Arthroscopic rotator cuff repair (RCR) with suture anchor–based fixation techniques has replaced former open and mini-open approaches. Nevertheless, long-term studies are scarce, and lack of knowledge exists about whether single-row (SR) or double-row (DR) methods are superior in clinical and anatomic results. To analyze long-term results after arthroscopic RCR in patients with symptomatic rotator cuff tears and to compare functional and radiographic outcomes between SR and DR repair techniques at least 10 years after surgery. Cohort study; Level of evidence, 3. Between 2005 and 2006, 40 patients with a symptomatic full-thickness rotator cuff tear (supraspinatus tendon tear with or without a tear of the infraspinatus tendon) underwent arthroscopic RCR with either an SR repair with a modified Mason-Allen suture–grasping technique (n = 20) or a DR repair with a suture bridge fixation technique (n = 20). All patients were enrolled in a long-term clinical evaluation, with the Constant score (CS) as the primary outcome measure. Furthermore, an ultrasound examination was performed to assess tendon integrity and conventional radiographs to evaluate secondary glenohumeral osteoarthritis. A total of 27 patients, of whom 16 were treated with an SR repair and 11 with a DR repair, were followed up after a mean ± SD period of 12 ± 1 years (range, 11-14 years). Five patients underwent revision surgery on the affected shoulder during follow-up period, which led to 22 patients being included. The overall CS remained stable at final follow-up when compared with short-term follow-up (81 ± 8 vs 83 ± 19 points; P = .600). An increasing number of full-thickness retears were found: 6 of 22 (27%) at 2 years and 9 of 20 (45%) at 12 years after surgery. While repair failure negatively affected clinical results as shown by the CS (P < .05), no significant difference was found between the fixation techniques (P = .456). In general, progressive osteoarthritic changes were observed, with tendon integrity as a key determinant. Arthroscopic RCR with either an SR or a DR fixation technique provided good clinical long-term results. Repair failure was high, with negative effects on clinical results and the progression of secondary glenohumeral osteoarthritis. While DR repair slightly enhanced tendon integrity at long-term follow-up, no clinical superiority to SR repair was found.

Objective: Functional posterior shoulder instability (FPSI) (type B1) is a severe type of instability, mainly in teenagers and young adults, that leads to loss of function, pain, and stigmatization among peers. An experimental nonsurgical treatment protocol based on neuromuscular electrical stimulation (NMES) showed very promising early results in the treatment of FPSI. The hypothesis of this study was that NMES-enhanced physical therapy leads to better outcomes than physical therapy alone as the current gold standard of treatment in patients with FPSI. Methods: In this multicenter randomized controlled trial, patients with FPSI were randomly allocated in a 1:1 ratio to either 6 weeks of physical therapy or 6 weeks of physical therapy with simultaneous motion-triggered NMES. Baseline scores as well as outcome scores at 6 weeks, 3 months, 6 months, and 12 months after the intervention were obtained. The predefined primary outcome of this trial was the Western Ontario Shoulder Instability Index (WOSI) at the 3-month time point. Results: Forty-nine patients were randomized and eligible for the trial. The group that received physical therapy with simultaneous motion-triggered NMES showed a significantly better main outcome measurement in terms of the 3-month WOSI score (64% [SD = 16%] vs 51% [SD = 24%]). Two-thirds of the patients from the physical therapist group crossed over to the group that received physical therapy with simultaneous motion-triggered NMES due to dissatisfaction after the 3-month follow-up and showed a significant increase in their WOSI score from 49% [SD = 8%] to 67% [SD = 24%]. The frequency of instability episodes showed a significant improvement in the group that received physical therapy with simultaneous motion-triggered NMES at the 3-month follow-up and beyond, while in the physical therapist group, no significant difference was observed. Conclusion: The current study shows that NMES-enhanced physical therapy led to statistically significant and clinically relevant improvement in outcomes in the treatment of FPSI compared to conventional physical therapy alone—from which even patients with prior unsatisfactory results after conventional physical therapy can benefit. Impact: Based on the results of this study, NMES-enhanced physical therapy is an effective new treatment option for FPSI, a severe type of shoulder instability. NMES-enhanced physical therapy should be preferred over conventional physical therapy for the treatment of patients with FPSI.

