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Background: Revision anterior cruciate ligament surgery remains challenging. Purpose: To analyze the authors' experience with revision anterior cruciate ligament surgery and determine the association between stability and functional results. Study Design: Case series; Level of evidence, 4. Methods: Between 1991 and 2002, 95 of 102 patients who underwent revision anterior cruciate ligament reconstruction at the authors' institution met the criteria for inclusion in the study. Of those, the 63 (66%) who returned for complete clinical and radiologic evaluation (mean follow-up, 72.7 months) formed the study group. Subjective evaluation focused on return to sports, arthritic symptoms, and subjective International Knee Documentation Committee criteria. Clinical evaluation included examination, KT-1000 arthrometer and functional testing, and radiographic analysis of alignment and arthritis. Results: Based on International Knee Documentation Committee subjective scores and return to sports, results were rated as excellent/good in 45 patients (71%), fair in 6 (10%), and poor in 12 (19%). A grade IA or IIA Lachman and a KT-1000 arthrometer side-to-side difference of <3 mm (32/63 patients) was associated with a good/excellent result (P < .05). The mechanical axis was midline in 78% (49/63 patients). Radiographic arthritis (16 patients, 25%) was associated with duration of instability after primary failure (P < .03). Return to sports occurred in 59% (37/63 patients). Sixteen patients (25%) required a second revision surgery. Conclusion: Revision anterior cruciate ligament surgery allowed approximately 60% of patients to go back to sports, most of them at lower levels than their prerevision function. Instrumented laxity of <3 mm was associated with a better result. Radiographic arthritis was associated with duration of instability symptoms after primary failure. Patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function. [ABSTRACT FROM AUTHOR]

Background: The treatment of type II superior labral anterior posterior (SLAP) lesions remains controversial. Many surgeons are reluctant to combine a SLAP repair with an acromioplasty for fear of postoperative shoulder stiffness and a poor clinical outcome. Hypothesis: A SLAP repair and an acromioplasty done concomitantly may yield acceptable outcomes. Study Design: Case series; Level of evidence, 4. Methods: We compared the clinical results of 50 patients who had either an isolated type II SLAP repair (SLAP group, 34 patients) or a combined type II SLAP repair and acromioplasty (combined group, 16 patients). Patients were excluded for full- thickness rotator cuff tears or instability. All patients were evaluated with the L'lnsalata Functional Shoulder Rating Questionnaire, with the American Shoulder and Elbow Surgeons (ASES) questionnaire, and by subjective evaluation. Results: At an average of 3.4 years postoperatively, the L'lnsalata and ASES scores were similar for the 2 groups: 87.1 and 85.8 for the SLAP group and 85.1 and 86.5 for the combined group, respectively (P> .05). Subjectively, only 65% of the patients in the SLAP group reported a ‘good’ or ‘excellent’ satisfaction with the surgery, compared with an 81 % ‘good’ or ‘excellent’ satisfaction rating among the patients in the combined group. Seven patients (21%) in the SLAP group had postoperative clinical impingement, compared with no patients (0%) in the combined group (P < .03). Conclusions: According to our data, these 2 procedures done concomitantly may yield acceptable outcomes. Our findings indicated that a combined type II SLAP repair and acromioplasty had no negative effect clinically and, furthermore, appeared to prevent residual clinical impingement. [ABSTRACT FROM AUTHOR]

Background: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. Purpose: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. Study Design: Case control study; Level of evidence, 3. Methods: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. Results: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'lnsalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 × 7.1 mm. Conclusion: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months. [ABSTRACT FROM AUTHOR]