Assessment of Rotator Cuff Partial Tear Treatment with Ultrasound Guided Platelet Rich Plasma Injection

Background Rotator cuff tears are a common orthopedic problem, and often these tears are so-called partial tears of the rotator cuff. A partial tear of the rotator cuff is an area of damage or degeneration to the rotator cuff tendons, where the tear does not go all the way through the tendons Objectives The aim of the work assessment of rotator cuff partial tear treatment with ultrasound guided platelet rich plasma injection. Patients and Methods Single arm interventional study which was conducted in Ain shams university hospitals in the period between March 2020 and October 2020, 10 confirmed cases of rotator cuff partial tear diagnosed by MRI were included in this study. Their ages ranging from 25 to 70 years old. Results Our study showed statistically significant improvements in 10 patients in VAS pain score, constant shoulder score, PENN shoulder score and OXFORD shoulder score. Conclusion The ultrasound-guided PRP injection for rotator cuff partial thickness tears is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising and wellproved results. PRP has the potential to heal the muscle-tendon unit of the rotator cuff and may be a primary nonsurgical treatment modality for rotator cuff tears.

Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes

Background: Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected. Purpose: To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff. Results: The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively ( P < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively ( P < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%. Conclusion: Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.

Stem Cell, Fibrin Glue, and Normal Saline on Partially Torn Tendons: A Randomized Controlled Trial

Background: Tendons have limited reparative ability and perform a relatively simple mechanical function via the extracellular matrix. Thus, the injured tendon might successfully treated by stem cell transplantation. We performed a randomized, controlled study to investigate the effects of mesenchymal stem cell injection for treating partial tears in the supraspinatus tendon.Methods: We enrolled 24 patients with shoulder pain lasting more than 3 months and partial tears in the supraspinatus tendon. Participants were assigned to three groups: stem cells in fibrin glue, normal saline/fibrin glue mixture, and normal saline only, with which intra-lesional injection was performed. Pain at activity and rest, shoulder function and tear size were evaluated. For safety measures, laboratory tests were taken and adverse events were recorded at every visit. Participants were followed up at 6, 12 weeks, 6, 12 months and 2 years after injection. The primary outcome measure was the improvement in pain at activity at 3 months after injection. Results: Twenty-three patients were included in the final analysis. Primary outcome did not differ among groups (p = 0.35). A mixed effect model revealed no statistically significant interactions. Only time significantly predicted the outcome measure. All participants reported transient pain at the injection site. There were no differences in post-injection pain duration or severity. Safety measures did not differ between groups, and there were no persistent adverse events.Conclusions: Stem cell injection into supraspinatus partial tears in patients with shoulder pain lasting more than 3 months was not more effective than control injections. (ClinicalTrials.gov Identifier: NCT02298023)

MRI EVALUATION OF MENISCAL AND LIGAMENTOUS INJURIES OF KNEE IN CORRELATION WITH ARTHROSCOPY

Background - In knee joint injuries, clinical examination, radiographs and CT scan is not enough to diagnose many internal derangements of this joint. MR studies are required to assess the injuries of the menisci, cartilage ligaments or bone. A cross-sectional, Materials and methodsanalytical–observational study was conducted at the Department of Radiodiagnosis. A total of 65 patients with clinical suspicion of knee ligament injury and were referred for MRI were examined, 41 patients were males and 24 were females, their ages ranging from18 to 60 yrs. ACL Resultstear was the most common lesion, presented in 53.84 % cases out of which 29.32% cases were partial tear and 24.62% cases were complete tear. Medial Meniscus tear was the second most common lesion. 25% cases presented with combined injuries and 75% cases presented with isolated injuries. The predominant pattern was ACL and MM tears, followed by ACL tear and LM tears. Correlation between MRI and arthroscopic ndings are statistically signicant with (88%) of the cases showed good correlation between MRI and arthroscopic ndings. The study Conclusionsrevealed the ability of MRI in evaluation of the various internal derangements, including their detection, types (partial/complete tear) localization, characterization and assessment of extent of damage and the strength of correlation between MRI and arthroscopic helped the orthopaedic surgeons as a conservative approach was indicated in partial tears while a repair/reconstruction was indicated in a complete tear.

