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Hardy V, Rony L, Bächler J, Favard L, Hubert L. Does isolated arthroscopic anterior acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2022; 108:103040. [PMID: 34389495 DOI: 10.1016/j.otsr.2021.103040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Critical shoulder angle (CSA)>35° correlates significantly with primary rotator cuff tear and re-tear after repair. Acromial axial orientation varies between individuals. The present study aimed to assess the impact of strictly anterior acromioplasty on CSA. HYPOTHESIS CSA is reduced by arthroscopic anterior acromioplasty. MATERIAL AND METHODS A single-center retrospective study included patients receiving isolated arthroscopic acromioplasty between January 2016 and December 2017. Exclusion criteria comprised history of surgery and fracture or dislocation of the shoulder. Pre- and post-operative AP shoulder radiographs were taken. The angle subtended by a line between the inferior and superior edges of the glenoid and a line between the inferior edge of the glenoid and the most lateral point on the acromion was measured. RESULTS One hundred and two patients were included: mean age, 50.5±10.1 years (range, 23-82 years). Mean CSA was 34.7±4.4° (range, 26-48°) preoperatively and 31.7±3.7° (range, 23-40°) postoperatively (p<0.001). In the group with CSA >35°, the decrease was significant: 34.4±3.2° (range, 28-40°) versus 38.9±2.8° (range, 36-48°) (p<0.001), with 64% CSA <35° after isolated anterior acromioplasty. DISCUSSION CSA was decreased by arthroscopic acromioplasty. However, in 36% of cases with preoperative CSA >35°, CSA was not normalized. CONCLUSION Anterior arthroscopic acromioplasty significantly reduced CSA in the overall population, and especially in case of high CSA. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10 Boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2021; 107:102936. [PMID: 33872821 DOI: 10.1016/j.otsr.2021.102936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/16/2020] [Indexed: 02/04/2023]
Abstract
This article has been withdrawn because we accidentally published the same article twice due to an error by the Managing editor/Elsevier. The correct version of the article has been published later in Orthop Traumatol Surg Res, 108 (2022) 103040, https://doi.org/10.1016/j.otsr.2021.103040. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Gacaferi H, Kolk A, Visser CPJ. Arthroscopic bursectomy less effective in the degenerative shoulder with chronic subacromial pain. JSES Int 2020; 5:220-227. [PMID: 33681841 PMCID: PMC7910744 DOI: 10.1016/j.jseint.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background Varying results after surgery in patients with subacromial pain syndrome (SAPS) have raised the question on whether there is a subgroup of patients that can benefit from surgery. Therefore, we aimed to identify preoperative and peroperative factors associated with a favorable patient-reported outcome after arthroscopic bursectomy in patients with SAPS. Methods Patients with chronic SAPS who underwent arthroscopic bursectomy after failed conservative management were included (n = 94). Patients were evaluated at the baseline, and 2 weeks, 8 weeks, 6 months, and 1 year after surgery. The primary outcome was the Western Ontario Rotator Cuff index (WORC) score one year after surgery. The secondary outcome measure was a visual analog scale for pain. Mixed model analyses were used to identify prognostic factors. Results The mean WORC (mean difference 39%, 95% confidence interval (CI) 32.8-45.3, P < .001) and visual analog scale pain scores (mean difference 41 mm points, 95% CI 3.37-4.88, P < .001) significantly improved one year after surgery. Nineteen patients (20%) developed a postoperative frozen shoulder. A longer duration of preoperative complaints and the peroperative identification of degenerative glenoid cartilage were associated with significantly worse WORC scores, with -0.086% per month (95% CI -0.156 to -0.016, P = .016) and -20% (95% CI -39.4 to -1.26, P = .037), respectively. Conclusion We identified demographic and clinical factors that predict the course after arthroscopic subacromial bursectomy. We found that arthroscopic bursectomy is less effective in patients with SAPS with a degenerative shoulder. This finding suggests that an improved treatment effect of arthroscopic subacromial bursectomy can be expected in patients with chronic SAPS if intra-articular pathologies such as glenohumeral osteoarthritis are sufficiently excluded.
