The uteroplacental circulation in the placenta can have a major impact on the fetus. Near infrared spectroscopy (NIRS) is the noninvasive method of measuring changes in blood volumes and oxygen concentrations in living tissue. The purpose of this study is to monitor changes in placental tissue oxygen index (TOI) levels, in patients with intrauterine fetal growth restriction during pregnancy, using NIRS. We measured placental TOI values of 15 normal pregnant woman and 15 patients with intrauterine growth restriction admitted to our hospital. The placenta was assessed by ultrasound examination and NIRS was performed on all patients. The TOI values of the IUGR group when hospitalized was 78.6 +/- 1.6 (SD). This value was significantly higher than that of the controls (78.6 +/- 1.6 [SD] versus 70.2 +/- 0.4 [SD]). And the TOI values of the IUGR group, when measured before delivery, were 77.8 +/- 1.6 (SD). The TOI values of the IUGR group before delivery were significantly higher than those of the control group (77.8 +/- 1.6 [SD] versus 70.3 +/- 0.4 [SD]). We propose that NIRS is a candidate, noninvasive method for assessing placental oxygen dynamics on a real-time basis. In the near future it may contribute to perinatal medical practice.

Background: Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique. Hypothesis: This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair. Study Design: Case series; Level of evidence, 4. Methods: The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up. Results: This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery ( P < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups. Conclusion: The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. Purpose/Hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years’ follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: –17° to 0°; group 2: –18° to −6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. Conclusion: No differences were observed in clinical and radiographic outcomes between patients underoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years’ follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

Background: Superior labral anterior-posterior (SLAP) lesions are common among elite gymnasts and throwing athletes. Although SLAP lesions in throwers are well-described in the literature, no study has described the characteristics of SLAP lesions in gymnasts. We aimed to reveal the characteristics of SLAP lesions in gymnasts by comparing the location and extension of these lesions between gymnasts and throwers. Hypothesis: The location and arc of SLAP lesions in gymnasts will be different from those in throwing athletes. Study Design: Case series; Level of evidence, 4. Methods: This study included 27 shoulders in 20 males and 3 females with a mean ± SD age of 20 ± 2.5 years (range, 16-25 years). We performed debridement alone for shoulders with a stable lesion. Anterior and/or posterior labral repair was added for unstable SLAP lesions depending on the extension and stability of the lesions. We investigated symptoms, onset, return to sport (based on patient records), and subjective shoulder values. SLAP lesions were evaluated through use of the Snyder classification. The location and arc of SLAP lesions were determined from surgical records and videos and described by use of the right shoulder clockface method. During the same period, 65 baseball players (65 shoulders; all males; mean age, 23 ± 7.0 years; range, 16-44 years) underwent arthroscopic SLAP surgery. We compared the location and arc of SLAP lesions between gymnasts and baseball players. Results: Symptoms during gymnastics included pain (100%), apprehension (48%), or catching (11%). We found that 20 shoulders had symptom onset during gymnastics, most commonly during rings events. Type II SLAP lesions were found in 17 shoulders, type III in 2 shoulders, and type IV in 8 shoulders. The mean center of SLAP lesions was at the 11:40 clockface position in 27 gymnasts and 10:40 clockface position in 65 baseball players, and the difference was statistically significant ( P < .001). The mean arc of SLAP lesions was 125° in gymnasts and 140° in baseball players, and the difference was not significant. We performed debridement in 2 shoulders (7%) and labral repair in 25 shoulders (93%). After surgery, all patients returned to gymnastics. The mean subjective shoulder value was 35 (range, 10-90) preoperatively and 76 (range, 40-100) postoperatively. Conclusion: SLAP lesions in gymnasts were significantly located anteriorly compared with those in baseball players. All patients returned to gymnastics after arthroscopic surgery. Secure repair of SLAP lesions may be important for good surgical outcomes, because 50% of patients experienced preoperative shoulder apprehension.

