To determine the clinical outcomes of arthroscopic stabilization of patients with anterior glenohumeral instability using knotless devices made from 4 different materials. A prospective cohort study was performed on patients who had an arthroscopic anterior shoulder stabilization for unidirectional anterior instability by a single surgeon using one of 4 devices: Suretac resorbable tac made of PGA (n=41), BioKnotless resorbable suture anchor made of PLLA (n=52), the OPUS Labrafix knotless anchor made from stainless steel (n=18), and the Pushloc knotless anchor made from PEEK (n=44). Standardized patient-determined and examiner-determined outcomes were obtained before operation and 6, 12, 24 weeks, and up to 10-year follow-up. Kaplan-Meier analysis for redislocation showed a fall in survival curves from 1 year (90% stable) to 3 years (40% stable) in the Suretac group then a plateau to 10 years; and a fall in stability survivorship for the Bioknotless group from 1 year (90% stable) to 5 years (60% stable). Survivorship curves for the 2 nonresorbable anchors were more encouraging with over 90% stable out to 3 years (Pushloc) and 4 years (Labrafix) (P<0.001). Arthroscopic stabilization for traumatic anterior instability leads to excellent outcomes when using nonresorbable knotless devices (6% and 5% recurrence at 3 to 5 y). The resorbable suture anchors and tacs in this study showed a higher recurrence rate (40% and 60%, respectively) at 5 years.
The major unexplained phenomenon in fibrotic conditions is an increase in replicating fibroblasts. In this report we present evidence that oxygen free radicals can both stimulate and inhibit proliferation of cultured human fibroblasts, and that fibroblasts themselves release superoxide (O2.-) free radicals. Fibroblasts released O2.- in concentrations which stimulated proliferation, a finding confirmed by a dose-dependent inhibition of proliferation by free radical scavengers. Oxygen free radicals released by a host of agents may thus provide a very fast, specific and sensitive trigger for fibroblast proliferation. Prolonged stimulation may result in fibrosis, and agents which inhibit free radical release may have a role in the prevention of fibrosis.
Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.
Background: Taping of the shoulder is common in many sports, particularly Australian football, a contact sport that often involves marking (catching) the ball overhead and has a high incidence of shoulder instability. Hypothesis: Taping of the shoulder reduces glenohumeral joint laxity and improves proprioception without impairing function. Study design: Crossover study design. Methods: 33 male players aged 18–31 years were recruited from a local Australian football club. The dominant shoulder of each player was tested with and without taping in a randomised fashion by an examiner blinded to the presence or absence of taping. The tests were (1) inferior glenohumeral joint laxity (the Orthopaedic Research Institute laxometer), (2) shoulder joint position sense accuracy using an optical tracking system, and (3) handballing accuracy. Results: The methods for testing laxity and joint position sense had good intraobserver reliability and sensitivity. All subjects tolerated the taping and testing. Glenohumeral joint laxity (p = 0.75), joint position sense (p = 0.56) and handballing accuracy (p = 0.6) were not changed by taping. Conclusions: Taping of the shoulder joint in uninjured and non-symptomatic Australian football players in a pattern that attempted not to restrict their range of overhead movement did not significantly affect the accuracy of joint position sense, inferior laxity or handball accuracy. Clinical relevance: These data suggest that taping of the shoulder is unlikely to decrease the incidence of injury—specifically dislocation—of the shoulder in Australian football players.
Randomized, prospective, double-blind, placebo-controlled clinical trial.To determine the effects of applying a force to C5 of the spine by a mechanically assisted instrument (MAI) in patients with referred shoulder pain.Manipulating C5 of the spine is a chiropractic treatment for referred shoulder pain; there are no clinical trials evaluating its efficacy. Outcome measures were patient ranked questionnaires and independent examiner findings. One hundred and twenty-five patients were diagnosed with referred shoulder pain of cervical origin; 65 patients were in the treatment cohort and 60 patients in the placebo cohort.This was a prospective, randomized, double-blind, placebo-controlled trial assessing the effects of applying a force to C5 by a MAI to patients with referred shoulder pain. The treatment cohort had the MAI set at the maximum setting to transmit a force into the spine; the placebo cohort had the MAI turned off. Primary outcome measures were frequency and severity of extreme shoulder pain obtained via a patient-reported questionnaire; secondary outcome measures were patient ranked pain and functional outcomes as well as examiner assessed range of motion and strength. Assessment procedures were completed at 24 weeks posttreatment and data were analyzed with intent-to-treat protocol.There was a reduction in the frequency but not severity of extreme shoulder pain in the treatment cohort, average ranking reducing from weekly to monthly (P < 0.05). Patients treated with the MAI had 10 N (P = 0.04) better internal rotation strength after 6 months posttreatment. No differences with any other outcome measures between the two cohorts at the 24-week study period.The major effect of applying a MAI to the level of C5 of the spine in referred shoulder pain is improved shoulder strength for internal rotation in this randomized double-blinded clinical trial.2.
Introduction Rotator cuff tendons are typically reattached to the proximal humerus using transosseous sutures or suture anchors. Their primary mode of failure is at the tendon–bone interface. Methods We investigated the addition of an adhesive, gelatin–resorcin–formalin (GRF) glue, to a single-row rotator cuff repair (RCR) on ex vivo sheep models. We hypothesised the addition of GRF glue would increase the repair construct strength. The study consisted of three groups of six sheep infraspinatus tendons with an inverted-mattress stitch, tension-band configuration. Group 1 was the control group where no glue was applied. Group 2 involved applying 2 × 2 cm of GRF glue to the infraspinatus footprint and a 2-min curing time. Group 3 allowed for a 15-min cure time. Results Failure occurred at the tendon–bone–suture interface in 6/6 of the control group, and 4/6 from groups 2 and 3. Failure occurred via the suture pulling out of the anchor in 2/6 of groups 2 and 3. No significant differences were noted between all three groups in ultimate failure load, repair stiffness or total energy to failure (p > 0.05). Discussion The addition of GRF glue to the tendon–bone–suture interface did not enhance RCR strength in an ovine model.
Being able to get away from everyday stressors and demands, even if close to home and just for a few minutes, is important for wellbeing. During the Covid-19 lockdown periods, people's ability to get away changed significantly. An increase in visits to nearby natural places is well documented. Little is known about other types of places people visited to get away. An online UK survey was conducted in 2020 (N = 850) investigating what places people visited to get away during the pandemic, what they did in those places, how place and activity choices were related to each other and to demographic variables, and to recalled hedonic and eudaimonic wellbeing during those visits. Participants visited a rich array of places and engaged in a variety of activities that supported their hedonic and eudaimonic wellbeing needs. Responses were grouped into four types of places (at home outdoors, at home indoors, away from home outdoors, and away from home indoors) and seven activity types (cognitive, walks, nature engagement, social activities, technology use, relaxing, and exercise). Place and activity choices were strongly linked. Visiting outdoor places was most beneficial for wellbeing (and most common), especially when it involved mindful engagement with nature (bird watching, gardening) or exercise. Staying indoors, engaging with technologies (computers, television) was least beneficial and more common among those with no degree or job, living in urban areas, and identifying as male. The findings demonstrate the importance of understanding place-activity interactions to support the wellbeing benefits derived from visits to places to get away.
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