Arthroscopic subacromial decompression: A clinical review

ABSTRACTS

Two groups were evaluated. Group A: six patients were allowed restricted active and passive knee range of motion (ROM) (30-90”) and limited weight bearing (WB) (50%) for 6 weeks postoperatively. Group B: 10 patients were allowed full active and passive ROM and WB immediately postoperatively. Graft biopsies were evaluated by three histologic criteria: (a) collagen refringence under polarized light, (b) focal dystrophic calcification indicative of cell necrosis, and (c) replacement of collagen by areas of fibrocartilage indicative of incomplete graft remodeling. Group A took longer postoperatively than group B: 8.8 versus 5.5 months (p < 0.05). The mean percent of collagen showing a normal refringement pattern under polarized light was 35% in group A and 62% in group B (NS). Focal dystrophic calcification was present in 33% patients in group A and 20% patients in group B (NS). Collagen replacement by focal areas of fibrocartilage was seen in 83% of patients in group A and in 20% in group B (p < 0.05). This study failed to demonstrate any adverse effect of immediate full ROM and WB on the arthroscopic or histologic appearance of PT ACL autografts. As judged by the decreased percent of patients with fibrocartilaginous metaplasia at an earlier stage postoperatively, there appears to be a beneficial effect of a more advanced postoperative protocol after autogenous PT ACL reconstruction. Arthroscopic Subacromial Decompression: A Clinical Review. Richard K. N. Ryu. Santa Barbara, California, U.S.A. Arthroscopic subacromial decompression has become a common technique, supplanting the open Neer acromioplasty in many instances of chronic rotator cuff disease. A review of 57 consecutive decompressions with a minimum follow-up of 12 months was undertaken to evaluate indications and results. Of the 57 patients, 49 patients with an average follow-up of 24 months (range 12-46) were available for analysis that consisted of a chart review combined with an office examination or telephone contact. Thirty men and 19 women with an average age of 47 years comprised the study group. Eleven (22%) had full-thickness tears whereas 3 1 (64%) had partial-thickness injuries and 7 (14%) had normal rotator cuffs at the time of arthroscopy. Arthroscopy,

Vol. 7. No. 3, 1991

Using the UCLA Shoulder Rating System based on pain, function, range of motion, and strength, 80% of the patients in this series had an excellent (29%) or good (51%) result whereas 20% (16% fair and 4% poor) were considered failures. Those with full-thickness tears were likely to experience a less satisfying outcome (55%). Of 19 workmens’ compensation cases, a satisfactory outcome was noted in 74% (11% excellent and 63% good), with a predominance of good over excellent results. Excluding those with full-thickness tears and the workmens’ compensation cases, a satisfactory outcome was achieved in 90% (43% excellent and 47% good), with a fair outcome in 10% and no poor results. One complication consisting of a deltoid muscle injury requiring a miniarthrotomy and repair was noted, with the overall result uncompromised. Arthroscopic subacromial decompression for mechanical derangement of the rotator cuff is a technically demanding procedure requiring appropriate skills in addition to critical preoperative treatment and evaluation. For those individuals in whom conservative measures fail and who meet stringent criteria, namely an intact rotator cuff and a nonwork-related injury, a highly reliable and satisfying outcome can be anticipated by both patient and surgeon. Arthroscopic Removal of Subacromial Calcification. Stephen J. Snyder, Robert A. Eppley, and Scott Brewster. Van Nuys, California, U.S.A.

Thirteen shoulders in 12 patients (average age 44 years) underwent arthroscopic removal of rotator cuff calcification and were then evaluated 1-5 years postoperatively. All patients had debilitating shoulder pain from 6 months to 5 years before surgery, with failed nonoperative treatment (i.e., physical therapy, corticosteroid injections, and/or nonsteroida1 antiinflammatory drugs). Calcium deposits were identified on plain radiographs and/or magnetic resonance scan and then were localized and removed through arthroscopy and bursoscopy. A technique was developed using a needle, a shaver, and copious irrigation so that the rotator cuff would not be damaged. Postoperatively, radiographs all showed complete removal of the calcification. At follow-up, all of the patients had achieved full range of motion. Three patients reported no pain with full activity, with 10 patients reporting slight