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Radhakrishnan R, Goh J, Tan AHC. Partial-thickness rotator cuff tears: a review of current literature on evaluation and management. Clin Shoulder Elb 2024; 27:79-87. [PMID: 37559523 PMCID: PMC10938024 DOI: 10.5397/cise.2022.01417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/12/2023] [Accepted: 03/12/2023] [Indexed: 08/11/2023] Open
Abstract
Rotator cuff disease is a common cause of shoulder pain for which partial-thickness rotator cuff tears occupy a significant proportion. Such tears are often difficult to diagnose and manage in the general clinic setting. A review of the available literature from well-known databases was performed in this study to provide a concise overview of partial-thickness rotator cuff tears to aid physicians in their understanding and management.
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Affiliation(s)
| | - Joshua Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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2
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Kim SH, Chang MY, Choi H, Lee JK. Index Finger Flexor Digitorum Profundus Function Deficit after Shoulder Arthroscopy Treated by Neurolysis: A Case Report. J Hand Surg Asian Pac Vol 2023; 28:727-732. [PMID: 38073411 DOI: 10.1142/s2424835523720232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
A 60-year-old woman presented functional deficit of the index finger flexor digitorum profundus (FDP) tendon after shoulder arthroscopic rotator cuff repair. As no recovery was observed for 10 months, we conducted an operative exploration of the median nerve and the anterior interosseous nerve, followed by an external neurolysis. The patient recovered FDP function 4.5 months after the second operation. In a patient with persistent isolated FDP dysfunction after shoulder arthroscopy, operative exploration and external neurolysis could facilitate functional recovery. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Seong Hun Kim
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Yung Chang
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Heemin Choi
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun-Ku Lee
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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3
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Gürbüz AF, Keven A, Emir Yetim E, Elasan S, Karaali K. Evaluation of the Differences in the MRI Findings Related to Primary and Secondary Adhesive Capsulitis. Can Assoc Radiol J 2023; 74:78-86. [PMID: 35938344 DOI: 10.1177/08465371221118072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6 mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.
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Affiliation(s)
| | - Ayşe Keven
- Department of Radiology, 64032Akdeniz University School of Medicine, Antalya, Turkey
| | - Emel Emir Yetim
- Department of Radiology, 64032Akdeniz University School of Medicine, Antalya, Turkey
| | - Sadi Elasan
- Department of Biostatistics, 53000Yüzüncü Yıl University, School of Medicine, Van, Turkey
| | - Kamil Karaali
- Department of Radiology, 64032Akdeniz University School of Medicine, Antalya, Turkey
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4
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Sundararajan SR, Dsouza T, Rajagopalakrishnan R, Bt P, Arumugam P, Rajasekaran S. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder - a prospective randomised study. Int Orthop 2022; 46:2593-2601. [PMID: 36048234 DOI: 10.1007/s00264-022-05558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. METHODS From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis. RESULTS Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. CONCLUSION Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
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Affiliation(s)
| | - Terence Dsouza
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Ramakanth Rajagopalakrishnan
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Palanisamy Arumugam
- Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
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5
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Gyftopoulos S, Conroy J, Koo J, Jones M, Miniaci A, Subhas N. Imaging of Patients Suspected of SLAP Tear: A Cost-Effectiveness Study. AJR Am J Roentgenol 2021. [PMID: 34406055 DOI: 10.2214/AJR.21.26420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Superior labral anterior-to-posterior (SLAP) tears are a common shoulder pathology. While MRI is the imaging gold standard for diagnosis of this pathology, the cost-effectiveness of the common MRI strategies is unclear. Objective: The primary objective of our study was to determine the cost-effectiveness of the common MRI-based strategies used for the diagnosis of SLAP tears. Methods: We created decision analytic models from the U.S. health care system perspective over a two-year time horizon for a hypothetical patient population of 25-year-olds with a previous diagnosis of SLAP tear. We used the decision models to compare the differences in incremental cost-effectiveness of the common MRI strategies and resulting treatment applied for this patient type, which included combinations of 1.5T and 3T imaging and unenhanced MRI and MR arthrogram protocols. Input data on cost, probability, and utility estimates were obtained through a comprehensive literature search. The primary effectiveness outcome was quality-adjusted life years (QALY). Costs were estimated in 2017 U.S. dollars. Results: When all imaging strategies were considered, the unenhanced 3T MRI based imaging strategy was the preferred and dominant option over 3T MR arthrography (MRA) and 1.5T imaging (MRI/MRA). When the model was run without 3T imaging as an option, 1.5T MRA was the favored option. Probabilistic sensitivity analyses confirmed the same preferred imaging strategy results. Conclusion: An unenhanced 3T MRI based strategy is the most cost-effective imaging option for patients with suspected SLAP tear. When 3T imaging is not available, 1.5T MRA is more cost-effective than 1.5T imaging. The main driver of these results is the fact that 3T MRI and 1.5T MRA are the most specific tests in these respective scenarios which results in fewer false positives and prevents unnecessary surgeries leading to decreased costs. Clinical Impact: Our cost-effectiveness model findings complement prior diagnostic accuracy work, helping produce a more comprehensive approach to define imaging utility for the SLAP patient population for radiologists, clinicians, and patients who have access to various types of MRI options.