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Affiliation(s)
- Hamez Gacaferi
- Department of Orthopedics, Alrijne Hospital, Leiden, the Netherlands.,Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Arjen Kolk
- Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Lädermann A, Chagué S, Preissmann D, Kolo FC, Rime O, Kevelham B, Bothorel H, Charbonnier C. Guided versus freehand acromioplasty during rotator cuff repair. A randomized prospective study. Orthop Traumatol Surg Res 2020; 106:651-659. [PMID: 32444201 DOI: 10.1016/j.otsr.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus on how to perform acromioplasty, particularly regarding the level and extent of bone resection, which depend on scapular and humeral morphologies. HYPOTHESIS We aimed to determine whether computer-assisted acromioplasty planning helps surgeons remove impinging bone, reduce unnecessary resections, and improve short-term outcomes of rotator cuff tears (RCR). PATIENTS AND METHODS We randomized 64 patients undergoing RCR of full-thickness supraspinatus tears into two groups: 'guided acromioplasty' (GA) and 'freehand acromioplasty' (FA). The pre- and post-operative scapula models were reconstructed using computed-tomography scans to quantify impinging bone removal, unnecessary bone resections, and identify zones of acromial bone removal. All patients were evaluated preoperatively and at 6 months to assess their range of motion (ROM), functional scores and tendon integrity using ultrasound. RESULTS The two groups did not differ in demographics, clinical or morphologic characteristics. Compared to FA, GA tended to lower impinging bone removal (55±26% vs. 43±27%, p=0.087) and to increase unnecessary resection of the total bone removed (49±22% vs. 57±27%, p=0.248). GA resulted in significant anterior under-resection, while FA resulted in significant medial over-resection. Clinical outcomes and ROM improved significantly for all patients, except for internal rotation in the GA group. There were no other significant differences between the two groups, neither in terms of post-operative scores nor in terms of clinical net improvements, nor tendon repair integrity. CONCLUSIONS This computer-assisted planning for acromioplasty during RCR proved no benefits in terms of bone removal, tendon healing, or clinical outcomes. Nonetheless such planning tools could help less experienced surgeons improve the efficacy of acromioplasty. LEVEL OF PROOF I, Randomized controlled trial (Therapeutic study).
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Sylvain Chagué
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
| | - Delphine Preissmann
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, CH-1008 Prilly, Switzerland
| | | | - Olivier Rime
- Division of Physiotherapy, La Tour Hospital, Meyrin, Switzerland
| | - Bart Kevelham
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
| | | | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Medical Research Department, Artanim Foundation, Meyrin, Switzerland
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Predicting Functional Outcomes Following Fracture Nonunion Repair-Development and Validation of a Risk Profiling Tool. J Orthop Trauma 2020; 34:e214-e220. [PMID: 32433198 DOI: 10.1097/bot.0000000000001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a tool that can be used preoperatively to identify patients at risk of poor functional outcome following operative repair of fracture nonunion. DESIGN Retrospective analysis of prospectively collected data. SETTING Academic medical center. PATIENTS/PARTICIPANTS Three hundred twenty-eight patients who underwent operative repair of a fracture nonunion were prospectively followed for a minimum of 12 months post-operatively. INTERVENTION After randomization, 223 (68%) patients comprised an experimental cohort and 105 (32%) patients comprised a separate validation cohort. Within the experimental cohort, forward stepwise multivariate logistic regression was applied to 17 independent variables to generate a predictive model identifying patients at risk of having a poor functional outcome [Predicting Risk of Function in Trauma-Nonunion (PRoFiT-NU) Score]. MAIN OUTCOME MEASUREMENTS Functional outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA). Poor outcome was defined as an SMFA function index greater than 10 points above the mean at 12 months post-operatively. RESULTS Significant predictors of poor outcome were lower extremity nonunion [odds ratio (OR) = 3.082; P = 0.021], tobacco use (OR = 2.994; P = 0.009), worker's compensation insurance (OR = 3.986; P = 0.005), radiographic bone loss (OR = 2.397; P = 0.040), and preoperative SMFA function index (OR = 1.027; P = 0.001). The PRoFiT-NU model was significant and a good predictor of poor functional outcome (χ(5) = 51.98, P < 0.0005; area under the receiver operating curve = 0.79). Within the separate validation cohort, 16% of patients had a poor outcome at a PRoFiT-NU score below 25% (low risk), 39% of patients had a poor outcome at a PRoFiT-NU score between 25% and 50% (intermediate risk), and 63% of patients had a poor outcome at a PRoFiT-NU score above 50% (high risk). CONCLUSIONS The PRoFiT-NU score is an accurate predictor of poor functional outcome following fracture nonunion repair. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence description of levels of evidence.
