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Retrospective cohort study, Level IV.

Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction.

Study Design:Abstract consensus paper with systematic literature review.Objective:The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts.Methods:The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences.Results:As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers.Conclusion:Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

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Objectives: Lateral clavicle fractures have been reported following coracoclavicular (CC) ligament reconstruction with bone tunnels through the clavicle. Several techniques for CC reconstruction with different drill-hole measurements have been described. Our objective was to evaluate clavicle weakening related to tunnel diameters for common CC-reconstruction techniques. Methods: Testing was performed on 2 groups of 18 matched pair clavicles, which were randomly distributed between groups. There were no significant differences between the groups regarding bone mess density (BMD), clavicle width, age, and gender. One clavicle from each pair was prepared according to one of two reconstruction techniques; the contralateral clavicle was left intact. Both techniques placed 2 tunnels through the medial clavicle, 30 mm and 45 mm from the lateral border. Group 1 (mean age: 53, range: 44-63; mean BMD: 0.48, range: 0.39-0.59) was prepared with 2.4 mm tunnels and augmentation devices. Group 2 (mean age: 56, range: 45-63; mean BMD: 0.47, range 0.35-0.61) was prepared with 6.0 mm tunnels with hamstring grafts and tenodesis screws. A 3-point bending load was applied to the distal clavicles at 15 mm/min until failure. Ultimate failure load and anteriorposterior width 45 mm medial from the lateral border were recorded for each specimen. Strength reduction was determined as the percent reduction in ultimate failure load between paired intact and surgically prepared clavicles. Relative tunnel size was determined as the quotient of tunnel diameter and clavicle width. An independent observer performed all clavicle width measurements. Non-parametric statistics were used (MWU, Kendall's Tau). Results: The 6.0 mm technique significantly reduced clavicle strength relative to intact (p = 0.02) and caused significantly more strength reduction than the 2.4 mm technique (p = 0.02) (Figure). The 2.4 mm technique was not significantly different from intact. All but one fractures occurred at the medial tunnel. Clavicle width at the medial hole varied highly (mean: 18.1 mm, range: 12.3 -27.1 mm). There was a significant approximately linear correlation between clavicle width and strength reduction (p = 0.04, tau = -0.36) and between relative tunnel size and strength reduction (p < 0.01, tau = 0.51). Therefore, clavicle strength reductions of 30% and 50% relative to the intact state can be expected with relative tunnel diameters of 34.5% and 49.8% of the clavicle width, respectively. The intraobserver correlation coefficient of the width measurement was excellent (0.99; 95% CI: 0.98 -0.99). Conclusion: Coracoclavicular ligamentous reconstruction with 6.0 mm tunnels, graft, and tenodesis screws caused significantly greater decreases in the strength of the clavicle when compared to 2.4 mm tunnels with augementation devices and undrilled controls. Additionally, strength reductions correlated highly with the ratio of tunnel width relative to overall clavicle width. This information can help optimize techniques for reconstructing unstable distal clav...

Background:Several meta-analyses of randomized clinical trials have been performed to analyze whether double-row (DR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing compared to single-row (SR) repair. The purpose of this study was to sum up the results of meta-analysis comparing SR and DR repair with respect on clinical outcomes and re-tear rates.Methods:A literature search was undertaken to identify all meta-analyses dealing with randomized controlled trials comparing clinical und structural outcomes after SR versus DR RCR.Results:Eight meta-analyses met the eligibility criteria: two including Level I studies only, five including both Level I and Level II studies, and one including additional Level III studies. Four meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas four favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas six found DR repair to be superior for tears greater than 3 cm tears.Conclusion:No clinical differences are seen between single-row and double-row repair for small and medium rotator cuff tears after a short-term follow-up period with a higher re-tear rate following single-row repairs. There seems to be a trend to superior results with double-row repair in large to massive tear sizes.

This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols implemented when such repair techniques are used.