Background: Lesions of the long head of the biceps (LHB) tendon are frequently associated with massive rotator cuff tears (RCT) and may be responsible for shoulder pain and disability.Objective: This study aimed to evaluate functional outcomes of arthroscopic biodegradable spacer implantation with or without biceps tenotomy as treatment for persistent shoulder dysfunction and pain due to a massive irreparable RCT.Methods: A total of 48 patients were implanted with the subacromial spacer using arthroscopic approach with or without biceps tenotomy. All patients were assessed for up to 12 months post-implantation and 18 patients were assessed for at least 24 months (and a maximum of 40 months). Improvement in shoulder function was assessed using Constant score.Results: Subacromial spacer implantation was performed arthroscopically in 48 patients. The mean total Constant score increased from 36 at baseline to 67 points at 12 months post implantation. Patients who underwent LHB tenotomy in addition to the subacromial spacer presented similar improvement of their shoulder function and score compared to the group that was treated with the spacer alone.Conclusion: Current study demonstrates that spacer implantation in this patient population provides significant improvement in function and decreases the pain. Additional LHB tenotomy did not influence the postoperative results during the follow-up.

Purpose: Studies on musculoskeletal manifestations (MSM) of childhood acute lymphoblastic leukemia (ALL) have yielded variable findings with regard to their clinical impact. We investigated the significance for differential diagnosis, treatment and outcome of musculoskeletal complaints as presenting symptoms of ALL, and their correlation with leukemia immunophenotypes, for which data is lacking. Methods: Data on 783 children in the national study for childhood ALL between 1984 and 2003 were reviewed retrospectively. Statistical analysis examined possible relationships between MSM at the time of diagnosis and demographic and clinical data, biological features of leukemia (peripheral blood counts, immunophenotype and main cytogenetic aberration), response to initial prednisone treatment, and outcome. Results: Of 765 children with data on orthopaedic complaints, 240 presented with MSM (31.4%). Among these children, B cell precursor (BCP) was much more common (209/576, 36.3%) than T cell ALL (25/176, 14.2%). Patients with MSM had lower white blood cell counts (WBC) (median of 9 vs. 20 × 10⁹/L, P < 0.001) and percentage of blast cells in the peripheral blood at diagnosis compared to those without (median of 27 vs. 53%, P < 0.001). Hepatomegaly and splenomegaly were less common in MSM group (67 vs. 53% <3 cm, P < 0.001, and 63 vs. 50% <3 cm, P < 0.001, respectively). Poor response to initial treatment with prednisone was recorded in 7.1% of patients with MSM versus 11.5% of those without ( P = 0.086). The analysis revealed no independent effect of MSM on event-free survival (EFS), after correcting for differences in EFS related to immunophenotype or initial WBC. Conclusions: MSM occur mostly in children with BCP ALL who present with less involvement of extramedullary organs, low peripheral blood blasts and white blood cells counts. These findings highlight the importance of including ALL in the differential diagnosis of MSM even in the presence of an apparently normal peripheral blood count. Our study also suggests that MSM are caused by leukemic cells with enhanced biological propensity to remain relatively confined within the intramedullary bone-marrow space.

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.

Background: Various fracture-specific reverse shoulder arthroplasty (RSA) systems exist on the market. We set out to examine whether the type of prosthesis used and the means of fixation (cemented or non-cemented) influenced the rate of tuberosity healing or the functional outcome of the operation. Methods: This retrospective cohort multicenter study included 146 patients who underwent RSA for an acute three- or four-part proximal humerus fracture and had a minimum follow-up of one year. Six fellowship-trained surgeons at two different centers performed all operations. The implants were either Tornier Aequalis or Depuy Delta Xtend, both fracture-specific Grammont-style systems. Results: The mean age ± standard deviation (SD) was 76 ± 7 years, and 83% of patients were female. The mean ± SD follow-up time was 30 ± 31 months. The Aequalis prosthesis was used in 82 patients (56%), and the Delta Xtend in 64 patients (44%). A total of 105 RSAs (72%) were cemented. Tuberosity healing rate was similar for the two implant systems (71% Aequalis vs. 82% Delta Xtend, p = 0.15) and for the cemented or non-cemented, respectively (73% cemented vs. 83% non-cemented, p = 0.22). There was no significant difference in the motion and functional outcomes between the two implant systems in this study. Conclusions: RSA for complex PHF in the elderly has similar short-term results, regardless of the type of fracture-specific implant or the fixation technique (cemented vs. cementless).

Background: The mortality rate following proximal humerus fractures (PHFs) in elderly patients is increased, but currently, there are no medium-term studies comparing mortality following treatment with Reverse Total Shoulder Arthroplasty (RTSA) to non-surgical treatment. Methods: This retrospective study compares two groups of elderly patients (aged 75 to 95 at the time of injury) who were diagnosed with PHFs. A total of 79 patients (mean age: 83.1 ± 4.6) were treated conservatively between 2008 and 2010, a time when RTSA was not yet considered a treatment option, and 81 patients (mean age: 82.4 ± 4.4) underwent RTSA between 2012 and 2017. Also, 1-month, 1-year, and 5-year mortality rates were recorded. Results: The 1-month, 1-year, and 5-year mortality rates were 1.2%, 7.4%, and 33.3% in the RTSA group and 2.5%, 11.4%, and 38.0% in the non-surgical treatment group (p = 0.98, p = 0.55, p = 0.65). A subgroup analysis revealed that the mild difference between groups can be attributed to male patients only. Conclusions: This study explored the impact of RTSA versus non-surgical treatment on mortality in elderly patients with PHFs and found similar mortality rates over five years. Better segmentation of the patient population may reveal subgroups with different mortality patterns.