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2020:S1877-0568(20)30111-0. [PMID: 32276845 DOI: 10.1016/j.otsr.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Rehman Y, Jones A, Madden K, Heels-Ansdell D, Busse JW. Association of Disability Benefits and/or Litigation With Time to Return to Work After Tibia Shaft Fracture Fixation. J Occup Environ Med 2020; 62:370-374. [DOI: 10.1097/jom.0000000000001841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hohmann E, Shea K, Scheiderer B, Millett P, Imhoff A. Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthroscopy 2020; 36:913-922. [PMID: 31882271 DOI: 10.1016/j.arthro.2019.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023]
Abstract
Since the introduction of acromioplasty by Neer in 1971 and arthroscopic subacromial decompression (SAD) by Ellman in 1987, the outcomes have been reported to be consistently good. Recently it was suggested that supervised physical therapy is comparable with SAD, which was contested by other studies claiming that SAD is clearly superior to nonoperative treatment. Before consideration for treatment, the diagnosis of impingement with an intact rotator cuff must be determined by clinical history, a detailed and structured clinical examination, and appropriate imaging. In favor of SAD are published long-term studies with a minimum of 10 years outlining significant functional and clinical improvement. The main factor for failure reported was workers compensation, calcific tendinopathy, and high-grade partial-thickness tears. Studies nonsupportive of SAD suffer from bias, crossover from the nonoperative group to the operative group following failure of conservative treatment, and loss of follow-up. Recently, lateral acromion resection has been suggested as a viable alternative, effectively reducing the critical shoulder angle. Following nonoperative treatment for at least 6 weeks, SAD is a viable and good surgical option for the treatment of shoulder impingement with an intact rotator cuff. Care should be taken to avoid resection of the acromioclavicular ligament. Five millimeters of lateral acromion resection is the recommended amount of resection. Patients with chronic calcific tendinitis, workers compensation, and partial-thickness tears should not be treated by SAD alone.
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Affiliation(s)
- Erik Hohmann
- Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates; School of Medicine, University of Pretoria, South Africa.
| | - Kevin Shea
- Division of Sports Medicine and Shoulder Surgery, University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | | | - Andreas Imhoff
- Department of Orthopaedic Sports Medicine, School of Medicine and Sports Science, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
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Savin DD, Waterman BR, Sumner S, Richardson C, Newgren J, Gowd AK, Romeo AA. Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis. Am J Sports Med 2020; 48:460-465. [PMID: 31855452 DOI: 10.1177/0363546519892922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The preferred surgical technique to manage biceps-superior labral pathology is often debated, and rates of revision and persistence of pain vary widely according to surgical technique and patient characteristics. PURPOSE To evaluate the clinical and functional outcomes of patients undergoing revision subpectoral tenodesis after failed primary tenodesis or tenotomy of the long head of the biceps. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients undergoing revision biceps management by the senior surgeon between 2006 and 2016 and with a minimum 24-month follow-up were retrospectively identified. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. Patient characteristic variables were recorded. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified. RESULTS In total, 25 patients with revision biceps tenodesis were identified at a mean follow-up of 76.5 ± 31.5 months. The average age was 44.4 ± 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). There was a significant improvement in the VAS score (P < .001), SANE (P = .001), SST (P = .035), functional score (P < .001), and forward elevation (P = .028), whereas postoperative strength (P = .440), abduction (P = .100), and external rotation (P = .745) improvement failed to achieve statistical significance after revision surgery. There was no difference in postoperative outcome measures between modes of failures, concomitant procedures, and sex. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. The overall complication rate was 48%, with half of these reporting pain of >3 on a scale of 10 and 4% of patients requiring additional surgeries. CONCLUSION The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint.
