Early reactions after reimplantation of the tendon of supraspinatus into bone. A study in rabbits.
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In 14 rabbits we determined the origin of the cells effecting healing of the tendon of supraspinatus inserted into a bony trough. After two weeks both the cellularity of the underlying bone and the thickness of the subacromial bursa were significantly increased in the operated compared with the control shoulders. The cellularity of the stump of the tendon, however, was significantly decreased in the operated shoulders. In this model, both the underlying bone and the subacromial bursa but not the stump of the tendon contributed to the process of repair. We conclude that the medial stump should be debrided judiciously but that cutting back to bleeding tissue is not necessary during repair of the rotator cuff. Moreover, great care should be taken to preserve the subacromial bursa since it seems to play an important role in the healing process. (+info)
Coracoacromial arch decompression in rotator cuff surgery.
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In rotator cuff surgery it is important to obtain adequate decompression of the coracoacromial arch. However, it is difficult to localize the impingement site preoperatively. Based on histological and morphological studies and the clinical findings in 45 patients and 15 cadavers, we have tried to determine the impingement site. In addition, as a part of these investigations, we assessed the clinical outcome for 100 patients. Soft tissue decompression was indicated in 12 shoulders, anterior acromioplasty in 67 and anterior acromioplasty with coracoplasty in 21. According to Neer's criteria there were 92 satisfactory and 8 unsatisfactory results. The mean postoperative UCLA score was 33.4 points and the results were rated excellent in 78, good in 18 and fair in 4. (+info)
Immunolocalization of cytokines and growth factors in subacromial bursa of rotator cuff tear patients.
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Inflammation in the subacromial bursa causes pain in patients suffering from rotator cuff tear, with this long-lasting inflammation leading to fibrosis and thickening of the subacromial bursa. Both inflammatory cytokines and mechanical stress, and impingement in the subacromial space, might induce and worsen this inflammation. However, little is known of the mechanism of this inflammation. In this study, we used immunohistological staining to demonstrate the expression of Interleukin-1 beta (IL-1 beta), Tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), and basic fibroblast growth factor (bFGF) in subacromial bursa derived from the patients suffering from rotator cuff tear. On the other hand the expression of these inflammatory cytokines and growth factors were little detected only to a small degree in patients with anterior shoulder instability who did not have severe shoulder pain and impingement in the subacromial space. Our findings suggest that those inflammatory cytokines and growth factors may play an important role in inflammation of the subacromial bursa. Controlling the expression of these cytokines and growth factors might be important for treating patients suffering from shoulder pain due to rotator cuff tear. (+info)
Modified and classic acromioplasty for impingement of the shoulder.
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We compared the results of modified and classic anterior acromioplasty in order to identify the significance of the resected acromion. Fifty patients with shoulder impingement syndrome resistant to conservative therapy underwent surgical treatment. We treated 30 patients with classic Neer acromioplasty (group 1), and 20 patients with modified Neer acromioplasty (group 2). The patients were assessed according to pain and shoulder movement. Excellent or good results were achieved in 28/30 patients in group I and 19/20 patients in group 2. The results indicate that both surgical techniques are effective procedures in the treatment of shoulder impingement syndrome, and the type of bone resection does not influence the clinical outcome. (+info)
Os acromiale associated with tear of the rotator cuff treated operatively. Review of 33 patients.
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Os acromiale is a rare anatomical abnormality and treatment is controversial. Our retrospective study analyses the outcome of excision, acromioplasty and bony fusion of the os acromiale when it is associated with a tear of the rotator cuff. After a mean follow-up of 41 months, 33 patients were radiologically and clinically assessed using the Constant score. The surgical procedure was to repair the rotator cuff together with excision of the os acromiale in six patients, acromioplasty in five, and fusion in 22. Of the 22 attempted fusions seven failed radiologically. The Constant scores were 82%, 81%, 81% and 84% for patients who had excision, acromioplasty, successful fusion and unsuccessful fusion respectively. There were no statistically significant differences. We conclude that a small mobile os acromiale can be resected, a large stable os acromiale treated by acromioplasty and a large unstable os acromiale by fusion to the acromion. Even without radiological fusion the clinical outcome can be good. (+info)
Local pressures in the subacromial space.
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We recorded pressures in the subacromial space with various degrees of humeral abduction. The recordings were made during open surgery and under general anaesthesia using a 2-mm-thick piezo-electric pressure transducer. The pressures were recorded in 14 patients with shoulder impingement syndrome (Neer's stage II) and in eight patients with acromioclavicular dislocation serving as controls. The pressures were higher in the impingement group than in the control group. In both groups the highest pressures were recorded antero-laterally under acromion. In patients with impingement syndrome, the pressures increased significantly with abduction. (+info)
Arthroscopic subacromial decompression.
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A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good. (+info)
In vivo leptin expression in cartilage and bone cells of growing rats and adult humans.
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The present investigation was carried out to analyse, immunohistochemically, in vivo leptin expression in cartilage and bone cells, the latter restricted to the elements of the osteogenic system (stromal cells, osteoblasts, osteocytes, bone lining cells). Observations were performed on the first lumbar vertebra, tibia and femur of four rats and on the humerus, femur and acromion of four patients. Histological sections of paraffin-embedded bone samples were immunostained using antibody to leptin. The results showed that, in growing rat bone, leptin is expressed in chondrocytes and stromal cells, but not in osteoblasts; bone lining cells were not found in the microscopic fields examined. In adult human bone, leptin is expressed in chondrocytes, stromal cells and bone lining cells; osteoblasts were not found in the microscopic fields examined. Osteocytes were found to be leptin positive only occasionally and focally in both rat and human bone. The in vivo findings reported show, for the first time, that leptin appears to be expressed only in the cells of the osteogenic lineage (stromal cells, bone lining cells, osteocytes) that, with respect to osteoblasts, are permanent and inactive, i.e. in those cells that according to our terminology constitute the bone basic cellular system (BBCS). Because the BBCS seems to be primarily involved in sensing and integrating mechanical strains and biochemical factors and then in triggering and driving bone formation and/or bone resorption, it appears that leptin seems to be mainly involved in modulating the initial phases of bone modelling and remodelling processes. (+info)