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Biomedical subjects

C A Rockwood

Publications and source records attributed to C A Rockwood.

At least 19 recordsLinked to original sources
PubMed2001

Complications of metallic suture anchors in shoulder surgery: A report of 8 cases.

PURPOSE: Metallic suture anchors are widely used in open and arthroscopic operations about the shoulder. We report the cases of 8 patients who were referred to our institution with complications following shoulder surgery in which metallic suture anchors were used. TYPE OF STUDY: Retrospective case series. METHODS: There were 7 male patients and 1 female patient with an average age of 36 years (range, 18 to 76 years). The initial operation was open anterior reconstruction for anterior instability of the glenohumeral joint in 5 patients, open rotator cuff tear repair in 2 patients, and an open posterior capsular reconstruction for posterior instability in 1 patient. All patients were referred for evaluation after a failed index reconstructive procedure. RESULTS: On average, 5.5 suture anchors (range, 3 to 8) per shoulder were used. Of 4 patients undergoing reconstruction with glenoid anchors only, 3 patients had an extraosseously positioned device. In this subset of glenoid-sided reconstructions, when more than 3 anchors were used, at least 1 anchor was inserted in an extraosseous position. In 2 of 3 patients with isolated humeral anchors, there was evidence of migration over time (1 intra-articular, 2 bursal). Three patients (38%) developed severe articular damage that was directly caused by a loose or intra-articular metal suture anchor. One patient developed a wound infection after reconstructive surgery. In all 8 patients, the index procedure failed and required subsequent surgery. CONCLUSIONS: The use of metallic suture anchors about the shoulder is commonplace and useful, but, as with other hardware used about the shoulder, there are significant risks if the anchors are improperly placed or if the index procedure fails.

Adult↗
PubMed2001

Shoulder arthrodesis.

Current indications for shoulder arthrodesis include posttraumatic brachial plexus injuries, paralysis of the deltoid muscle and rotator cuff, chronic infection, failed revision arthroplasty, severe refractory instability, and bone deficiency following resection of a tumor in the proximal aspect of the humerus. The trapezius, levator scapulae, serratus anterior, and rhomboid muscles must be functional to optimize the functional result following shoulder arthrodesis. A consensus has not been reached concerning the ideal position of the shoulder arthrodesis, although excessive abduction or flexion has been associated with chronic postoperative pain. Decortication of both the acromiohumeral and the glenohumeral surfaces to increase the surface area available for arthrodesis is the most common means for obtaining successful fusion. Although there are numerous methods for stabilization of a shoulder arthrodesis, the most popular method today is probably the AO technique with either a single plate or double plates.

Arthrodesis↗
PubMed2001

The often overlooked posterior dislocation of the shoulder.

Unlike most shoulder dislocations, the posterior dislocation is truly a diagnostic challenge to the treating physician because it may be missed more often than it is recognized. In fact, more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years. A history of seizures, electroshock, or a fall onto a flexed, adducted arm should alert the physician to the possibility of posterior dislocation. A careful physical examination with comparison to the unaffected arm must be performed with particular attention given to subtle posterior fullness and anterior flatness of the shoulder, along with a lack of external rotation and abduction. A radiographic trauma series made in the scapular plane must always be obtained in cases of shoulder trauma to rule out posterior dislocation. A computed tomographic scan may also be necessary. The correct diagnosis of this injury will facilitate proper orthopedic evaluation and treatment and will reduce the incidence of missed posterior shoulder dislocation and its associated morbidity.

Casts, Surgical↗
PubMed1999

Isolation and characterization of polyethylene wear debris associated with osteolysis following total shoulder arthroplasty.

We evaluated the interface membranes surrounding three total shoulder prostheses that had been removed because of progressive aseptic loosening associated with osteolysis. The mean time between the uncomplicated initial arthroplasty and the revision procedure was twelve years (10.5, 10.5, and 16.0 years). Membranes from around both the humeral and the glenoid component were obtained from all three shoulders and were studied histologically to determine the biological response involved in the development of aseptic loosening. For the purpose of comparison, periprosthetic tissue was also obtained from the sites of four failed total hip prostheses that were associated with osteolysis. Polyethylene particles were retrieved with an enzymatic digestion technique that involved the use of papain. Raman vibrational spectroscopy verified that the particles were ultra-high molecular weight polyethylene. The particles were isolated from the tissue, and a computerized image-analysis system characterized 582 of them in terms of size and morphology. Each particle was defined with the use of six shape descriptors: equivalent circle diameter, roundness, form factor, aspect ratio, elongation, and outline fractal dimension. The particles from the hips had a mean equivalent circle diameter (and standard error of the mean) of 0.62 +/- 0.03 micrometer, were predominantly globular in shape, and had low mean values for aspect ratio (1.46 +/- 0.02) and elongation (1.85 +/- 0.03) and relatively high values for roundness (0.74 +/- 0.01) and form factor (0.87 +/- 0.01). In contrast, the particles from the shoulders had a mean equivalent circle diameter of 1.04 +/- 0.03 micrometers. In addition, they had relatively high values for aspect ratio (2.36 +/- 0.07) and elongation (4.96 +/- 0.23) and correspondingly low values for roundness (0.54 +/- 0.01) and form factor (0.67 +/- 0.01), indicating that they were more fibrillar in shape. The particles from the shoulders and those from the hips were significantly different (p < 0.0001) with respect to all of the descriptors except outline fractal dimension. The particles from the shoulders, in general, were larger and more fibrillar than the particles from the hips.

