Leonardo Osti

The rationale to anatomically repair this tendon is to restore the functional biomechanics of the shoulder. Clinical and imaging assessment are required before undertaking arthroscopy. In this way, associated pathologies of the biceps and labrum may be successfully addressed. The arthroscopic repair of the tendon implies to use suture anchors and reinsert the tendon itself over the footprint. Results after arthroscopy are comparable to those observed after open procedures.

Fatty degeneration is a degenerative condition of the tendon-muscle unit of rotator cuff muscles, characterized by atrophy of muscle fibers, fibrosis, and fatty accumulation within and around the muscles. Many classification may be useful to stage this pathology, especially on Computed Tomography (CT) and magnetic resonance imaging (Mari) findings. Stem cell-based therapies for repair and regeneration of tendons and muscles may be used to promote healing and to make this condition reversible. Diagnosis and management of this condition is mandatory as in patients undergoing rotator cuff repair, it may influence outcomes, increase the likelihood of re-tearing, and evolve negatively.

The aim of this study is to report the clinical and functional outcomes following arthroscopic management of anterior impingement, grade III–IV cartilage lesions, and mild to moderate osteoarthritis of the ankle in former soccer players. The study included 15 former male professional soccer players with mild to moderate degenerative changes of the ankle who had undergone arthroscopic debridement and management of secondary injuries of the ankle. Preoperatively and at the last follow-up, at an average of 7.4 years, the American Orthopaedic Foot and Ankle Society (AOFAS) and the Kaikkonen scales and visual analogue scale (VAS) assessment were administered to all patients. Ankle osteoarthritis was assessed from weightbearing anteroposterior and lateral radiographs of both ankles. At the last follow-up, the average AOFAS score had increased significantly from 48 (range, 29–69) to 86 (range, 63–94) (P < 0.0001), with good to excellent scores in 11 patients (74 %). The average Kaikkonen preoperative score of 43 (range, 28–70) had significantly improved to 85 (range, 61–95) (P < 0.0001), with good excellent scores in 11 patients (74 %). VAS values were also improved at the last follow-up. At the last appointment, only one (7 %) patient had abandoned altogether any sport, as he did not feel safe with his ankle and he felt too old to continue. Anterior ankle arthroscopy for management of mild to moderate ankle arthritis is safe, effective, and low cost and allows former athletes to safely return to ordinary daily activities and recreational sport activities.

Hyaluronic Acid (HA) has been already approved by Food and Drug Administration (FDA) for osteoarthritis (OA), while its use in the treatment of tendinopathy is still debated. The aim of this study was to evaluate in human rotator cuff tendon derived cells the effects of four different HA on cell viability, proliferation, apoptosis and the expression of collagen type I and collagen type III. An in vitro model was developed on human tendon derived cells from rotator cuff tears to study the effects of four different HA preparations (Ps) (sodium hyaluronate MW: 500-730 KDa - Hyalgan®, 1000 kDa Artrosulfur HA®, 1600 KDa Hyalubrix® and 2200 KDa Synolis-VA®) at various concentrations. Tendon derived cells morphology were evaluated after 0, 7 and 14 d of culture. Viability, proliferation, apoptosis were evaluated after 0, 24 and 48 h of culture. The expression and deposition of collagen type I and collagen type III were evaluated after 1, 7 and 14 d of culture. All HAPs tested increased viability and proliferation, in dose dependent manner. HAPs already reduce apoptosis at 24 h compared to control cells (without HAPs). Furthermore, HAPs stimulated the synthesis of collagen type I in a dose dependent fashion over 14 d, without increase in collagen type III; moreover, in the presence of Synolis-VA® the expression and deposition of collagen type I was significantly higher as compare with the other HAPs. HAPs enhanced viability, proliferation and expression of collagen type I in tendon derived cells.

Pulsed electromagnetic fields (PEMFs) may improve clinical outcomes following microfractures and prevent their decline over time. Sixty-eight patients who underwent partial medial meniscectomy and microfractures to the medial femoral condyle for management of grade III–IV cartilage lesions were randomly divided into two groups using a block randomization procedure. After surgery, 34 patients underwent PEMFs application in the I-ONE group; 34 patients underwent placebo treatment in the placebo group. All patients had the same postoperative rehabilitation protocol. Sixty patients (28 in the I-ONE group, 32 in the placebo group) were assessed at an intermediate follow-up of two years and a minimum follow-up of five years after surgery. The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow up of two years. At two years, IKDC and Lysholm and Constant scores were significantly improved compared to baseline in both groups with no significant inter-group differences. At the last follow up (minimum five years), clinical and functional outcomes were decreased in both the groups, with significant better outcomes in the I-ONE group. At five years, the percentage of patients still active at the same level they were pre-operatively was greater in the I-ONE group (82 % vs 68 %, P = 0.28). At radiographic assessment, at the latest evaluation, six patients (21.4 %) in the I-ONE group and nine (28.1 %) in the placebo group demonstrated grade I–II degenerative changes according to Fairbank grading system (Χ = 0.36, P = 0.55). PEMFs application can improve the effectiveness of microfracture in the long term.

The aim of this quantitative review is to document potential benefit and adverse effects of hyaluronic acid (HA) injection into the shoulder with rotator cuff tears. a systematic literature search was performed in english PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined key words "hyaluronic acid", "rotator cuff tear", "hyaluronate", "shoulder", "viscosupplementation", with no limit regarding the year of publication. Articles were included if they reported data on clinical and functional outcomes, complications in series of patients who had undergone HA injection for management of rotator cuff tears. Two Authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The papers were accurately analyzed focusing on objective rating scores reported. a total of 11 studies, prospective, 7 were randomized were included by full text. A total of 1102 patients were evaluated clinically after different HA injection compare with corticosteroid injection, physically therapies, saline solution injection and control groups. The use of HA in patients with rotator cuff tears improve VAS and functional score in all trials that we have analyzed. intra-articular injection with HA is effective in reducing pain and improving function in shoulder with rotator cuff tears and without severe adverse reaction. Level I.

Microfractures at the footprint may be a potential additional source of growth factor and enhance the tendon healing at the bone-tendon junction when repairing rotator cuff tears. Fifty-seven patients who underwent shoulder arthroscopy for repair of complete rotator cuff tears were randomly divided into two groups, using a block randomisation procedure. Patients underwent microfracture at the footprint in the treatment group. The patients in the control group (n = 29) did not receive that treatment. All patients had the same post-operative rehabilitation protocol. The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow-up of two years. At three months from the index procedure, visual analogue scale (VAS), range of motion (ROM) and University of California at Los Angeles (UCLA) and Constant scores were significantly better in group 1 than in group 2 (P < .05). At the last follow-up (minimum two years), clinical and functional outcomes were further improved in both the groups but inter-group differences were not significant. No technique-related complications were recorded. Microfractures at the footprint are simple, safe, inexpensive and effective at producing less pain in the short term in patients who undergo rotator cuff repair, but at two years they do not result in significantly different outcomes, either clinically or at imaging, compared to traditional rotator cuff repair.