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Affiliation(s)
- David D Savin
- Desert Orthopedic Center at Eisenhower, Palm Desert, California, USA
| | - Brian R Waterman
- Wake Forest University Baptist Medical Center, Winston Salem, North Carolina, USA
| | | | | | | | - Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston Salem, North Carolina, USA
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Barth J, Sirveaux F, Clavert P. Is acromioplasty justifiable? Orthop Traumatol Surg Res 2019; 105:S199-S200. [PMID: 31694802 DOI: 10.1016/j.otsr.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Johannes Barth
- Centre Ostéo-Articulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France
| | | | - Philippe Clavert
- Service de Chirurgie de l'Epaule et du Coude, Hautepierre 2, CHRU Strasbourg, Avenue Molière, 67200 Strasbourg, France.
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Idarraga AJ, Wright-Chisem A, Bohl DD, Lee S, Lin J, Holmes GB, Hamid KS. Functional Capacity Evaluation for Injuries to the Foot and Ankle. Foot Ankle Int 2019; 40:1282-1287. [PMID: 31319712 DOI: 10.1177/1071100719864694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle. METHODS A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient's preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria. RESULTS In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement (P < .001) and clearance to RTW (P = .034). CONCLUSION Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alexander J Idarraga
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Adam Wright-Chisem
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - George B Holmes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Lopiz Y, Marcelo H, Arvinius C, Rodriguez-Rodriguez L, García-Fernández C, Marco F. Is fibromyalgia a cause of arthroscopic subacromial decompression failure? Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Brix LD, Thillemann TM, Bjørnholdt KT, Nikolajsen L. High prevalence of persistent pain 6 months after arthroscopic subacromial decompression and/or acromioclavicular joint resection. SICOT J 2019; 5:21. [PMID: 31210126 PMCID: PMC6580795 DOI: 10.1051/sicotj/2019021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aims of this prospective study were to determine the prevalence of pain 6 months after arthroscopic subacromial decompression (ASD) and/or acromioclavicular joint resection (AC resection), to reveal causes of the pain, and to identify risk factors for persistent pain. Methods: Preoperatively, patients were tested for their endogenous capacity to modulate pain and completed questionnaires concerning psychological vulnerability. Patients with pain 6 months after surgery were examined by an experienced orthopaedic surgeon to reveal any shoulder pathology responsible for the pain. Results: Data from 101 patients were available for analysis 6 months after surgery. Thirty-six patients had persistent pain: 32 underwent examination by the surgeon who identified shoulder pathology in ten patients, but not in the remaining 22 in whom ongoing insurance case, unemployment, and a general tendency to worry were risk factors for persistent pain. Conclusion: The prevalence of persistent pain 6 months after ASD and/or AC resection was 35.6% (95% CI 26.1–45.8%) and the proportion of patients with shoulder pathology was 9.9%. An association between ongoing insurance case, unemployment, general tendency to worry (t-STAI), and unexplained persistent pain 6 months after surgery was found.
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Affiliation(s)
- Lone Dragnes Brix
- Department of Anaesthesiology, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark
| | - Theis Muncholm Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
| | | | - Lone Nikolajsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
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Is fibromyalgia a cause of arthroscopic subacromial decompression failure? Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:275-280. [PMID: 31040062 DOI: 10.1016/j.recot.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/19/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022] Open
Abstract
Isolated arthroscopic subacromial decompression (IASD) is a widely used surgical procedure with high success rates. However, up to 25% of patients experience residual pain. It is unclear whether aberrant central nervous system processing of pain as described in fibromyalgia (FM) could have a detrimental effect on outcomes. To test this hypothesis, the authors conducted a retrospective case- control study of patients undergoing IASD. MATERIAL AND METHODS Between 2008 and 2015, 26 patients with preoperative diagnosis of fibromyalgia and an IASD procedure were identified. Six patients were lost to follow-up. Each fibromyalgia patient was matched with one control patient (n=20) recruited from the remainder with IASD. Outcomes were assessed by DASH score (Disability Arm Shoulder and Hand), Constant (CS), relative Constant score (rCS) and Visual Analogue Scale (VAS). Patient satisfaction was determined with a single 2-level question. Failure of the IASD was defined as persistent pain (VAS>3) at last follow-up. RESULTS The average age of the sample was FM/Control group 51/48, with a mean follow-up of 36/42 months respectively. Both groups exhibited significant clinical improvement in the pain VAS, DASH and rCS at final follow-up (P<.001) compared with the preoperative scores. Mean postoperative scores FM/Control group were: Constant 63.5/74 (P=.07), rCS 82/88 (P=.18), DASH 38.9/20.7 (P=.009), VAS 3.8/2.8 (P=.2). Eighty-five percent of patients in the control group were satisfied with the surgery compared with 55% in the FM group (P=.03). Failure of the procedure was 60% in the FM group, and 30% in the control group (P=.056). CONCLUSIONS Fibromyalgia can be considered a prognostic factor of a poor postoperative outcome after an IASD. However the clinical improvement experienced by these patients over their preoperative situation leads us to recommend their surgical treatment when indicated.
