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131


The effect of arthroscopic suture passing instruments on rotator cuff damage and repair strength

Chokshi, Biren V; Kubiak, Erik N; Jazrawi, Laith M; Ticker, Jonathan B; Zheng, Nigel; Kummer, Frederick J; Rokito, Andrew S
There are a variety of arthroscopic devices used to pass sutures through the rotator cuff for its repair. Because they vary in size and shape, it is possible that they could damage the cuff and affect the integrity of the repair. We chose four devices for assessment--SutureLasso (Arthrex, Naples, FL), straight BirdBeak (Arthrex, Naples, FL), Viper (Arthrex, Naples, FL), and a #7 tapered Mayo needle--and performed cuff reattachments in four paired shoulders using suture anchors. These repairs were cycled and tested to failure. The SutureLasso and Mayo needle repairs failed at approximately 285 N whereas the BirdBeak and Viper failed during cycling at 150 N. It appears that the devices, which made the bigger holes in the cuff, can compromise the integrity of the repair
PMID: 16878832
ISSN: 0018-5647
CID: 69066

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction

Youm, Thomas; Murray, Doug H; Kubiak, Erik N; Rokito, Andrew S; Zuckerman, Joseph D
This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates
PMID: 16194734
ISSN: 1058-2746
CID: 62378

Enthesopathy on shoulder MRI: A potential secondary marker for rotator cuff disorders [Meeting Abstract]

Coen, AR; Schweitzer, ME; Rafii, M; Sherman, OH; Rokito, AS
ISI:000228717800427
ISSN: 0361-803x
CID: 56260

Ochronotic arthropathy: a report of 3 cases [Case Report]

Moghtaderi, Sam; Rokito, Andrew S; Zuckerman, Joseph D
PMID: 15828518
ISSN: 1078-4519
CID: 70984

Assessment of clavicular translation after arthroscopic Mumford procedure: direct versus indirect resection--a cadaveric study

Miller, Craig A; Ong, Bernard C; Jazrawi, Laith M; Joseph, Thomas; Heywood, Christian S; Rosen, Jeffrey; Rokito, Andrew S
PURPOSE: To compare the horizontal stability of the distal clavicle following arthroscopic resection of its lateral end by direct and indirect techniques. TYPE OF STUDY: Biomechanical test of cadaveric specimens. METHODS: We performed arthroscopic distal clavicle resection on 12 fresh-frozen human cadaveric shoulders using direct (group 1, n = 6) or indirect (group 2, n = 6) approaches. In both groups 5 mm of distal clavicle were resected using an arthroscopic burr. The specimens were mounted on a materials testing device that allowed translation of the clavicle along the anteroposterior axis. The degree of posterior translation was measured from maximum anterior displacement of the clavicle. RESULTS: Mean posterior translation was 19.4 mm (range, 18 to 23 mm; SD, 2.2) and 21.3 mm (range, 18 to 25 mm; SD, 3.1) for groups 1 and 2, respectively. This difference was not statistically significant ( P = .27). Conclusions: This study suggests that there is no significant difference in anteroposterior stability of the clavicle following arthroscopic distal clavicle resection with either a direct or indirect approach. CLINICAL RELEVANCE: Clinically, this study addresses concerns about increased potential instability associated with the indirect technique of distal clavicle resection. From a biomechanical standpoint, based on this study, there is no concern for increased instability with the indirect technique of distal clavicle resection compared to a direct technique
PMID: 15650668
ISSN: 1526-3231
CID: 56063

Chronic exertional compartment syndrome: diagnosis and management

Bong, Matthew R; Polatsch, Daniel B; Jazrawi, Laith M; Rokito, Andrew S
During exercise, muscular expansion and swelling occur. Chronic exertional compartment syndrome represents abnormally increased compartment pressures and pain in the involved extremity secondary to a noncompliant musculofascial compartment. Most commonly, it occurs in the lower leg, but has been reported in the thigh, foot, upper extremity, and erector spinae musculature. The diagnosis is obtained through a careful history and physical exam, reproduction of symptoms with exertion, and pre- and post-exercise muscle tissue compartment pressure recordings. It has been postulated that increased compartment pressures lead to transient ischemia and pain in the involved extremity. However; this is not universally accepted. Other than complete cessation of causative activities, nonoperative management of CECS is usually unsuccessful. Surgical release of the involved compartments is recommended for patients who wish to continue to exercise
PMID: 16022217
ISSN: 0018-5647
CID: 58724

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation

Hale, James; Rokito, Andrew S; Chu, Jamie
The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved
PMID: 16022220
ISSN: 0018-5647
CID: 58722

Posterior capsulorrhaphy for treatment of recurrent posterior glenohumeral instability

Shin, Robert D; Polatsch, Daniel B; Rokito, Andrew S; Zuckerman, Joseph D
The surgical treatment of recurrent posterior shoulder instability via a posterior approach has had a variable degree of success reported in the literature with recurrence rates ranging between 8% and 45%. The purpose of this study was to review the results of posterior capsulorrhaphy in a consecutive series of patients with recurrent posterior instability. Seventeen consecutive patients underwent operative management for posterior glenohumeral instability. The dominant shoulder was involved in ten patients. All patients were male with an average age of 28.1 years (range: 16 to 54 years). Ten patients had sustained a specific injury which precipitated the instability. Six patients reported dislocations requiring formal closed reduction maneuvers; the remainder described episodes of recurrent subluxation with spontaneous reduction. All patients underwent a posterior capsulorrhaphy using an infraspinatus splitting approach. Eight shoulders required repair of a posterior capsulolabral detachment. In addition, one patient required augmentation with a posterior bone block for significant glenoid rim deficiency. Outcome was assessed by personal interview, clinical assessment, and standardized radiographs. At an average follow-up of 3.9 years (range: 1.8 to 10.8 years) patients estimated their overall shoulder function to be 81% of the contralateral unaffected shoulder. The subjective result was excellent for eight patients, good for five patients, fair in two patients, and poor in two patients. One of the poor outcomes was in a patient with glenohumeral degenerative changes at the index procedure which progressed and eventually required a total shoulder arthroplasty. The other poor result was in a patient found to have a full-thickness rotator cuff tear 10.6 years after the index procedure. Two patients (12%) had recurrence of their instability. Both of these patients sustained a significant re-injury which precipitated their symptoms. Five patients complained of occasional night pain at the time of their last follow-up examination. Only one patient (who was re-injured) had to change professions as a result of shoulder symptoms. Posterior capsulorrhaphy for treatment of isolated posterior glenohumeral instability yields satisfactory clinical results. Recurrent instability in this series was associated with a specific re-injury and did not appear to increase with longer follow-up
PMID: 16536210
ISSN: 0018-5647
CID: 64472

Accuracy of non-contrast MRI for diagnosis of SLAP lesions [Meeting Abstract]

Bhandarkar, P; Rafii, M; Moore, S; Sherman, O; Rokito, A
ISI:000220593100217
ISSN: 0361-803x
CID: 46654

Modified Weaver-Dunn procedure for acromioclavicular joint dislocations

Rokito, Andrew S; Oh, Young Ho; Zuckerman, Joseph D
PMID: 14763525
ISSN: 0147-7447
CID: 44531