Aged↗
PubMed1998

Neuropathic arthropathy of the shoulder.

We retrospectively reviewed the records of six men (seven shoulders) with neuropathic arthropathy of the shoulder who were referred to our shoulder service during a twenty-eight-year period (from 1969 through 1997). The etiology of the neuropathic condition was syringomyelia in five patients (six shoulders) and chronic alcoholism in one patient. Five patients (six shoulders) were initially misdiagnosed, and seven operative procedures that were unrelated to the etiology of the neuropathic condition were performed in four of these patients. Radiographs revealed destruction of the shoulder joint and marked resorption of the humeral head in all patients. Magnetic resonance images revealed a syrinx of the central cord in all of the patients except for the one who had chronic alcoholism.

Adult↗
PubMed1998

Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder.

Between June 1983 and March 1992, we performed a capsular reconstruction procedure through an anterior approach in ten patients (ten shoulders) who had multidirectional laxity of the shoulder and symptomatic atraumatic posterior glenohumeral instability. The procedure included closure of the capsule in the rotator interval and imbrication of the anterior, inferior, and posteroinferior aspects of the capsule by a double-breasting technique that decreases the overall capsular volume. The mean duration of follow-up was sixty months (range, twenty-four to 103 months). According to the system of Rowe and Zarins, the result was graded as excellent for five shoulders, good for four, and poor for one. On the basis of our results, we recommend capsular reconstruction through an anterior approach only in patients who have persistent multidirectional laxity and symptomatic atraumatic posterior instability of the shoulder despite participation in an intensive rehabilitation program.

Adolescent↗
PubMed1998

Reconstruction of chronic and complete dislocations of the acromioclavicular joint.

The authors report on a technique for the treatment of symptomatic, chronic complete dislocations of the acromioclavicular joint. The coracoacromial ligament is substituted for the coracoclavicular ligaments, and a special temporary coracoclavicular lag screw is used to stabilize the clavicle to the coracoid during ligament healing. The technique has been used on 23 patients who were observed for an average of 5.2 years. Good to excellent results were obtained in 19 of 23 patients. The four patients with fair or poor results had one or more resections of the distal clavicle before the reconstruction. Subjectively, 22 of 23 patients reported improvement in their shoulder.

Acromioclavicular Joint↗
PubMed1997

Nonoperative management of full-thickness tears of the rotator cuff.

Rotator cuff tendonopathies are among the most common disorders encountered in the shoulder. There is an abundance of literature on the operative management of these lesions, but only a small amount devoted to nonoperative treatment of full-thickness tears of the rotator cuff. The purpose of this article is to review the literature pertaining to full-thickness tears as well as our results with expectant management.

Female↗
PubMed1997

Delayed primary repair of a kyrogenic spinal accessory nerve injury: a case report.

The course of the accessory nerve through the posterior cervical triangle is superficial and in close juxtaposition to the posterior cervical lymph node chain. These anatomic features contribute to the common occurrence of kyrogenic injury to the accessory nerve. Unfortunately, the diagnosis of this injury often is delayed because the clinical presentation may mimic shoulder impingement or adhesive capsulitis. The authors present a case with a 15-year followup of a 48-year-old woman who underwent successful delayed primary repair of an accessory nerve injury after a lymph node biopsy. Electromyographic examination is recommended at 3 weeks after a suspected accessory nerve lesion, and if evidence of trapezial denervation is present, early surgical exploration is indicated because spontaneous recovery is rare.

Accessory Nerve Injuries↗
PubMed1997

Resection arthroplasty of the sternoclavicular joint.

The results of resection of the medial end of the clavicle to treat a painful sternoclavicular joint in fifteen patients were retrospectively reviewed. The patients fell into two groups: eight patients who had had a primary arthroplasty of the sternoclavicular joint in which the costoclavicular ligament was left intact (group I), and seven patients who had had revision of a failed arthroplasty of the sternoclavicular joint and in whom the costoclavicular ligament had to be reconstructed (group II). The results for these two groups were compared at an average of 7.7 years postoperatively. All eight patients in group I had an excellent result. In sharp contrast, three patients in group II had an excellent result, three had a fair result, and one had a poor result. We conclude that preservation or reconstruction of the costoclavicular ligament is essential at the time of resection of the medial portion of the clavicle in order to obtain a satisfactory result.

