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BACKGROUND: Numerous techniques have been used to treat acromioclavicular (AC) joint dislocation, with anatomic reconstruction of the coracoclavicular (CC) ligaments becoming a popular method of fixation. Anatomic CC ligament reconstruction is commonly performed with cortical fixation buttons (CFBs) or tendon grafts (TGs). PURPOSE: To report and compare short-term complications associated with AC joint stabilization procedures using CFBs or TGs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We conducted a retrospective review of the operative treatment of AC joint injuries between April 2007 and January 2013 at 2 institutions. Thirty-eight patients who had undergone a procedure for AC joint instability were evaluated. In these 38 patients with a mean age of 36.2 years, 18 shoulders underwent fixation using the CFB technique and 20 shoulders underwent reconstruction using the TG technique. RESULTS: The overall complication rate was 42.1% (16/38). There were 11 complications in the 18 patients in the CFB group (61.1%), including 7 construct failures resulting in a loss of reduction. The most common mode of failure was suture breakage (n = 3), followed by button migration (n = 2) and coracoid fracture (n = 2). There were 5 complications in the TG group (25%), including 3 cases of asymptomatic subluxation, 1 symptomatic suture granuloma, and 1 superficial infection. There were no instances of construct failure seen in TG fixations. CFB fixation was found to have a statistically significant increase in complications (P = .0243) and construct failure (P = .002) compared with TG fixation. CONCLUSION: CFB fixation was associated with a higher rate of failure and higher rate of early complications when compared with TG fixation.

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BACKGROUND: Complete repair of massive rotator cuff tears can be limited by tendon retraction and poor tissue quality. When a complete repair cannot be accomplished, a significant partial repair may be possible. HYPOTHESIS: A partial repair will yield comparable outcomes to complete repair of massive rotator cuff tears in this specific patient population. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All consecutive arthroscopic rotator cuff repairs done at the authors' institution over a 2-year period were identified. A retrospective chart review was performed. Inclusion criteria required that each patient have a massive rotator cuff tear (30 cm(2) or greater). Patients were categorized as either partial or complete repair. The University of California, Los Angeles (UCLA) shoulder scores were used to measure patient outcomes at an average follow-up of 24 months (10-40 months). RESULTS: Of 1128 consecutive arthroscopic rotator cuff repairs, 97 (9%) patients were noted intraoperatively to have massive tears measuring 30 cm(2) or greater. Complete repair was achieved in 52 patients, whereas partial repair was possible in 45 patients. Eleven patients were lost to follow-up. The 41 remaining patients with only partial repair achieved a postoperative mean UCLA score of 29.49, and the 45 patients with complete repair achieved a mean UCLA score of 29.64, yielding significant improvement in both the partial repair group (P = .0001) and the complete repair group (P = .0001) compared with preoperative UCLA scores. However, no statistically significant differences in postoperative outcomes were noted when the 2 groups were compared with one another (P = .89). CONCLUSION: Partial repair of massive rotator cuff tears yielded outcomes comparable with complete repair of massive tears.

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BACKGROUND: There are many techniques described to repair acute distal biceps tendon ruptures. The authors' objective is to report the results of a single-incision technique using a combination of a soft tissue button and biotenodesis interference screw with accelerated rehabilitation. HYPOTHESIS: Dual fixation of a distal biceps rupture will allow for early return to function. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From February 2004 to July 2007, 41 elbows in 40 patients had repair of an acute distal biceps tendon rupture (<6 weeks) through an anterior incision using a soft tissue button and interference screw combined technique. The patients were evaluated pre- and postoperatively with a physical examination, radiographs, and the Andrews-Carson elbow score. Nine patients were unavailable for follow-up. The remaining 31 patients (32 elbows) were contacted for a telephone interview at an average of 24 months postoperatively. RESULTS: The preoperative Andrews-Carson score averaged 168 and the postoperative Andrews-Carson score averaged 196 points at final clinical follow-up. There was a statistically significant difference between the pre- and postoperative Andrews-Carson scores (P < .001). One patient had heterotopic ossification associated with decreased pronation and supination. Two superficial radial nerve palsies completely resolved by final follow-up. The average postoperative time to resume normal activities or return to work was 6.5 weeks. CONCLUSION: Repair of acute distal biceps tendon ruptures using a soft tissue button and interference screw technique through a limited anterior incision can allow for accelerated rehabilitation and early return to function.