Purpose: To correlate MRI findings after suture anchor repair of distal biceps tendons with symptoms. Materials and Methods: 24 men with 25 distal biceps tendon ruptures (one bilateral) treated with suture anchor repair were retrospectively included. Follow-up after a mean of 31 months (range, 12 – 74) included clinical examination and MRI. The pain level and flexion strength compared to the uninvolved arm were recorded. MRI was performed at 1.5 T obtaining FABS position images (both elbows in 7 patients) and evaluated for artifacts, signal abnormalities, and rerupture by two experienced readers in consensus and blinded to symptoms. Pain and loss of flexion strength > 20 % were tested against MRI findings as dichotomous data using Fisher’s exact chi-square tests (p < 0.05). Crosssectional areas of operated and uninvolved tendons were measured and evaluated with the Wilcoxon signed rank test (p < 0.05). Results: FABS views enabled good evaluation in 96 % of tendons. Rerupture was present in 3 of 25 elbows. Tendinous signal increase was seen in 59 % of intact tendons. We found activity-related pain or pain at rest in 32 % and a loss of flexion strength in 27 % of these cases. Testing revealed no significant correlation for any of the MRI features with any of the clinical parameters (p > 0.05). There was a 2.7-fold mean increase of the tendon cross-sectional area on the repaired side compared to the uninvolved contralateral tendon (p = 0.02). Conclusion: We found good MRI visualization of postoperative tendons, but no correlation between symptoms and MRI signal abnormalities or rerupture. The increase in caliber of the repaired tendon might promote an impingement in pronation. Ziel: Korrelation von MRT-Bildgebung und Symptomatik nach Fadenankerrefixation der distalen Bizepssehne. Material und Methoden: 24 Männer mit 25 distalen Bizepssehnenrupturen (eine bilateral) wurden durchschnittlich 31 Monate (Spannweite: 12 – 74) nach Fadenankerrefixation nachuntersucht und retrospektiv eingeschlossen. Schmerzen und Flexionskraft im Seitenvergleich wurden erfasst und ein 1,5 T MRT in FABS-Position durchgeführt (7 Patienten erhielten eine beidseitige MRT). Die MRT-Auswertung erfolgte im Konsens durch zwei hinsichtlich der Symptomatik verblindete, erfahrene Untersucher anhand der Kriterien Artefakte, Signalalteration, Reruptur. Die Merkmale Schmerz und Flexionskraftverlust (> 20 % zur Gegenseite) wurden mittels exakten Chi-Quadrat-Tests nach Fisher gegen die MRT-Merkmale getestet (jeweils dichotom, p < 0,05). Ein Test auf Gleichheit der Sehnenquerschnittfläche von gesunder und operierter Seite erfolgte nach deren Messung mit dem Wilcoxon-Vorzeichen-Rang-Test (p < 0,05). Ergebnis: Mit der FABS-MRT konnte die distale Bizepssehne in 96 % der Fälle gut beurteilt werden. Eine Reruptur wurde an 3 von 25 Ellenbogen festgestellt. Tendinöse Signalveränderungen hatten 59 % der intakten Sehnen. Bei intakter Sehne zeigten 32 % am Ellenbogen belastungsabhängige Schmerzen oder Schmerzen in Ruhe und 27% einen Flexionskraftverlust. Für den Test der klinischen gegen die bildgebende Merkmale ergab sich kein signifikanter Zusammenhang (p > 0,05). Die Querschnittfläche der refixierten Sehne war um das 2,7-Fache größer als auf der gesunden Seite (p = 0,02). Schlussfolgerung: Wir fanden eine gute Beurteilbarkeit der postoperativen Sehnen in der MRT, dabei aber keinen Zusammenhang zwischen Symptomatik und MRT-Signalveränderungen oder Reruptur. Die Kaliberzunahme der refixierten Sehne könnte ein Impingement in Pronation begünstigen.

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.

Aim: We aimed to compare the clinical results after ligamentous elbow dislocation between patients treated nonoperatively (group A) and patients who underwent ligamentous repair (group B).Methods: Hospital records were investigated for cases of ligamentous elbow dislocation from January 2015 to December 2018. In total, 30 patients were identified: nine with nonoperative treatment and 21 with surgical ligamentous repair. The range of motion (ROM) including arc of extension/flexion and pronation/supination, valgus instability, and posterolateral rotatory instability were evaluated. The scores of several outcome measures assessing elbow injury were evaluated. Sonographic examination was performed on all patients to evaluate translation under valgus and posterolateral rotatory stress.Results: Overall, 14 patients with simple elbow dislocation (group An = 5, 46.4 ± 19.3 years, follow-up [FU] 27 ± 12.4 months; group Bn = 9, 57.3 ± 21.0 years, FU 36 ± 11.1 months; 4 female patients in each group) were evaluated. No significant difference was seen in extension/flexion and ext/flex-arc although there was a tendency to limited extension (p = 0.07) in group A. A significantly reduced supination (84 ± 15° vs. 77 ± 21°,p = 0.02) was observed regarding the contralateral side in group B. There was no significant difference in the evaluated scores between the groups. A significantly increased medial angulation during ultrasound evaluation was found in group B compared with the contralateral side.Conclusion: There were no significant differences concerning ROM and functional scores between the nonoperative treatment and ligamentous repair groups. On clinical evaluation, a higher rate of sufficiently healed ligaments was found following surgical repair, although this was not reflected in the ultrasound evaluation.