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Rotator cuff repair in patients over 70 years of age 

Bone Joint J 2013;95-B:199–205.

P. M. Robinson, MBChB(Hons), BMedSci, MRCS(Eng), Specialty Registrar Trauma and Orthopaedics
J. Wilson, MRCSEd, MSc, Specialty Registrar Trauma and Orthopaedics
S. Dalal, FRCSEd(Tr & Orth), Consultant Orthopaedic Surgeon
R. A. Parker, BSc, MSc, Medical Statistician
P. Norburn, MBChB, MRCP, FRCR, Consultant Radiologist and
B. R. Roy, MSc (Bioeng), FRCS(Tr & Orth), DMI, Consultant Orthopaedic Surgeon

This study reports the clinical and sonographic outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years and aimed to determine factors associated with re-tear. A total of 69 consecutive repairs were performed in 68 patients with a mean age of 77 years (70 to 86). Constant-Murley scores were collected pre-operatively and at one year post-operatively. The integrity of the repair was assessed using ultrasound. Re-tear was detected in 20 of 62 patients (32%) assessed with ultrasound. Age at operation was significantly associated with re-tear free survival (p = 0.016). The mean pre-operative Constant score was 23 (sd 14), which increased to 58 (sd 20) at one year post-operatively (paired t-test, p < 0.001). Male gender was significantly associated with a higher score at one year (p = 0.019).

We conclude that arthroscopic rotator cuff repair in patients aged ≥ 70 years is a successful procedure. The gender and age of the patient are important factors to consider when planning management.


Anatomical and Functional Results After Arthroscopic Hill-Sachs Remplissage

Pascal Boileau, MD; Kieran O'Shea, MD; Pablo Vargas, MD; Miguel Pinedo, MD; Jason Old, FRCSC; Matthias Zumstein, MD
The Journal of Bone & Joint Surgery.  2012; 94:618-626  doi:10.2106/JBJS.K.00101


Large osseous defects of the posterosuperior aspect of the humeral head can engage the glenoid rim and cause recurrent instability after arthroscopic Bankart repair for glenohumeral dislocation. Filling of the humeral head defect with the posterior aspect of the capsule and the infraspinatus tendon (i.e., Hill-Sachs remplissage) has recently been proposed as an additional arthroscopic procedure. Our hypothesis is that the capsulotenodesis heals in the humeral bone defect without a severe adverse effect on shoulder mobility, allowing return to preinjury sports activity.


Of 459 patients operated on for recurrent traumatic anterior shoulder instability, forty-seven (10.2%) underwent arthroscopic Bankart repair combined with Hill-Sachs remplissage with use of suture anchors. All had a large Hill-Sachs lesion (Calandra grade III), engaging over the glenoid rim, without substantial glenoid bone loss. Nine patients had had prior unsuccessful surgery to address glenohumeral instability (three Bankart and six Bristow-Latarjet procedures). The average age at the time of surgery (and standard deviation) was 29 ± 5.4 years. Postoperatively, comparative shoulder motion was precisely measured with use of digital photographic images. Capsulotenodesis healing was assessed on a computed tomography (CT) arthrogram (n = 38) or magnetic resonance image (MRI) (n = 4). The mean duration of follow-up was twenty-four months.


Healing of the posterior aspect of the capsule and the infraspinatus tendon into the humeral defect was observed in all forty-two patients who underwent postoperative imaging, and thirty-one (74%) had a remplissage of ≥75%. Compared with the normal (contralateral) side, the mean deficit in external rotation was 8° ± 7° with the arm at the side of the trunk and 9° ± 7° in abduction at the time of the last follow-up. Of forty-one patients involved in sports, thirty-seven (90%) were able to return postoperatively and twenty-eight (68%) returned to the same level of sports, including those involving overhead activities. Ninety-eight percent (forty-six) of the forty-seven patients had a stable shoulder at the time of the last follow-up.


Arthroscopic Hill-Sachs remplissage, performed in combination with a Bankart repair, is a potential solution for patients with a large engaging humeral head bone defect but no substantial glenoid bone loss. The posterior capsulotenodesis heals predictably in the humeral defect. The slight restriction in external rotation (approximately 10°) does not significantly affect return to sports, including those involving overhead activities. The procedure, which may also be useful for revision of previous failed glenohumeral instability surgery, is not indicated for patients with glenoid bone deficiency.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Outcomes of arthroscopic rotator cuff repairs in obese patients

William J. Warrender, BS, Ouida L. Brown, MD, Joseph A. Abboud,

Journal of Shoulder and Elbow Surgery
Volume 20, Issue 6 , Pages 961-967, September 2011


Rotator cuff tears are common orthopedic injuries and their arthroscopic treatment can be technically challenging. This study evaluated the outcomes of arthroscopic rotator cuff repairs in obese patients. We hypothesized that there would be a direct correlation between worse outcomes of arthroscopic rotator cuff repairs and increasing body mass index (BMI).

