Faculty Bibliography

BACKGROUND:Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome. HYPOTHESIS/OBJECTIVE:Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes. STUDY DESIGN/METHODS:Prospective nonrandomized clinical outcomes study. METHODS:Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospective study. A standardized evaluation was performed preoperatively and postoperatively at annual intervals. All patients underwent postoperative magnetic resonance imaging at least 1 year after surgery. Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison. RESULTS:Thirty-two patients were available for evaluation. Overall, the patients experienced a significant (P < .05) improvement in their American Shoulder and Elbow Surgeons survey (40-85) and Constant (53-80) scores. The overall retear rate was 31%. Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores, this was not significant. CONCLUSION/CONCLUSIONS:These data support open rotator cuff repair as an effective technique that restores excellent shoulder function. The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff. In fact, those with a retear still had a significant improvement in all clinical areas assessed, including strength.

PURPOSE/OBJECTIVE:The efficacy of a multimodality protocol using neoadjuvant and concomitant hormonal therapy, brachytherapy, and three-dimensional conformal external beam radiotherapy (RT) in high-risk prostate cancer was evaluated using biochemical outcomes and posttreatment biopsy results. METHODS AND MATERIALS/METHODS:Between February 1994 and November 1999, 132 high-risk patients were treated with combined hormonal therapy (9 months), permanent radioactive seed brachytherapy, and external beam RT, with follow-up ranging from 36 to 88 months (median, 50 months). The eligibility criteria were any of the following: Gleason score 8-10, initial prostate-specific antigen (PSA) level >20 ng/mL, clinical Stage T2c-T3, or positive seminal vesicle biopsy, or two or more of the following: Gleason score 7, PSA level >10-20 ng/mL, or Stage T2b. Twenty percent of patients had a positive seminal vesicle biopsy before therapy. Negative laparoscopic pelvic lymph node dissections were performed in 44% of patients. RESULTS:The actuarial overall freedom from PSA failure rate was 86% at 5 years. The freedom from PSA failure rate at 5 years was 97% for those with a Gleason score of < or =6 (35 of 36), 85% for a Gleason score of 7 (50 of 59), and 76% for a Gleason score of 8-10 (28 of 37; p = 0.03). A trend was noted toward worse outcomes in seminal vesicle biopsy-positive patients, with a 5-year freedom from PSA failure rate of 74% vs. 89% for all other patients (p = 0.06). Posttreatment prostate biopsies were performed in 47 patients and were negative in 96% at the first biopsy and 100% at the last biopsy. CONCLUSION/CONCLUSIONS:Trimodality therapy with androgen suppression, brachytherapy, and external beam RT for high-risk prostate cancer results in excellent biochemical and pathologically confirmed local control.

Bleeding into large joints is the most common orthopaedic manifestation of hemophilia. Involvement of the shoulder rarely is reported, lending to its relative neglect in the orthopaedic literature. Through retrospective chart and radiographic reviews, the incidence and progression of radiographic and clinical changes that occur in the shoulder of patients with hemophilia is described. We retrospectively reviewed 822 patient charts and found 93 patients with symptomatic shoulders. Seventy-nine of these 93 patients were rated according to Pettersson's scoring method. The clinical charts were reviewed for the presence of shoulder symptoms and dysfunction. A spectrum of radiographic changes was seen beginning with mild subchondral irregularity and greater tuberosity cyst formation progressing to joint space narrowing, osteophyte formation, marginal erosion, and deformity. Of the 54 patients for whom an adequate shoulder history was available, the severity of symptoms correlated with the Pettersson score. The current study is the largest to date examining the type and progression of radiographic changes caused by hemophilic shoulder arthropathy. We observed a consistent pattern of radiographic changes, the severity of which correlated directly with shoulder symptoms.