No abstract

Reverse total shoulder arthroplasty is a treatment option for patients with symptomatic glenohumeral arthritis and a deficient rotator cuff. The reported complication rates vary from 0% to 68%. Given this variation, our purposes were to (1) determine the learning curve for the procedure, (2) identify complications and surgical pitfalls, and (3) compare our results with those of similar published series. We retrospectively reviewed 20 consecutive patients (mean age, 73 years; range, 45-88 years) who had reverse total shoulder arthroplasty by one surgeon, tabulating intraoperative and postoperative complications. Minimum followup was 3 months (average, 9 months; range, 3-21 months). The intraoperative complication rate for the first 10 patients was higher than that for the second 10 patients. There were 33 complications in 15 patients: 11 patients collectively had 22 intraoperative complications and eight patients collectively had 11 postoperative complications. At radiographic followup, 11 patients had scapular notching and nine patients had heterotopic ossification. Our complication rate was higher than published rates.

This study aimed to identify the role of intermittent pneumatic compression in treating peripheral arterial disease and to investigate the types of treatment programs that are most effective. Data was sourced from English-language articles which were identi ed by a computer search using MEDLINE from 1966 to 2001, followed by extensive bibliography review. Studies were included if they contained pertinent material involving a compression device and arterial ow dynamics in lower limbs. A total of 26 English-language studies were identi ed that met the inclusion criteria. The diverse patient criteria and methods used in the studies provided an opportunity to examine the effectiveness of each, but made it dif cult to compare one study with another. To assist in focusing on overall trends in improvement, patient type and treatment type disparities must be identi ed. In conclusion, it is evident that an intermittent pneumatic compression program appears promising and may be used in patients with severe peripheral arterial disease who are not candidates for revascularization using surgery or percutaneous angioplasty. It is now the goal to establish randomized, prospective, controlled trials to clarify the most bene cial regimen for treating such disease.

Biceps tenodesis provides reliable pain relief for patients with biceps tendon abnormality. Previous cadaver studies have shown that, for biceps tenodesis, an interference screw provides biomechanical strength to failure superior to that of suture anchors. This finding has led some providers to conclude that screw fixation for biceps tenodesis is superior to suture anchor fixation. The purpose of the current study was to test the hypothesis that the strength of a 2-suture-anchor technique with closing of the transverse ligament is equal to that of interference screw fixation for biceps tenodesis.In 6 paired, fresh-frozen cadaveric shoulder specimens, we excised the soft tissue except for the biceps tendon and the transverse ligament. We used 2 different methods for biceps tenodesis: (1) suture anchor repair with closing of the transverse ligament over the repair, and (2) interference screw fixation of the biceps tendon in the bicipital groove. Each specimen was preloaded with 5 N and then stretched to failure at 5 mm/sec on a materials testing machine. The load-to-failure forces of each method of fixation were recorded and compared. Mean loads to failure for the suture anchor and interference screw repairs were 263.2 N (95% confidence interval [CI], 221.7-304.6) and 159.4 N (95% CI, 118.4-200.5), respectively. Biceps tenodesis using suture anchors and closure of the transverse ligament provided superior load to failure than did interference screw fixation. This study shows that mini-open techniques using 2 anchors is a biomechanically comparable method to interference fixation for biceps tendon tenodesis.

Acetabular labral repair requires positioning the labrum on the edge of the acetabulum with appropriate tension and rotation to recreate the suction seal with the femoral head. Considering that the labrum is a triangular shape in cross-section, rotation of the articular face of the labrum relative to the femoral head also affects the suction seal. The purpose of the toggle suture technique described herein is to control the rotation of the labrum to allow the articular face to directly contact the femoral head and optimize the suction seal. The technique is performed by passing the midaspect of a suture around the labrum at the chondrolabral junction. The loop is retrieved and delivered outside the same portal. One of the 2 free suture tails is then passed through the loop, which is then manually tensioned. This creates a single loop around the labrum with a suture tail on either side that allows for rolling, or “toggling,” of the labrum to place the articular face in line with the femoral head.