Materials and methods

A retrospective review of patients undergoing arthroscopic rotator cuff repair by one orthopedic surgeon between 2005 and 2008 was performed. The study included 149 rotator cuff repairs. Recorded data included age, sex, BMI, size of rotator cuff tear on magnetic resonance imaging and intraoperatively, number of anchors used for repair, functional outcomes (American Shoulder and Elbow Surgeons and University of Pennsylvania scores), surgery time, total time for anesthesia, positioning, and hospital stay. Tears were classified by size. Strict inclusion and exclusion criteria were used. Surgical procedures were performed with general anesthesia, interscalene block, beach chair positioning, and a standardized operative technique. Patients followed a standard postoperative rehabilitation protocol.


Mean patient age was 66 years. Mean follow-up was 16.3 months. Tears were classified as high grade partial (12%), small (23%), medium (29%), large (22%), and massive (14%). Patients were classified as normal weight (38%), overweight (23%), obese (20%), and morbidly obese (19%). A statistically significant correlation was found between obesity and worse functional outcomes, longer operative times, and longer length of hospital stay.


This study reports new data concerning the association of BMI and early clinical outcome after arthroscopic rotator cuff repair surgery. Even though the obese group had greater limiations and lower rates of satisfaction at final follow-up than their non-obese counterparts, they still reported significant improvements from the surgery.


Obesity has a negative impact on the operative time of arthroscopic rotator cuff repairs, length of hospitalization, and functional outcomes.


Charles Sumner Neer II 10 November 1917–28 February 2011

Volume 20, Issue 4, Page 517 (June 2011), Journal of Shoulder and Elbow Surgery

Louis U. Bigliani, MD

Charles Sumner Neer II (Fig. 1), son of pioneer Oklahoma Territory surgeon Charles S. Neer and Pearl Brooke Neer, was born and raised in Vinita, Oklahoma. A graduate of Dartmouth College and the University of Pennsylvania Medical School, his residency training years were interrupted by military service in World War II as an orthopaedic surgeon. He served in 3 theaters as a Captain in the Army. Following the war he returned to Columbia-Presbyterian Medical Center in New York to complete his training and join the Orthopaedic Service of the Presbyterian Hospital and faculty of the College of Physicians & Surgeons of Columbia University. He eventually became Chief of both the Fracture Service and the Adult Reconstructive Service. It was a relationship that endured for 50 years. Until his passing, Dr. Neer continued as Emeritus Consultant in Orthopaedic Surgery and Emeritus Professor & Special Lecturer in Clinical Orthopaedic Surgery.

Throughout his brilliant career he was a highly-valued member of his profession receiving many honors both nationally and internationally, especially for his contributions in shoulder surgery and reconstruction. He served as a representative on the American Board of Orthopaedic Surgery, a position for which he earned the Board’s Distinguished Service Award. Dr. Neer was Founding President of the American Shoulder & Elbow Surgeons, Founding Chairman of the Board of Trustees of the Journal of Shoulder and Elbow Surgery, and founding Chairman of the International Board of Shoulder and Elbow Surgery.

Dr. Neer was a creative and innovative surgeon and developed surgical techniques and prostheses that advanced the art of shoulder surgery. A Neer prosthesis is on permanent display at the Smithsonian Institute. He was a prolific writer authoring many definitive articles on topics including displaced humeral fractures, subacromial impingement, multidirectional instability, and shoulder arthroplasty. His articles were characterized by thoughtful insight, attention to detail, and intellectual honesty. The British Journal of Bone and Joint Surgery recently searched the Orthopaedic literature from 1945 to 2008 for the top 100 quoted articles. Dr. Neer had 5 articles in the top 100 – more than anyone else, a remarkable achievement. In 1990, he published his classic textbook “Shoulder Reconstruction”.

Dr. Neer was also a committed educator and mentor. He created the first shoulder and elbow service and fellowship. He trained numerous fellows and welcomed visitors from around the world to his service. He trained and fostered many of the leaders of shoulder surgery in the world. He also lectured extensively throughout the world on many aspects of shoulder surgery. Dr. Neer will be remembered for his outstanding contributions that advanced the art and science of orthopaedics and shoulder surgery.


Loss of visual acuity due to central serous retinopathy after steroid injection into the shoulder bursa

Al-Amin Kassam,  William White,  Roland H. Ling,  Jeff B. Kitson,

Volume 20, Issue 4, Pages e5-e6 (June 2011)

Steroid injections are commonly given in both the hospital and primary care setting for shoulder pain. We present a case report of a patient undergoing an ultrasound-guided subacromial bursal injection of steroid that coincided with a sudden loss of visual acuity caused by central serous retinopathy.

Central serous retinopathy is an idiopathic condition with recognized associations with exogenous steroids, such as nasal sprays, skin preparations, and long-term oral steroids. Little is known about the acute presentation after a single injection of steroid.

It is important for health care professionals to be aware of this link between a single steroid injection and central serous retinopathy because of the high number of steroid injections undertaken yearly in hospital and primary care settings.