Background
The New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).
Methods
Information collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post‐operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores.
Results
A total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini‐open and 1044 (43.2%) open procedures. Twenty‐four‐month follow‐up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini‐open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches.
Conclusion
RCR has good to excellent outcomes in terms of improvement in pain and function at 2‐year follow‐up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini‐open approaches for RCR.
Background: In recent years, there has been a trend toward more aggressive management of slipped capital femoral epiphysis (SCFE) with acute anatomical realignment; however, the literature is unclear with regard to the indications for this. Questions/purposes: To collect long-term patient-reported outcome scores on a group of SCFE patients using modern hip scores. The second aim was to determine whether there is a threshold level of deformity beyond which patients have predictably poor outcomes following in situ pinning. Patients and methods: Patients presenting with SCFE between 2000 and 2009 completed a survey consisting of three modern hip scores and were classified into poor, intermediate, and good outcome groups. The posterior slope angle (PSA) was used to measure slip deformity. We examined the relationship between patient characteristics and functional outcomes. The relationship between PSA score and overall outcome was examined using receiver operator curve (ROC) analysis. Results: The total study population was 63; 14% patients had poor, 29% had intermediate, and 57% had good functional outcomes. The mean Non-Arthritic Hip Scores (NAHSs) for those with poor outcomes was 51, 76 in the intermediate group, and 95 in the good group (p <0.001). PSA was significantly lower in those with good functional outcomes. ROC analysis demonstrated that a higher PSA was moderately predictive of a poor clinical outcome (area under the curve of 0.668). In both the poor and intermediate outcome groups, 50% of patients had a PSA of 40 or greater, whereas only 31% of those with good clinical outcomes had PSA of 40 or greater. Conclusions: A significant proportion of post-SCFE patients have ongoing suboptimal hip function after pinning in situ. Those with a PSA more than 40 have a higher chance of a poor outcome.
We examined the MRI scans of 35 adult hands to assess the feasibility of the hamate and the capitate as potential donor grafts in the management of comminuted intra-articular fractures at the base of the middle phalanges. Essentially neither the hamate nor the capitate were perfect anatomic matches in most digits, but the capitate had the advantage of having more uniform facets, and the capitate facet shapes were similar to those of the little finger. The measurement of angles in the coronal and sagittal plane showed that in some respects the differences between the potential graft and the base of the middle phalanges were smaller for the capitate than for the hamate. Moreover, the sagittal morphology of the capitate made it less prone to joint overstuffing than the hamate. We conclude that the capitate may be considered as a graft donor in selected cases, especially for the little finger.
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