Adolescent↗
PubMed1997

Operative treatment of irreparable rupture of the subscapularis.

Between 1980 and 1994, 221 shoulders with recurrent anterior glenohumeral subluxation or dislocation were reconstructed at our institution. At the time of the operation, thirteen shoulders were found to have an irreparable injury of the subscapularis muscle, which we believed to be a contributing factor to the ongoing instability. All but three of the thirteen patients had had two to six previous reconstructions. Operative treatment of the irreparable rupture included a dynamic muscle transfer using the pectoralis major in seven shoulders, the pectoralis minor in five, and both of these muscles in one. According to a modification of the grading system of Neer and Foster, the result was satisfactory for ten shoulders and unsatisfactory for three at a mean of five years after the operation. All shoulders with a satisfactory result demonstrated active contraction of the transferred pectoralis muscle and diminished anterior glenohumeral translation. On the basis of our analysis, we concluded that transfer of the pectoralis muscle is effective for reconstruction of the shoulder in patients who have loss of the subscapularis muscle.

Adult↗
PubMed1997

Treatment of complications of shoulder arthrodesis.

A reconstructive osteotomy was performed to correct symptomatic malposition after arthrodesis of the shoulder in nine of fourteen patients who had complications related to the arthrodesis. The clinical position of the arm in relation to the trunk was determined with the method described by Rowe. Malposition was primarily the result of fusion in more than 15 degrees of either flexion or abduction, or both, coupled with improper rotation, defined as rotation of less than 40 degrees or more than 60 degrees. Reconstructive osteotomy eliminated pain and improved the ability of the patient to perform six activities of daily living. The complications necessitating operative treatment after the arthrodesis in the remaining five patients included failure of the arthrodesis site to unite (three patients), a wound hematoma at the iliac-crest donor site (one patient), and a superficial wound infection (one patient). Two additional complications - a fracture through a screw-hole in the humerus and a fracture distal to the internal fixation device - occurred after the reconstructive osteotomies for malposition. All of the complications resolved with treatment. Arthrodesis of the shoulder is a technically demanding procedure that can lead to serious complications that necessitate operative intervention. Careful attention to operative technique and to the position of the arthrodesis are essential.

Activities of Daily Living↗
PubMed1997

Repair of soft tissue to bone using a biodegradable suture anchor.

The medial collateral ligaments of 18 New Zealand rabbits were surgically detached from bone. In one knee, the ligament was repaired using a biodegradable suture anchor composed of a co-polymer of lactic and glycolic acid. The contralateral medial collateral ligament was not repaired. Animals were sacrificed at 4, 8, and 12 weeks after the operation, and the knee that had the ligament repair was compared with the contralateral control knee. All knees were tested manually tested for stability to valgus stress and then prepared for histologic examination. Medial collateral ligaments repaired using the biodegradable suture anchor demonstrated stability to valgus stress and anatomic healing at the bone-tendon junction. Resorption of the implant was virtually complete by 12 weeks. All specimens demonstrated less inflammatory reaction to the suture anchor than to the attached Vicryl suture. This contrasts with the control group, which was grossly unstable and demonstrated scarring in this nonanatomic position. These results demonstrate efficacy of this particular material of biodegradable implant and justify further investigative efforts.

Animals↗
PubMed1996

The capsular imbrication procedure for recurrent anterior instability of the shoulder.

One hundred and thirty-eight patients (142 shoulders) who had recurrent anterior instability of the shoulder that was unresponsive to a specific physician-directed rehabilitation program were managed with an anatomical capsular imbrication reconstruction. The procedure included repair of the capsulolabral injury, when present, and reinforcement of the anteroinferior capsular ligaments with an imbrication technique that decreases the over-all capsular volume. The shoulders were divided into two groups: 108 shoulders in which the recurrent instability was related to a defined traumatic episode (Group I) and thirty-four shoulders with no distinct history of trauma (Group II). The anatomical capsular imbrication was the primary procedure in ninety shoulders and was used to treat at least one failed previous reconstruction in fifty-two shoulders. According to the grading system of Rowe et al., 93 per cent (132) of the shoulders had a good or excellent result at an average of five years (range, two or twelve years) after the operation. The results after a previous failed reconstruction were especially encouraging. Of the fifty-two shoulders that had had at least one previous reconstructive procedure, forty had an excellent result, five had a good result, four had a fair result, and three had a poor result. The results of this study suggest that this procedure restores stability while preserving a functional range of motion in patients who have symptomatic recurrent anterior instability of the shoulders, regardless of the etiology.

Adolescent↗