ROLE OF HIGH RESOLUTION ULTRASOUND IN THE DISORDERS OF ACHILLES TENDON.

Background: The Achilles tendon is the most common tendon that can get injured. The tendon can get affected in a wide variety of conditions and present with varied clinical manifestations. A detailed knowledge of the conditions affecting this tendon, their clinical manifestations and their appearance in imaging studies will help narrow down the diagnosis and provide precise treatment. Aim: Aim of the study was to identify the most common pathologies that affect the Achilles tendon and to correlate the clinical presentation with the high resolution ultrasound appearance. Settings and design: This was a prospective study Methods and Material: 52 patients with suspected Achilles tendon pathology were evaluated. After taking a detailed clinical history and performing a clinical examination, HRUS was performed on all the patients. The disorders affecting the patients were characterised based on clinical presentation and ultrasound examination. Correlation was done between the clinical and HRUS presentation of these cases. Results The most common symptom at the time of presentation was pain which was present in 41 patients (78.9%). Other symptoms included loss of plantar flexion seen in 20 patients (38.4%), swelling in 36 patients (69%) and stiffness seen in 12 patients (23%). Tears in the tendon were the most common type of pathology noted in 25 patients (48.07%),18 patients (34.6%) presented with complete tears and 5 patients (13.4%) with partial tears. Complete tears occurred more frequently at a site 3-4 cm from the calcaneal insertion while partial tears were most commonly insertional. 10 (19.2%) patients had findings suggestive of tendinopathy and their most common complaint was chronic pain and swelling. 5 patients (9.62%) had features of enthesitis. Among them 3 had psoriatric arthropathy and 2 had ankylosing spondylitis. Conclusion The spectrum of disorders involving the Achilles tendon are diverse and the clinical examination maybe imprecise, especially in acute conditions. HRUS offers a highly accurate tool that can diagnose these conditions and guide the management. Keywords: Tendoachilles, Achilles tendon, Paratendinopathy, Tendinopathy, Tears, High resolution ultrasound

Treatment of Partial Posterior Cruciate Ligament Injuries with Platelet-Rich Plasma in Growth Factors (PRGF) Intraligamentous Infiltration and a Specific Knee Brace

Posterior cruciate ligament (PCL) injuries are not as common as other knee ligament injuries, but may present a challenging scenario for even skilled knee surgeons. Complete PCL tears are typically encountered in the setting of multiligament knee injuries and require surgical treatment. Isolated complete PCL injuries are uncommon and the best treatment is debated, and likely depends on the degree of symptoms and objective instability. However, many PCL injuries will be partial tears (grade I or II). The purpose of this chapter is to describe our treatment of choice for partial PCL injuries through a conservative approach. Level of evidence Level IV.

Role of high-frequency USG in rotator cuff injury and its comparison with MRI

Introduction: Rotator cuff injury is one of the common causes of long-term shoulder pain anddisability encountered in the orthopedic clinic. The spectrum of rotator cuff injury includestendonitis, partial tears, and complete tears. They also may influence the development of thedegenerative disease of glenohumeral joint and rotator cuff arthropathy. Material and Methods:The present, prospective study entitled “Role of high-frequency USG in rotator cuff injury and itscomparison with MRI” was conducted in the Department of Radiodiagnosis on a total of 100 patientswho presented with signs and symptoms of shoulder joint injury in Department of Orthopedic whowere then referred for USG and MRI examination to the Department of Radiodiagnosis. Result:Mean age of the patients was 38.26±14.51 years and the majority of patients belonged to the 3rddecade (34%). About 7% of patients belonged to the 2nd decade, 18% of patients each belonged tothe 4th and 5th decades of age group. Only 8% and 7% of patients in the present study belonged toextremes of age i.e. >60 years and <20 years respectively. Conclusion: Based on the findings ofthe present study, it is concluded that rotator cuff injuries are commonly encountered conditions inroutine practice, and males are commonly affected as compared to females.