Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Methods: Arthroscopic Mumford procedures were performed
on 5 cadaver shoulders by a single surgeon utilizing the
anteromedial and Neviaser portals. After marking each portals
with methylene blue, dissection of nearby structures were
carried out immediately after each procedure was completed.
Important structures (subclavian artery as well as brachial plexus
and its branches) were identified and the nearest measurements
were made from each portal edges to these structures. Results:
The anteromedial portal was noted to be closest to the
suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal
was noted to be closest also to the SSN at 1.60 cm. The
suprascapular nerve was the structure most at risk during the
Mumford procedure. The anteromedial portal was noted to be
the most risky portal to utilize compared to the Neviaser portal.
Conclusion: Extra precaution needs to be given to the
anteromedial portal while performing an arthroscopic distal
clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.
Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.
BACKGROUND: This study aimed to report the outcome of patients who underwent arthroscopic rotator cuff repair (ARCR) and to determine the factors associated with return to work and activity.
MATERIALS: Three hundred sixty-five patients who underwent ARCR were prospectively evaluated. The cohort was divided into 2 groups based on clinical results at 6 months. Group A consisted of patients who were considered to have a satisfactory outcome based on return to their previous professional or spare-time activities. Group B consisted of patients with an unsatisfactory outcome based on a lack of return to normal work or activities.
RESULTS: Of the patients, 305 had a satisfactory outcome (group A) and 60 were categorized as having an unsatisfactory outcome (group B). On multivariate analysis, preoperative factors associated with group B included female gender and heavy manual labor. Postoperative bursitis on ultrasound at 6 months was associated with being in group B. Lack of tendon healing was not associated with group B. However, if a patient without healing had persistent pain at 6 months, the pain persisted at 9 months.
CONCLUSION: ARCR is an effective procedure that leads to significant improvement in pain, function, and tendon healing in most cases. However, in 1 of 5 cases, patients were unable to resume normal activity at 6 months postoperatively. Persistent limitation at 6 months was associated with female gender, heavy manual workers, and the presence of postoperative persistent bursitis.
KEYWORDS: Arthroscopic rotator cuff repair; double row; recovery of function; return to work; tendon non-healing or retear; treatment outcome; ultrasound; workers' compensation claim