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Baron JE, Duchman KR, Hettrich CM, Glass NA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Carpenter JE, Cox CL, Feeley BT, Frank RM, Grant JA, Jones GL, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Miller BS, Neviaser AS, Seidl AJ, Smith MV, Wright RW, Zhang AL, Wolf BR. Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization. Am J Sports Med 2021; 49:2020-2026. [PMID: 34019439 DOI: 10.1177/03635465211013709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. HYPOTHESIS Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o'clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. RESULTS In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o'clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). CONCLUSION Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Kyle R Duchman
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Shannon F Ortiz
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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- Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Julie Y Bishop
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew J Bollier
- University of Iowa, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Jonathan T Bravman
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert H Brophy
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian T Feeley
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rachel M Frank
- University of Colorado, Denver, Denver, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John A Grant
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Grant L Jones
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John E Kuhn
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Drew A Lansdown
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - C Benjamin Ma
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Eric C McCarty
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Andres S Neviaser
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Adam J Seidl
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew V Smith
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Alan L Zhang
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian R Wolf
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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7
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Matson A, Kunkel Z, Bernal-Crespo V, Chainani A, Chainani M, Finley S, Friedman L, Little D, Garrigues G. The histopathology of the humeral head in glenohumeral osteoarthritis. Osteoarthritis and Cartilage Open 2021; 3:100147. [DOI: 10.1016/j.ocarto.2021.100147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
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Abstract
Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12-18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6-9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.
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9
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Sivasubramanian H, Chua CXK, Lim SY, Manohara R, Ng ZWD, V PK, Poh KS. Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed? Orthop Traumatol Surg Res 2021; 107:102766. [PMID: 33333264 DOI: 10.1016/j.otsr.2020.102766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder. MATERIALS AND METHODS The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months. RESULTS Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01). CONCLUSION This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques. LEVEL OF STUDY II; Meta-analysis and systematic review.
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Affiliation(s)
- Harish Sivasubramanian
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Chen Xi Kasia Chua
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore.