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PURPOSE: The purpose of this study was to evaluate the effectiveness of arthroscopic posterior shoulder reconstruction. METHODS: We treated 136 shoulders in 131 patients with a diagnosis of primary posterior instability who failed 6 months of vigorous rehabilitation by operative stabilization between 1989 and 2001. Inclusion criterion was primary posterior instability that failed an extensive rehabilitative program with functional impairment and pain. Exclusion criterion was less than 12 months of follow-up and Suretac (Smith & Nephew, Andover, MA) or laser stabilization, leaving 92 shoulders in 90 patients available for the study (69 male, 21 female). Follow-up ranged from 12 to 132 months (average, 28 months). Each patient underwent diagnostic arthroscopy and surgical repair at the same time using one of several primary procedures. The procedure used was based on the pathologic entity noted at the time of surgery. RESULTS: At an average follow-up of 28 months, 97% of the shoulders were stable and considered a success based on the Neer-Foster rating scale. Posterior pathology varied, and a reverse Bankart lesion alone was found 51% of the time, a stretched posterior capsule 67% of the time, and a combination of a reverse Bankart lesion and capsular stretching 16% of the time. The rotator interval was obviously damaged in 61% of cases. Multiple accompanying lesions were found, including anterior-superior labral tears and SLAP tears (20%), superior glenohumeral ligament injury (7%), middle glenohumeral ligament injury (38%), anteroinferior glenohumaral ligament injury (37%), and an enlarged axillary pouch (20%). CONCLUSIONS: No essential lesion is present for posterior instability. Multiple varied pathologies will be present in a shoulder presenting with posterior instability. Arthroscopic surgery allows inspection of the joint and anatomic-specific repairs based on pathology. Careful attention to all the supporting structures of the shoulder, including the rotator interval, the anterior-superior labrum, and its attached superior glenohumeral ligament, the coracohumeral ligament, the inferior glenohumeral ligament complex, and the infraspinatus, in addition to the posterior labrum and capsule, allows excellent outcomes to be achieved with arthroscopic posterior reconstruction techniques. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

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BACKGROUND: Little data exist regarding the treatment of young high school and college athletes with medial ulnar collateral ligament insufficiency of the elbow. It would be logical to assume that younger patients would have less damage to the ligament, allowing the possibility of repair. HYPOTHESIS: Many young athletes with injuries to the medial ulnar collateral ligament have proximal or distal injuries that may be amenable to repair, indicating that graft reconstruction may not always be necessary to obtain satisfactory results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Sixty patients who had direct repair of the medial ulnar collateral ligament were retrospectively evaluated using the Andrews and Carson elbow score. All patients had symptomatic instability that precluded them from participation in their desired sports, all failed a nonoperative treatment program, and all had comparative stress radiographs, magnetic resonance images, or computerized tomograms with contrast studies that had positive findings for insufficiency of the ligament. RESULTS: The mean age of the 47 male and 13 female patients was 17.2 years. The mean follow-up was 59.2 months. All patients underwent medial ulnar collateral ligament repair by one of the following procedures: suture plication with repair to bone drill holes (n = 9) or suture repair to bone using anchors (n = 51). The mean overall preoperative Andrews-Carson outcome score of 132 improved to 188 postoperatively (P < .0001). Good-to-excellent overall results were obtained in 93% of patients. Fifty-eight of the 60 patients were able to return to sports within 6 months of the surgery at the same or higher level as before the injury. There were 4 failures, 2 early and 2 late (after return to play for 5 and 6 years of unrestricted play, respectively). Three patients sustained a complication of transient postoperative ulnar neuropathy symptoms that resolved spontaneously. CONCLUSION: Primary repair of proximal and distal injuries of the medial ulnar collateral ligament is a viable alternative in the non-professional athlete. Graft reconstructions may not be necessary to obtain favorable outcomes and rapid return to sports in non-professional athletes who require surgical intervention for medial elbow instability.

