ORTON Research Institute and ORTON Hospital

Helsinki, Finland

ORTON Research Institute and ORTON Hospital

Helsinki, Finland
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Vastamaki M.,ORTON Research Institute and ORTON Hospital | Lohman M.,University of Helsinki | Borgmastars N.,Vaasa Central Hospital
Clinical Orthopaedics and Related Research | Year: 2013

Background: Recurrent or persistent defects in the rotator cuff after its repair are common. Short- and medium-term surveys have revealed, after open repair, patients with an intact rotator cuff have increased function and ROM. However, no long-term studies have verified cuff integrity on MR arthrography or correlated it with clinical and functional outcomes. Questions/purposes: We evaluated long-term cuff integrity and fatty infiltration after open repair using MR arthrography and determined whether these findings correlated with clinical and functional results. Methods: Using MR arthrography, we retrospectively evaluated 67 patients (48 men, 19 women) who underwent open rotator cuff repair between 1980 and 1989. Their mean age at surgery was 52 years. Minimum followup was 16 years (mean, 20 years; range, 16-25 years). Results: The retear rate was 94%, and mean size of rerupture was 3.5 × 3.6 cm (ranges, 0.5-5.0 cm × 0.5-5.2 cm; median, 4 × 4 cm). The remaining four patients had a partial supraspinatus tendon tear. Fatty infiltration was marked in the supraspinatus and infraspinatus tendons. Cuff integrity correlated with clinical results: active external rotation and forward flexion, and flexion, abduction, and external rotation strengths, were better in patients with an intact rotator cuff or a small retear of 4 cm2 or less than in patients with larger tears. Cuff integrity also correlated with functional results. Conclusions: Rotator cuff integrity was lost in 94% of patients after a minimum followup of 16 years. Cuff integrity correlates well with clinical and functional results even several years postoperatively. A large retear seems to be the most important factor in deteriorating long-term clinical and functional results after open rotator cuff repair. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. © 2012 The Association of Bone and Joint Surgeons®.


Viljakka T.,ORTON Research Institute and ORTON Hospital | Tallroth K.,ORTON Research Institute and ORTON Hospital | Vastamaki M.,ORTON Research Institute and ORTON Hospital
Scandinavian Journal of Surgery | Year: 2016

Background and Aims: The natural history of Kienböck's disease is controversial. Only three papers report a pure natural history without treatment. We hypothesized that the natural course of Kienböck's disease may be better than reported. Material and Methods: We examined eight patients with Lichtman stage III Kienböck's disease without any treatment, evaluating clinical and radiological results (9 wrists; 7 men, mean age at onset of symptoms 34 years) over a period of 10–38 years (mean, 27.3 years) after symptom onset. Results:Lichtman stage remained the same in five of nine wrists. The inner structure of the lunate improved in three, remained the same in three, and deteriorated in three wrists, and its shape improved in two, remained the same in four, and deteriorated in three wrists. Pain averaged visual analog scale 3.1 at rest, 3.4 during motion, 3.6 with slight, and 5.2 with heavy exertion. The range of motion improved at extension 19% and at flexion 14%, reaching 81% and 72% of that of the contralateral wrist, and grip strength reaching 93%. The Disabilities of the Arm, Shoulder, and Hand averaged 11.3, Optional Disabilities of the Arm, Shoulder, and Hand 18.0, and Mayo Clinic score 70.0. The radiographic course did not correlate with clinical course. Conclusions:The long-term natural history of Lichtman stage III Kienböck's disease is insufficiently good to suggest thoughtful observation alone as an option to treat it. © The Finnish Surgical Society 2015.


PubMed | ORTON Research Institute and ORTON Hospital
Type: Journal Article | Journal: Clinical orthopaedics and related research | Year: 2013

Recurrent or persistent defects in the rotator cuff after its repair are common. Short- and medium-term surveys have revealed, after open repair, patients with an intact rotator cuff have increased function and ROM. However, no long-term studies have verified cuff integrity on MR arthrography or correlated it with clinical and functional outcomes.We evaluated long-term cuff integrity and fatty infiltration after open repair using MR arthrography and determined whether these findings correlated with clinical and functional results.Using MR arthrography, we retrospectively evaluated 67 patients (48 men, 19 women) who underwent open rotator cuff repair between 1980 and 1989. Their mean age at surgery was 52years. Minimum followup was 16years (mean, 20years; range, 16-25years).The retear rate was 94%, and mean size of rerupture was 3.53.6cm (ranges, 0.5-5.0cm0.5-5.2cm; median, 44cm). The remaining four patients had a partial supraspinatus tendon tear. Fatty infiltration was marked in the supraspinatus and infraspinatus tendons. Cuff integrity correlated with clinical results: active external rotation and forward flexion, and flexion, abduction, and external rotation strengths, were better in patients with an intact rotator cuff or a small retear of 4cm(2) or less than in patients with larger tears. Cuff integrity also correlated with functional results.Rotator cuff integrity was lost in 94% of patients after a minimum followup of 16years. Cuff integrity correlates well with clinical and functional results even several years postoperatively. A large retear seems to be the most important factor in deteriorating long-term clinical and functional results after open rotator cuff repair.Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.


PubMed | ORTON Research Institute and ORTON Hospital
Type: Journal Article | Journal: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society | Year: 2016

The natural history of Kienbcks disease is controversial. Only three papers report a pure natural history without treatment. We hypothesized that the natural course of Kienbcks disease may be better than reported.We examined eight patients with Lichtman stage III Kienbcks disease without any treatment, evaluating clinical and radiological results (9 wrists; 7 men, mean age at onset of symptoms 34years) over a period of 10-38years (mean, 27.3years) after symptom onset.Lichtman stage remained the same in five of nine wrists. The inner structure of the lunate improved in three, remained the same in three, and deteriorated in three wrists, and its shape improved in two, remained the same in four, and deteriorated in three wrists. Pain averaged visual analog scale 3.1 at rest, 3.4 during motion, 3.6 with slight, and 5.2 with heavy exertion. The range of motion improved at extension 19% and at flexion 14%, reaching 81% and 72% of that of the contralateral wrist, and grip strength reaching 93%. The Disabilities of the Arm, Shoulder, and Hand averaged 11.3, Optional Disabilities of the Arm, Shoulder, and Hand 18.0, and Mayo Clinic score 70.0. The radiographic course did not correlate with clinical course.The long-term natural history of Lichtman stage III Kienbcks disease is insufficiently good to suggest thoughtful observation alone as an option to treat it.

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