| | - Sheng Yang Lim
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Ruben Manohara
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Zhao Wen Dennis Ng
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Prem Kumar V
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Keng Soon Poh
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
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10
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Meller R, Steimer D, Hawi N. Arthroskopische Therapie der glenohumeralen Arthrose. Arthroskopie 2020; 33:348-353. [DOI: 10.1007/s00142-020-00393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Bhattacharjee S, Lee W, Lee MJ, Shi LL. Preoperative corticosteroid joint injections within 2 weeks of shoulder arthroscopies increase postoperative infection risk. J Shoulder Elbow Surg 2019; 28:2098-2102. [PMID: 31262638 DOI: 10.1016/j.jse.2019.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is currently no consensus regarding the safe timing interval between corticosteroid shoulder injections and future shoulder arthroscopies. Our study assessed the relationship between preoperative corticosteroid injection timing and shoulder arthroscopy infectious outcomes. METHODS We used an insurance database to identify and sort all shoulder arthroscopy patients by corticosteroid shoulder injection history within 6 months before surgery. Patients who received injections were stratified by the timing of their most recent preoperative injection. The overall infection rate and rate of severe infections requiring treatment through intravenous antibiotics or surgical débridement in the 6-month postoperative period were compared using χ2 tests between the injection cohorts and a control group of patients defined as those with no injection history. RESULTS We identified 50,478 shoulder arthroscopy patients, of whom 4115 received injections in the 6-month preoperative period. We found a significant increase in both the overall infection rate (P < .0001) and severe infection rate (P < .0001) in patients who received injections within 2 weeks before surgery (n = 79; 8.86% and 6.33%, respectively) compared with those who received no injections in the 6-month preoperative period (n = 46,363; 1.56% and 0.55%, respectively). No other significant differences were observed. CONCLUSIONS Our results suggest that in patients who have received corticosteroid injections, shoulder arthroscopic procedures may be safely performed after at least 2 weeks has passed since the most recent injection to minimize the risk of postoperative infection. In addition, procedures performed within 2 weeks of an injection may increase the risk of postoperative infection.
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Affiliation(s)
| | - Wonyong Lee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Michael J Lee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
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12
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Rojas J, Familiari F, Bitzer A, Srikumaran U, Papalia R, McFarland EG. Patient Positioning in Shoulder Arthroscopy: Which is Best? Joints 2019; 7:46-55. [PMID: 31879731 PMCID: PMC6930847 DOI: 10.1055/s-0039-1697606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
When performing diagnostic and surgical arthroscopic procedures on the shoulder, the importance of patient positioning cannot be understated. The optimum patient positioning for shoulder arthroscopy should enhance intraoperative joint visualization and surgical accessibility while minimizing potential perioperative risk to the patient. Most shoulder arthroscopy procedures can be reliably performed with the patient either in the lateral decubitus (LD) or beach chair (BC) position. Although patient positioning for shoulder arthroscopy has been subject of controversy, there is no conclusive evidence to suggest superiority of one position versus another. Each position offers advantages and disadvantages and surgeon's experience and training are pivotal on selecting one position versus another. Regardless of the position, a proper positioning of the patient should provide adequate access to the joint while minimizing complications. The purpose of this review is to summarize setup and technical aspects, the advantages and disadvantages, and the possible complications of the LD and BC positions in shoulder arthroscopy.
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Affiliation(s)
- Jorge Rojas
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Villa del Sole" Clinic, Catanzaro, Italy
| | - Alexander Bitzer
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
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13
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Abstract
Glenohumeral arthritis in the young adult is a particularly challenging condition for which optimal treatment algorithms have yet to be established. Arthroscopic joint-preserving treatments have the advantage of delaying arthroplasty in this younger population while maintaining the patient's natural anatomy and do not appear to compromise later arthroplasty. Various surgical techniques are available such that the overall procedure is tailored to the patient's individual pathology. Most short- and mid-term studies show good outcomes with low conversion to total shoulder arthroplasty and sustained improvements in functional outcome scores.
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Affiliation(s)
- David C Carver
- Lake Tahoe Sports Medicine Fellowship, 212 Elks Point Road, Suite 200, PO Box 11889, Zephyr Cove, NV 89448, USA. https://twitter.com/carversportsmed
| | - Tyler J Brolin
- Department of Orthopaedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
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14
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Abstract
Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a role of early corticosteroid injection in shortening the overall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors' technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.
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Holbrook HS, Parker BR. Peripheral Nerve Injury Following Interscalene Blocks: A Systematic Review to Guide Orthopedic Surgeons. Orthopedics 2018; 41:e598-e606. [PMID: 30125041 DOI: 10.3928/01477447-20180815-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/18/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this review was to determine the incidence and duration of peripheral neurologic symptoms following interscalene blocks for shoulder surgery. Three databases were reviewed for subjective and objective injuries by guidance modality and delivery method. The incidence of neurologic injuries following single site injection interscalene blocks, 3.16%, was significantly less than the 5.24% incidence for continuous catheter infusion interscalene blocks. Less than 0.51% of peripheral neurologic symptoms persisted beyond 1 year for both groups. There is a notable risk of injury following interscalene blocks by all modes of guidance and anesthetic technique, but only a small percentage of injuries persist. [Orthopedics. 2018; 41(5):e598-e606.].