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Many procedures have been described for treating lateral epicondylitis with good success. The purpose of this report is to compare 3 operative methods for treatment of recalcitrant lateral epicondylitis-open, arthroscopic, and percutaneous. All patients with lateral epicondylitis who were operated on over a 7-year period were retrospectively reviewed. A minimum of 3 months of conservative care before surgery had failed in these patients, and they had a minimum of 2 years of follow-up. Concomitant pathology, complications, and necessary further care were noted. The outcomes were evaluated preoperatively and postoperatively with the Andrews-Carson score and visual analog scale scores for pain at rest, worst pain, and pain with activity. We included 109 patients in the study: 24 percutaneous, 44 arthroscopic, and 41 open procedures. The mean duration of conservative care was 13.2 months, including 2.5 conservative measures and 1.35 cortisone injections. The mean follow-up was 47.8 months. The preoperative Andrews-Carson score was 160.3. The postoperative Andrews-Carson score was 195. There was a statistically significant difference between preoperative and postoperative Andrews-Carson scores for each of the groups. There were no significant differences among the populations regarding age, gender, dominance, conservative measures used, cortisone injections, recurrences, complications, failures, visual analog scale scores, and preoperative and postoperative Andrews-Carson scores. In addition, no difference in outcome scores was noted when intraarticular and concomitant pathology was addressed in comparison to the population in which tendinosis alone was addressed. Open, arthroscopic, and percutaneous treatments of lateral epicondylitis offer 3 highly effective ways for the clinician to address this common clinical problem.

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PURPOSE: To retrospectively compare patients who received radial head excision for early, isolated radiocapitellar arthritis with those who had delayed surgery for the same problem in order to analyze risk factors for progression of the arthritis. Isolation of risk factors for progression should allow guidelines for early excision and perhaps prevent progression to panarticular arthritis. TYPE OF STUDY: Retrospective analysis of a group of patients with radiocapitellar arthritis. METHODS: From 1995 to 2001, 36 consecutive patients with arthritic damage to the radiocapitellar joint were treated with arthroscopic debridement and radial head excision. Twenty-eight of the 36 underwent concurrent arthroscopic modification of the Outerbridge-Kashiwagi procedure because of the additional presence of ulnohumeral arthritis. All patients were re-examined 18 to 91 months (mean, 52 months) after the procedure and evaluated using the Andrews-Carson (A-C) elbow rating system. RESULTS: In patients who underwent radial head excision alone, flexion increased 29 degrees, extension 38 degrees, with an increase in total arc of motion of 62 degrees. In patients who underwent radial head excision and ulnohumeral arthroplasty, postoperative flexion increased 19 degrees, extension 27 degrees, with an increase in total arc of motion of 46 degrees. The difference between the 2 groups of patients was significant (P = .002). The average preoperative A-C score for patients undergoing radial head excision alone was 72 and the average postoperative score was 170. The average preoperative score for patients undergoing radial head excision and ulnohumeral arthroplasty was 92 and the average postoperative score was 150. Two patients who underwent the combined procedure had to return to surgery: 1 for a contracture release and 1 for radial head replacement secondary to intractable pain. They both did well subsequently. CONCLUSIONS: Patients undergoing radial head excision alone increased their average A-C score almost 100 points. Those undergoing both procedures increased their score an average of 58 points. In addition, those undergoing only radial head excision had a 20-point higher average overall postoperative A-C rating than those undergoing both procedures. Patients who underwent radial head excision alone had a greater return of range of motion and fewer postoperative complications than those who underwent the combined procedure. LEVEL OF EVIDENCE: Level IV.

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