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Despite the growing interest on delaminated rotator cuff tear, the optimal surgical method is still controversial. In this prospective study, the result of two different surgical methods; en masse repair and separate double layer double row repair were compared. Both treatments were effective in improving clinical outcomes. Lower pain scores were seen in separate double-layer double-row repair. ABSTRACT DATA Introduction: Recently, there has been a growing interest on the delaminated tear of full thickness rotator cuff tear. For the treatment of delaminated rotator cuff tear, conventional suture bridge (transosseous equivalent) repair, described as en masse repair and separate double layer double row repair have been performed. The aim of this study was to determine the optimal surgical method for the treatment of delaminated rotator cuff tear. For this purpose, we compared clinical results between conventional en masse repair and separate double-layer repair for the treatment of delaminated rotator cuff tear. Methods: Between August 2007 and March 2014, a total of 82 patients who underwent arthroscopic rotator cuff repair of a delaminated tear were enrolled and randomized into 2 groups. In group 1 (n ¼ 48), arthroscopic conventional en masse repair was performed. In group 2 (n ¼ 34), separate double-layer double-row repair was performed. Articular layer was repaired in knotless manner. The American Shoulder and Elbow Surgeons score, Constant score, Simple Shoulder Test score, and visual analog scale (VAS) score for pain and range of motion (ROM) were assessed before surgery; at 3, 6, and 12 months after surgery; and at the last follow-up visit. Magnetic resonance imaging (MRI) was performed at 12 months postoperatively to examine the retear rate and pattern. Results: There was no significant difference between groups in the preoperative demographic data, including patient age, sex, symptom duration, tear size, and functional scores (P > .05). The mean follow-up period was 25.9 months. The group 2 had significantly lower VAS pain scores (P<.05) at postoperative 3, 6, and 12 months. The functional scores and ROM showed no significant difference between the groups at each time point. Eight of 48 patients in group 1 and six of 34 patients in group 2 showed re-tears on MRI at 12 month follow up, but the difference was not significant statistically(P > .05). Conclusion: Both conventional en masse repair and separate double-layer double-row repair were effective in improving clinical outcomes in the treatment of delaminated rotator cuff tears. However, lower pain scores were seen in patients who underwent separate double-layer double-row repair.

While critical bone loss has yet to be defined for arthroscopic Bankart reconstruction, our data indicate that "critical" bone loss should be lower than the 20% to 25% threshold often cited. In our population with a high level of mandatory activity, bone loss above 13.5% led to a clinically significant decrease in WOSI scores consistent with an unacceptable outcome, even in patients who did not sustain a recurrence of their instability.

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Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

In the largest prospective study evaluating shoulder instability in in-season contact athletes, 27% of athletes returned to play and completed the season without subsequent instability. While the majority of athletes who return to sport complete the season, recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation.

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The use of drugs and supplements to enhance performance has become a part of mainstream athletics. Many team physicians and sports medicine practitioners are unfamiliar with the benefits and risks of these products and thus are unable to educate young athletes on this topic. In spite of numerous reports on the health risks of anabolic steroid use, 1 to 3 million Americans have used them. Human growth hormone has been tried by up to 5% of 10th graders, although no scientific study has shown that it is an effective performance-enhancing drug. Amphetamines and similar compounds may be the most widely abused drug in baseball; recently, they have come under increased scrutiny in sport. Erythropoietin is a highly effective aerobic enhancer that has been linked to multiple deaths in cyclists and other endurance athletes. The neutraceutical industry, led by supplements such as creatine, ephedra, and androstenedione, remains unregulated by the Food and Drug Administration and has serious issues with quality and side effects. An understanding of these products is essential for the sports medicine practitioner to provide sound, safe advice to the athlete.