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16
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Yoo JC, Koh KH, Shon MS, Bae KH, Lim TK. Clinical Outcome after Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder. Clin Shoulder Elb 2018; 21:127-133. [PMID: 33330165 PMCID: PMC7726396 DOI: 10.5397/cise.2018.21.3.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant’s score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34–74). Mean follow-up duration was 24 months (range, 12–40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.
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Affiliation(s)
- Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Shon
- Department of Orthopaedic Surgery, National Medical Center, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kyu Hwan Bae
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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17
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Abstract
Articular cartilage injuries in the glenohumeral joint present a unique and difficult problem for the patient and surgeon alike. Various etiologies exist for the development of these cartilage lesions; therefore, treatment options are vast and must be chosen thoughtfully, especially in the young, active patient. Across all treatment modalities, the goal is for the patient to regain lasting function and mobility while decreasing pain.
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18
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Abstract
BACKGROUND The treatment of glenohumeral arthritis represents a major challenge in highly active younger patients. In these patients, an endoprosthetic treatment often achieves only unsatisfactory results with a limited lifetime of the implant. OBJECTIVES The aim of the study was to identify joint-preserving therapies for glenohumeral arthritis. MATERIALS AND METHODS For this study, an extensive and selective literature search was performed. RESULTS There are several options available for joint-preserving treatment of glenohumeral arthritis. In addition to arthroscopic debridement with treatment of concomitant pathologies, CAM procedures (CAM: comprehensive arthroscopic management) according to Millett, as well as the interposition of allografts are other options. For all therapy options, an improved range of motion and pain reduction is described. A joint gap of <2 mm, bipolar cartilage lesions and age are described as risk factors for failure of the therapies. DISCUSSION Short and mid-term results have been described for arthroscopic debridement, but there are no long-term and high-quality studies to enable us to make clear recommendations. The CAM procedure and the interposition of an allograft are demanding procedures that should be reserved for experienced arthroscopists. The therapies are an option for younger patients in accordance with individual decisions and realistic expectations.
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Affiliation(s)
- Marc-Frederic Pastor
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - Tomas Smith
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - Mathias Wellmann
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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19
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Lee SH, Joo MS, Lim KH, Kim JW. Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: Comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion. Clin Shoulder Elb 2018; 21:37-41. [PMID: 33330149 PMCID: PMC7726375 DOI: 10.5397/cise.2018.21.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/21/2018] [Accepted: 02/12/2018] [Indexed: 01/02/2023] Open
Abstract
Background The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. Methods Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. Results The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). Conclusions In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).
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Affiliation(s)
- Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Min Su Joo
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Kyeong Hoon Lim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Jeong Woo Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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20
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Schlegel TF, Abrams JS, Bushnell BD, Brock JL, Ho CP. Radiologic and clinical evaluation of a bioabsorbable collagen implant to treat partial-thickness tears: a prospective multicenter study. J Shoulder Elbow Surg 2018; 27:242-251. [PMID: 29157898 DOI: 10.1016/j.jse.2017.08.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of partial-thickness cuff tears remains controversial. Although conservative therapy may treat symptoms, these defects do not spontaneously heal and conversion to a full-thickness lesion with subsequent repair may alter the tendon footprint. The ability to induce new tissue formation and limit tear progression in intermediate- and high-grade partial-thickness tears without surgical repair may represent a significant advancement in the treatment paradigm for these lesions. METHODS We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12) or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. Following arthroscopic subacromial decompression without repair, a bioinductive implant was attached over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons and Constant-Murley scores preoperatively and at 3 and 12 months postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. RESULTS At 1-year follow-up, clinical scores improved significantly (P <.0001) and the mean tendon thickness increased by 2.0 mm (P <.0001). Magnetic resonance imaging evidence of complete healing was found in 8 patients and a considerable reduction in defect size was shown in 23, whereas 1 lesion remained stable. In 1 noncompliant patient with a high-grade articular lesion, progression to a full-thickness tear occurred while shoveling snow 1 month after surgery. No serious adverse events related to the implant were reported. CONCLUSIONS Arthroscopic implantation of a bioinductive collagen scaffold is a safe and effective treatment for intermediate- to high-grade partial-thickness rotator cuff tears of the supraspinatus tendon.
