334 ABSTRACTS

lograft showed continued maturi ty beyond 18 months, with a statistically significant finding in all features that were evaluated.

subscapularis and teres minor intact. ASD for mas- sive rotator cuff tears is a limited-goals procedure and should be offered as such.

Arthroscopic Management of Massive Rotator Cuff Tears. Richard K. N. Ryu. Private practice, Santa Barbara, California, U.S.A.

Management of the massively torn rotator cuff poses a challenge to the children. Historically open repair has been successful; however the potential morbidity and technical difficulties are well docu- mented. Over the past decade, open and now ar- throscopic debridement alone for massive tears has been attempted, with satisfying results reported. This study was undertaken to evaluate the role of arthroscopic subacromial decompression (ASD) alone in the management of massive rotator cuff tears.

From 1986 to 1992, of the 198 ASDs performed, 29 were performed in patients with massive rotator cuff tears. A massive rotator cuff tear was defined as being >4 cm in its greatest dimension. Twenty- five of the 29 patients were available for follow-up, which averaged 21 months (range 6-58). The aver- age age was 62.1 years (range 51--81) with 15 men and 10 women comprising the study group. Addi- tional procedures included manipulation (n = 3) and Mumford procedures (n = 9). Fourteen pa- tients had labral tearing, nine had biceps lesions (four complete), and nine had significant articular chondromalacia. All operations were performed on an outpatient basis, videotaped, and reviewed.

Using the UCLA rating scale, 40% of the patients had a satisfactory outcome. Of these patients, nearly 50% had an excellent result. Pain and func- tion were improved in both the satisfactory and un- satisfactory groups, whereas improvements in strength and forward flexion were less reliable. In- dividuals with a type III acromion had a signifi- cantly higher success rate, whereas those with a "4" tendon tear pattern experienced the least ben- efit. There were no complications.

Arthroscopic subacromial decompression alone for massive rotator cufftears is a distinct alternative to open repair in selected cases. With ASD alone, excellent results can be achieved. Pain and function are reliably improved in most patients, whereas those with "4" tendon involvement may experience modest pain relief only. The ideal candidate is the older patient with a suprainfraspinatus tear pattern, complaining of pain as a primary symptom, with the

Incidence of Positive Anterior Slide Tests in Symp- tomatic and Asymptomatic Athletes. W. Ben Kibler. Lexington Clinic Sports Medicine Center, Lexing- ton, Kentucky, U.S.A.

The anterior slide test (AST) has been proposed as a clinical tool in the evaluation of superior glen- oid labral pathology. This study evaluates the inci- dence of positive anterior slide tests in three groups of symptomatic athletes [group A, with isolated su- perior glenoid labral tears (SGLT); group B, with rotator cuff pathology; and group C, with glenohu- meral instability] and in two groups of asymptom- atic athletes (group D, throwing athletes with inter- nal rotation deficit or muscle strength imbalance; and group E, lower body athletes).

AST was found to be positive in a high percent- age of cases where isolated SGLT were present. It was also positive in SGLT in the presence of other shoulder pathology. AST was shown to be negative in the absence of clinical symptoms or in the ab- sence of use. Finally, it was not associated with biomechanical deficits of inflexibility or muscle strength imbalance.

Based on these data, AST, when present, sug- gests the presence of SGLT, with or without asso- ciated pathology or adaptations.

Primary Arthroscopy in Injuries and Fractures of the Ankle Joint. Wolf-Riidiger Dingels and Astrid Gesang. Department fiir General Surgery, Trauma- tology, and Endoscopic Surgery, Sana-Krankenhaus Htirth, Hfirth/K61n, Germany.

Since 1990, primary arthroscopy in injuries of the ankle joint has been performed regularly. At this writing we have performed 204 such procedures.

After accident, anamnesis and clinical examina- tion of the patient is followed by sonographic and conventional radiological checks.

Indications for arthroscopy are established on the basis of hemarthrosis, exclusion of accompanying injuries of osteochondral fractures, graduation of outer ligament ruptures seen on video monitoring, posttraumatic diseases, blockades apart from osteo- chondritic lesions, loose bodies, hypertrophic syno- vitis, and radiological arthrosis.

The patient undergoes arthroscopy under local or general anesthesia, and we prefer a 5-mm arthro-

Arthroscopy, VoL [0, No. 3, 1994