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Early Results of Transcatheter Arterial Embolization for Relief of Chronic Shoulder or Elbow Pain Associated with Tendinopathy Refractory to Conservative Treatment. J Vasc Interv Radiol 2018; 29:510-517. [DOI: 10.1016/j.jvir.2017.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
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Shields E, Thirukumaran C, Noyes K, Voloshin I. A Review of a Workers' Compensation Database 2003 to 2013: Patient Factors Influencing Return to Work and Cumulative Financial Claims After Rotator Cuff Repair in Geriatric Workers' Compensation Cases. Geriatr Orthop Surg Rehabil 2017; 8:208-214. [PMID: 29318082 PMCID: PMC5755839 DOI: 10.1177/2151458517732209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/28/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Workers' compensation status is associated with poor outcomes after rotator cuff repair surgery. The purpose of this study was to analyze a database of geriatric workers' compensation patients after surgical repair of the rotator cuff and identify both medical and nonmedical patient factors that influence the time it takes for them to return to work at full duty, including a comparison of arthroscopic and open techniques. Methods An all workers' compensation database was queried for rotator cuff claims that were surgically managed using arthroscopic, open, or both approaches from 2003 to 2013 in patients aged ≥60. Primary outcomes were the number of days for return to full work (RTW) following surgery and the total reimbursement for health care. Multivariate analysis was performed, and data are presented as average ± standard deviation. Results The database yielded 1903 claims for surgically treated rotator cuff conditions (arthroscopic n = 935; open n = 926; both n = 42). In multivariate RTW analyses, we did not find a significant difference between groups (RTW in days was 153 ± 134 for arthroscopy [P = .81], 160 ± 160 for open [Ref], and 140 ± 82 days for both [P = .75]). However, multivariate analysis of reimbursement claims found arthroscopic surgery claims to be 13% higher compared to claims for open surgery only (US $29 986 ± 16 259 for arthroscopy vs US $26 495 ± 13 186 for open, P < .001). Patients aged ≥65 had more medical expenses than patients aged 60 to 64 (P = .03). Potentially modifiable variables that significantly prolonged RTW timing and higher health-care claims included need for vocational rehabilitation services and filing of a legal suit. Conclusions Return to full-duty work in geriatric workers' compensation patients after rotator cuff repair takes about 5 months regardless of surgical approach and costs significantly more in patients aged ≥65. Arthroscopic repairs generated 13% more cumulative health-care costs than open surgery alone. More efficient vocational rehabilitation services and minimizing legal suits may help get patients back to work sooner and reduce overall costs.
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Affiliation(s)
- Edward Shields
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Katia Noyes
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ilya Voloshin
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
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Jacobsen JR, Jensen CM, Deutch SR. Acromioplasty in patients selected for operation by national guidelines. J Shoulder Elbow Surg 2017; 26:1854-1861. [PMID: 28688937 DOI: 10.1016/j.jse.2017.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/16/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder impingement syndrome is the most common shoulder disorder. Even though conservative treatment is the primary treatment of choice, surgery has increased substantially in several countries during the last 20 years. This has resulted in recommended clinical guidelines for treatment of shoulder impingement syndrome in countries such as The Netherlands and Denmark during recent years. The aim of this study was to investigate the effectiveness of an arthroscopic subacromial decompression in 244 patients selected for surgery according to national clinical guidelines. MATERIALS AND METHODS Patients were included from an Internet-based shoulder and elbow database. They were asked to complete 2 questionnaires consisting of the Oxford Shoulder Score (OSS) and the EuroQol 5-Dimension 3-Level and visual analog scale preoperatively and at 6-month follow-up. All patients were carefully selected for surgery according to the national guidelines, with symptoms persisting for at least 6 months. Furthermore, subgroups related to the OSS were formed to assess the clinical outcome according to preoperative status and age. RESULTS For the complete study group, an OSS change of 10 (8.8-11.2; P = .0001) was found at 6-month follow-up. No significant difference was found between the genders (P = .17). The largest clinical effect from the intervention was found in the low preoperative OSS (pre-OSS) group, in which a mean change of 17 was found. The moderate and high pre-OSS groups had mean changes of 13 and 5, respectively. Similarly, according to the EuroQol 5-Dimension 3-Level and visual analog scale, the largest improvements were seen in the low and moderate pre-OSS groups. CONCLUSION Arthroscopic subacromial decompression is a valid treatment, reducing pain and improving quality of life for patients selected for surgery according to the Danish national guidelines.