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Affiliation(s)
| | | | | | | | - Charles P Ho
- Steadman Philippon Research Institute, Vail, CO, USA
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21
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Memon M, Kay J, Ginsberg L, de Sa D, Simunovic N, Samuelsson K, Athwal GS, Ayeni OR. Arthroscopic Management of Septic Arthritis of the Native Shoulder: A Systematic Review. Arthroscopy 2018; 34:625-646.e1. [PMID: 29096980 DOI: 10.1016/j.arthro.2017.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/29/2017] [Accepted: 07/23/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate arthroscopic management of native shoulder joint septic arthritis-specifically, indications, patient outcomes, and complications. METHODS PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction was performed independently and in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction. The quality of all included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, ranges, κ values, and intraclass correlation coefficient values. RESULTS Overall, 27 studies (19 case reports and 8 case series) were identified, including 115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months). The indications for shoulder arthroscopy owing to infection included pain; limited range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count, erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication and functional improvement after a single arthroscopic procedure. However, 43 patients (37%) had ongoing symptoms or complications, including 32 (30%) who required revision arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%) in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of the humeral epiphysis developed on plain radiographs. CONCLUSIONS Arthroscopic management of native shoulder septic arthritis can yield alleviation of pain and a return to full range of motion, daily activities, and sports. However, there is a high reoperation rate, which may correlate with poor patient prognostic factors. This systematic review did not show the superiority of either arthroscopic surgery or open arthrotomy for the management of shoulder septic arthritis. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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22
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Iolascon G, Gimigliano F, Moretti A, de Sire A, Migliore A, Brandi M, Piscitelli P. Early osteoarthritis: How to define, diagnose, and manage. A systematic review. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hamamoto JT, Frank RM, Higgins JD, Provencher MT, Romeo AA, Verma NN. Shoulder Arthroscopy in the Lateral Decubitus Position. Arthrosc Tech 2017; 6:e1169-e1175. [PMID: 29354413 PMCID: PMC5621971 DOI: 10.1016/j.eats.2017.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/11/2017] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Improved visualization is imparted due to applied lateral and axial traction on the operative arm, which increases the glenohumeral joint space. To perform arthroscopy surgery in the lateral decubitus position successfully, meticulous care during patient positioning and setup must be taken. In this Technical Note, we describe the steps required to safely, efficiently, and reproducibly perform arthroscopic shoulder surgery in the lateral decubitus position.
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Affiliation(s)
- Jason T. Hamamoto
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center/Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Rachel M. Frank
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center/Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - John D. Higgins
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center/Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | | - Anthony A. Romeo
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center/Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center/Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.,Address correspondence to Nikhil N. Verma, M.D., Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, U.S.A.Department of Orthopaedic SurgeryDivision of Sports MedicineRush University Medical CenterMidwest Orthopaedics at Rush1611 West Harrison StreetSuite 300ChicagoIL60612U.S.A.
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24
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Tao MA, Karas V, Riboh JC, Laver L, Garrigues GE. Management of the Stiff Shoulder With Arthroscopic Circumferential Capsulotomy and Axillary Nerve Release. Arthrosc Tech 2017; 6:e319-24. [PMID: 28580248 DOI: 10.1016/j.eats.2016.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/04/2016] [Indexed: 02/03/2023] Open
Abstract
Management of the stiff shoulder is a common and frequently daunting clinical scenario. Arthroscopic capsular release is usually an option for management of severe, chronic glenohumeral joint contractures when conservative treatment fails. Technical hurdles including a thickened capsule, reduction in joint volume, and difficulty with positioning the shoulder intraoperatively can make this procedure challenging. In addition, incomplete release and recalcitrant stiffness are frequent issues. We believe a complete release of the capsule entails special attention to the axillary pouch and requires identification and protection of the axillary nerve. We present a technique for a complete arthroscopic circumferential capsulotomy and detail our approach to safely dissect and protect the axillary nerve under arthroscopic visualization.
