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The aim of this study is to describe a new surgical procedure to plicate the anterior bundle medial collateral ligament (aMCL) into its humeral footprint using a suture anchor, and to present the results of a preliminary clinical series. Eight patients with posttraumatic medial elbow pain and signs of medial elbow instability underwent aMCL plication with suture anchors and decompression of ulnar nerve. Arthroscopic evaluation permitted to define signs of minor medial elbow instability; 70°-scope was used to document from an intra-articular point of view of the aMCL status. The patients were then retrospectively evaluated with the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPI) and single-assessment numeric evaluation (SANE) by an independent examiner. In all cases, the 70°-scope allowed direct visualization of the aMCL. Lateral subluxation of the coronoid process into the trochlea was observed in all patients. Postoperative median SANE was 50 [35–74.5] points; postoperative median OES was 17 [15.5–31.5] points; postoperative median MEPI was 65 [57.5–72.5] points. None of the patients reported further episodes of medial elbow instability or pain and all patients returned to normal daily activities. The 70°-scope arthroscopic evaluation of the joint allows a direct evaluation of the inner aMCL status. Lateral subluxation of the coronoid process into the trochlea was observed and can be considered a sign of minor medial elbow instability. Mini-open suture anchor aMCL plication is an original technique that enables an anatomic and minimally invasive ligament retension. The authors introduce a valid and safe treatment of posttraumatic medial elbow laxity.

The presence of intra-articular findings that may complement the extra-articular pathology in lateral epicondilytis has been suggested, and a role for minor instability of the elbow as part of the causative process of this disease has been postulated. This study was designed to describe two new clinical tests, aimed at detecting intra-articular pathology in patients affected by recalcitrant lateral epicondylitis and investigate their diagnostic performance. Ten patients suffering of atraumatic lateral elbow pain unresponsive to conservative treatment were considered in this study. Two clinical tests were developed and administrated prior to arthroscopy: Supination and Antero-Lateral pain Test (SALT); Posterior Elbow Pain by Palpation-Extension of the Radiocapitellar joint (PEPPER). Sensitivity, specificity, predictive values and accuracy of SALT and PEPPER as diagnostic tests for seven intra-articular findings were calculated. In 90% of the patients, at least one test was positive. All patients with signs of lateral ligamentous patholaxity or intra-articular abnormal findings had a positive response to at least one of the two tests. SALT proved to have a high sensitivity but a low specificity and is accurate in detecting the presence of intra-articular abnormal findings, especially synovitis. PEPPER test was sensible, specific and accurate in the detection of radial head chondropathy. Two new diagnostic tests (SALT and PEPPER) were specifically designed to evoke pain from intra-articular structures. These tests could be a valid support in the diagnostic algorithm of recalcitrant lateral elbow pain. Positive findings may be indicative of a minor instability of the lateral elbow condition. Diagnostic study, development of diagnostic criteria on basis of consecutive patients, level II.

The aim of this literature review was to report complications associated with arthroscopic rotator cuff repair (RCR). A computerized search of articles published between 200 and 2009 was performed using MEDLINE and PubMed. We included clinical studies (Level 1-4): (a) investigating patients with rotator cuff tears, managed by a completely arthroscopic RCR technique; (b) reported data about complications. Data about arthroscopic-assisted techniques were excluded. Articles that meet criteria inclusion were analytically examined. Complications were classified into general complications and specific complications related to arthroscopic RCR. We found 414 complications in 2,890 patients; most of them were specific complications related to arthroscopic RCR. Re-rupture was the most frequently encountered complication: re-tear rate ranged between 11.4 and 94%. Stiffness and hardware-related complications were observed in 74 and 12 patients, respectively. Eleven less common complications were also reported: 5 neurovascular, 3 septic, 2 thromboembolic events, and 1 anesthesiological complication. This review stated that arthroscopic RCR is a low-risk surgical procedure. Anatomical failure of the repair is the most common complication encountered in the literature.

During standard acromioplasty, the inferior fibers of the coracoacromial ligament are inevitably detached. Partial or complete sectioning of the coracoacromial ligament results in secondary weakening of the deltoid muscle and an incremental risk of anterior-superior glenohumeral migration. This technique allows the re-attachment of the inferior fibers to the intact portion of the ligament and re-establishes mechanical continuity of the coracohumeral arc.

The aim of this retrospective study was to report clinical results of a selective population undergone to arthroscopic functional repair of massive, contracted, immobile rotator cuff tears.From 2005 to 2009, 311 patients with rotator cuff tears were treated at our institution. Of them, 26 shoulders in 25 patients with a mean age of 64 years that presented a massive, contracted immobile tear repaired using an interval slide technique, were included in this study.The mean postoperative follow-up period was 39 months (range 19-70 months). The mean postoperative disabilities of the arm, shoulder and hand (DASH) score and simple shoulder test (SST) score were, respectively, 20.91 and 8.8 (range DASH: 0.83-59.1; range SST: 2-12). Based on single assessment numeric evaluation score, the outcome of surgery was satisfactory with a mean of 76 % (range 0-100 %). The residual level of pain was low, as reported by a final mean visual analog scale score of 1.8 (range 0-8). The mean postoperative range of motion was 157.5° in forward elevation (range 90°-180°) and 55.3° in extra rotation (range 0°-90°). Eleven patients reached mid-back, in 7, the lower back and in 8 cases, upper back.Arthroscopic functional repair could be considered an appropriate treatment option in case of massive, contracted and immobile cuff tears. This treatment can provide improvement in pain and function that positively affects patients' quality of life without precluding other, more invasive, eventually consequent solutions.