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Affiliation(s)
- Jón Rói Jacobsen
- Department of Orthopaedic Surgery, Regional Hospital Randers, Randers, Denmark.
| | - Carsten M Jensen
- Department of Orthopaedic Surgery, Regional Hospital Randers, Randers, Denmark
| | - Søren R Deutch
- Department of Orthopaedic Surgery, Regional Hospital Randers, Randers, Denmark
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Jodoin M, Rouleau DM, Larson-Dupuis C, Benoit B, Leduc S, Laflamme GY, Gosselin N, Sabir M, De Beaumont L. Effects of concomitant mild traumatic brain injury on resuming work after suffering from an isolated limb fracture: A cohort study. Brain Inj 2017; 31:1683-1688. [PMID: 28876146 DOI: 10.1080/02699052.2017.1341644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated limb fracture. This follow-up study included a total of 170 working age subjects with an isolated limb fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. METHODS Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers' compensation status was obtained through the hospitals' orthopaedic clinic data. RESULTS The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers' compensation, the mTBI group still missed significantly more days of work (M = 299.4 days; SD = 333.0) than the control group (M = 105.2 days; SD = 121.6) (p < 0.0001). CONCLUSION This study shows that mTBI increases work disability by preventing working-age individuals from rapidly returning to work.
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Affiliation(s)
- Marianne Jodoin
- a Department of Psychology , University of Montreal , Montreal , QC , Canada.,b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | | | - Camille Larson-Dupuis
- a Department of Psychology , University of Montreal , Montreal , QC , Canada.,b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - Benoit Benoit
- b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - Stéphane Leduc
- b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - G-Yves Laflamme
- b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - Nadia Gosselin
- a Department of Psychology , University of Montreal , Montreal , QC , Canada.,b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - Meriem Sabir
- a Department of Psychology , University of Montreal , Montreal , QC , Canada.,b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada
| | - Louis De Beaumont
- b Montreal Sacred Heart Hospital Research Centre , Montreal , QC , Canada.,c Department of Surgery , University of Montreal , Montreal , QC , Canada
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Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers' compensation cases. J Shoulder Elbow Surg 2016; 25:1115-21. [PMID: 27066964 DOI: 10.1016/j.jse.2016.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/25/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study analyzed workers' compensation patients after surgical or nonoperative treatment of clavicle fractures to identify factors that influence the time for return to work and total health care reimbursement claims. We hypothesized that return to work for operative patients would be faster. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and Current Procedural Terminology codes were used to retrospectively query the Workers' Compensation national database. The outcomes of interest were the number of days for return to full work after surgery and total reimbursement for health care-related claims. The primary independent variable was treatment modality. RESULTS There were 169 claims for clavicle fractures within the database (surgical, n = 34; nonoperative, n = 135). The average health care claims reimbursed were $29,136 ± $26,998 for surgical management compared with $8366 ± $14,758 for nonoperative management (P < .001). We did not find a statistically significant difference between surgical (196 ± 287 days) and nonoperative (69 ± 94 days) treatment groups in their time to return to work (P = .06); however, there was high variability in both groups. Litigation was an independent predictor of prolonged return to work (P = .007) and higher health care costs (P = .003). CONCLUSION Workers' compensation patients treated for clavicle fractures return to work at roughly the same time whether they are treated surgically or nonoperatively, with surgery being roughly 3 times more expensive. There was a substantial amount of variability in return to work timing by subjects in both groups. Litigation was a predictor of longer return to work timing and higher health care costs.
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