Background Degenerative greater tuberosity (GT) changes are often associated with rotator cuff tears. However, little is known about the impact of GT morphology on surgical outcomes. The aim of this study was to examine the relationship between clinical and radiological outcomes, after rotator cuff repair, and GT morphology. Methods We retrospectively investigated shoulders that underwent arthroscopic repair of nontraumatic full-thickness supra-/infraspinatus tears. The exclusion criteria were a lack of either radiographs or magnetic resonance images, revision surgery, partial repair, complications such as infection or dislocation, and follow-up < 2 years. GT morphology on radiographs was classified into 5 groups: normal, sclerosis, bone spur, roughness, and femoralization. The acromiohumeral interval (AHI) was measured on anteroposterior radiographs. Fatty degeneration of the cuff muscles was evaluated using the global fatty degeneration index (GFDI). Postoperative cuff integrity was classified using Sugaya's classification at 2 years after surgery. Clinical outcomes were assessed preoperatively and at postoperative 2 years with the Japanese Orthopaedic Association score and the University of California, Los Angeles shoulder rating scale. Results The study included 220 shoulders in 212 patients (104 men and 108 women), with a mean age of 66 years (range 43-85). The mean follow-up period was 28 months (range, 24-60 months). Seven shoulders (3.2%) were classified as normal, 65 (29.5%) as sclerosis, 55 (25.0%) as bone spur, 78 (34.5%) as roughness, and 15 (6.8%) as femoralization. The preoperative AHI, in the roughness and femoralization groups, was significantly smaller than that in the sclerosis ( P < .01) and bone spur groups ( P < .001). The roughness and femoralization groups had a greater number of large tears ( P = .006). In the roughness and femoralization groups, mean GFDI was significantly higher than that in the sclerosis group ( P < .001 for both). Repaired cuff integrity was not different between all groups, respectively. Both Japanese Orthopaedic Association and University of California, Los Angeles scores improved postoperatively from 73.3 to 95.6 points and 18.2 to 34.0 points ( P < .001 for both), respectively, and there were no significant differences between all groups, respectively. Conclusion Roughness or femoralization of the GT was related to larger tears, with smaller AHI and higher GFDI. Repaired cuff integrity and clinical outcomes in shoulders with roughness or femoralization of the GT were not inferior to shoulders with the other types of GT morphologies in this study. Arthroscopic repair can be indicated for shoulders with advanced changes of the GT, if fatty degeneration of the cuff muscles is not severe.

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Objectives: Recently suture bridging technique has become the most popular footprint reconstruction procedure, and many surgeons prefer to perform lateral row fixation after tying the medial-row suture. According to some authors, strangulation caused by medial-row knot can lead to re-tear at the muscle-tendon junction, which is called type II failure. They have reported type II failure occurred 59˜74% in re-tear cases with conventional suture bridging. In order to avoid stress concentration on the medial-row, we prefer to use triple-loaded suture anchors for the medial-row, and perform lateral-row fixation of suture bridging before tying medial-row suture. This is a procedure in which we reduce the cuff to the tuberosity first, then press down the cuff to the footprint by tying the remaining suture. The purpose of this study was to assess the functional outcomes and structural integrity after our suture bridging technique. Methods: From April 2012 to May 2015, a consecutive series of 373 patients (4 bilateral cases) with complete rotator cuff tear were performed arthroscopic rotator cuff repair in our hospital. There were 90 small, 135 medium, 117 large, and 35 massive tears according to Cofield classification. Functional outcomes were assessed using JOA and UCLA score preoperatively and at final follow-up which was 29 months on average after surgery. Repair integrity was evaluated with MRI performed at a mean of 14 months after surgery and was graded using Sugaya classification. In addition, re-tear was divided into 2 groups. Type I failure is detachment from the footprint (group F1). Type II failure is muscle-tendon junction failure (group F2). We also investigated the relationship between clinical outcomes and repair integrity/tear pattern. Statistical analysis was performed using paired t test for comparing clinical outcomes and one-factor ANOVA/Tukey-Kramer test or Kruskal-Wallis test/Steel Dwass test to compare difference between the groups. Results: Regarding clinical outcomes, both JOA and UCLA scores have significantly improved overall from 72 to 95 and 18 to 34, respectively (P <0.0001). Postoperative MRI demonstrated successful repair in 318 shoulders (84.4%: group S) and re-tear (Sugaya type IV and V) in 59 shoulders (15.6%). There were 16 re-tears (7.1%) in small to medium tears and 43 re-tears in large and massive tears (28.3%). Among 59 re-tears, 39 shoulders (66%) were type I failures (group F1) and 20 shoulders (34%) were type II failures (group F2). Postoperative JOA score was significantly improved in both successful and failed repairs: 72 to 95 in group S, 72 to 94 in group F1 and 70 to 91 in group F2 (P <0.0001). Although preoperative scores demonstrated no significant difference between 3 groups, postoperative scores were significantly different between group S and group F2 (P=0.0008) and group F1 and group F2 (P=0.027). Similarly, postoperative UCLA score in group F2 was also significantly inferior to group S (p=0.0008) and group F1 (P =0.036). Conclusion: Our suture bridging technique abbreviating medial-row knot tying demonstrated excellent functional outcomes and structural integrity after surgery. In addition, rate of muscle-tendon junction failure, which proved to be functionally deteriorated compared with type I failure, was obviously lower when compared with previous reports with conventional suture bridging.