome was functional outcome, assessed using a validated outcome score, at 1 year. Secondary outcomes included pain scores, structural assessment of the joint, and adverse events. KJD is associated with improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from baseline to 1 year as well as reductions in pain scores and improvements in structural parameters assessed radiographically and by magnetic resonance imaging. KJD is not associated with decreased knee flexion, but is associated with a high risk of pin site infection. In patients aged 65 years or under at 1 year, no differences in WOMAC or pain scores was detected between patients managed with KJD compared with high tibial osteotomy or total knee arthroplasty. KJD may represent a potential treatment for knee arthritis, though further trials with longer term follow-up are required to establish its efficacy compared with contemporary treatments. This is a Level I (systematic review and meta-analysis) study.