Background: Healing of the tendon is not always related to successful clinical outcomes after rotator cuff repair. We hypothesized that certain radiologic factors may affect clinical outcomes after arthroscopic rotator cuff retear repair and that these radiologic factors could help predict the clinical process. The purpose of this retrospective study was to identify radiologic factors associated with clinical outcomes after arthroscopic rotator cuff retear repair.Methods: Between January 2012 and December 2019, 96 patients with Sugaya classification 4 or higher retear after arthroscopic rotator cuff repair were included. The included patients initially had sufficient repair footprint coverage, and retear diagnosis was made on follow-up magnetic resonance imaging at about 6 months post-surgery The associations between clinical outcomes and factors such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion were assessed. Also, radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance were analyzed. Multiple linear regression analysis was used to identify variables with significant results in univariable analyses.Results: Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. At the last follow-up, these scores improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). After univariable analyses, multiple linear regression analysis conducted in a stepwise manner revealed that the variance of the tear length, specifically that of the mediolateral dimension of the tear, had a statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01).Conclusions: In patients with arthroscopic rotator cuff retear repair, variance in the mediolateral tear length had significantly negative association with clinical outcomes. However, since explanatory power was only moderate, these results should be interpreted with caution, and further mechanical study with a larger sample is needed.
Delayed arteriovenous (AV) fistula after soft tissue reconstruction with flap surgery is a rare complication. Here, we describe a case of delayed AV fistula formation after 4 years of reverse flow sural island flap surgery in the lower leg. The patient had swelling, tenderness, and color change to dark purple on previous flap area and foot, similar to cellulitis. Thrill and murmur were observed. AV fistula was formed around the previous vascular pedicle area, as revealed in angiography. We excised the right posterior tibial artery-saphenous vein fistula. The patient is having satisfactory progress since the surgery. We suggest that AV fistula was caused by enhanced angiogenesis and vascular damage.
Background: Despite improved outcomes, failure or nonhealing of graft materials has been reported after superior capsular reconstruction (SCR) for massive irreparable rotator cuff tears. Purpose: To evaluate the short-term clinical and radiological outcomes of a novel technique for SCR using an Achilles tendon–bone allograft. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of patients who underwent SCR using an Achilles tendon–bone allograft with the modified keyhole technique and who had a minimum follow-up of 2 years. The visual analog scale score for pain, American Shoulder and Elbow Surgeons score, and Constant score were evaluated as subjective outcomes, while range of motion of the shoulder joint and isokinetic strength were evaluated as objective outcomes. The acromiohumeral interval (AHI), bone-to-bone healing of the allograft and humeral head on computed tomography, and graft integrity on magnetic resonance imaging were evaluated as radiological outcomes. Results: This study included 32 patients with a mean age of 56.8 ± 4.2 years and a mean follow-up of 28.4 ± 6.2 months. A significant improvement from preoperatively to the last follow-up was seen in the mean visual analog scale score for pain (from 6.7 to 1.8), American Shoulder and Elbow Surgeons score (from 42.7 to 83.8), Constant score (from 47.2 to 78.5), and AHI (from 4.8 to 8.2 mm) ( P < .001 for all) as well as range of motion in forward elevation and internal rotation ( P < .001 for both). Medial-to-lateral graft integrity was good in all patients. Nonunion at the fitting zone of the keyhole on the greater tuberosity was diagnosed in 1 case (3.1%), and failure of incorporation between the allograft and remnant tendon at the site of posterior margin convergence was observed in 4 cases (12.5%). Conclusion: The outcomes after SCR using an Achilles tendon–bone allograft and the keyhole technique improved, with an increased AHI and excellent integrity in the medial and lateral directions compared with preoperatively. This technique is a reasonable option for the surgical treatment of irreparable rotator cuff tears.
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