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25
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Mitchell JJ, Warner BT, Horan MP, Raynor MB, Menge TJ, Greenspoon JA, Millett PJ. Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure. Am J Sports Med 2017; 45:794-802. [PMID: 27836903 DOI: 10.1177/0363546516668823] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient selection is critical when choosing between arthroscopic joint preservation and total shoulder arthroplasty in young patients with glenohumeral osteoarthritis (GHOA). PURPOSE To identify prognostic factors predictive of early failure in patients undergoing comprehensive arthroscopic management (CAM) for GHOA. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 107 shoulders in 98 patients with minimum 2-year follow-up who underwent CAM were identified and evaluated. All shoulders met clinical and radiographic criteria for total shoulder arthroplasty (TSA), but the patients opted for joint preservation with arthroscopic management. Radiographic and preoperative factors were analyzed to determine predictors of early failure, defined as progression to TSA within the study period. RESULTS There were 72 men and 26 women with a mean age of 52 years (range, 29-77 years). Seventeen (15.8%) of 107 shoulders progressed to TSA at a mean of 2 years (range, 0.46-8.2 years). Shoulder status for the rest had a mean follow-up of 3.9 years (range, 2-9.4 years). There were a number of radiographic features that were correlated with early failure. Patients who failed had significantly less preoperative joint space than did those who succeeded (1.3 vs 2.6 mm; P = .004). Higher Kellgren-Lawrence grades for osteoarthritis and age older than 50 were also associated with failure. Shoulders with Walch type B2 and C glenoid were significantly more likely to fail than were Walch types A1, A2, and B1 ( P < .05). CONCLUSION The CAM procedure has been shown to reliably improve pain and function in active patients with advanced GHOA; however, it is important to inform patients about the limitations of the procedure. Patients with less joint space and abnormal posterior glenoid shape were significantly more likely to progress to early failure.
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Affiliation(s)
| | - Brent T Warner
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - M Brett Raynor
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Travis J Menge
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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26
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Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review. Open Orthop J 2017; 11:65-76. [PMID: 28400876 PMCID: PMC5366387 DOI: 10.2174/1874325001711010065] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it. Methods: A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided. Results: Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option. Conclusion: Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.
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Affiliation(s)
| | - George Markopoulos
- Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece
| | - Eirini Devetzi
- Rheumatology 424 Military General Hospital, Thessaloniki, Greece
| | - Ilias Bisbinas
- Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece
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27
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Mannava S, Jinnah AH, Plate JF, Stone AV, Tuohy CJ, Freehill MT. Basic Shoulder Arthroscopy: Beach Chair Patient Positioning. Arthrosc Tech 2016; 5:e731-5. [PMID: 27709029 DOI: 10.1016/j.eats.2016.02.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/11/2016] [Indexed: 02/03/2023] Open
Abstract
Shoulder arthroscopy is an orthopaedic procedure that has grown significantly in popularity over the last 40 years. The 2 principle patient positions during shoulder arthroscopy include the beach chair position and lateral decubitus position. This Technical Note details the operating room setup for shoulder arthroscopy in the beach chair position. Proper positioning for this procedure will minimize potential complications and facilitate ease of surgical intervention.
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28
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Dwyer T, Henry PD, Cholvisudhi P, Chan VW, Theodoropoulos JS, Brull R. Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures. Reg Anesth Pain Med. 2015;40:431-442. [PMID: 26192546 DOI: 10.1097/aap.0000000000000178] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. WHAT'S NEW As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.
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29
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Bidwai AS, Mayne AIW, Nielsen M, Brownson P. Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder. Shoulder Elbow 2016; 8:9-13. [PMID: 27582995 PMCID: PMC4935169 DOI: 10.1177/1758573215578590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In light of recent interest in the cost-effectiveness of the treatment options available for frozen shoulder, we aimed to determine the results of limited anterior capsular release and controlled manipulation under anaesthesia (MUA) in the treatment of primary frozen shoulder in terms of patient-related outcomes measure, range of motion and re-intervention rates. METHODS This single-surgeon series included prospectively collected data on all patients undergoing capsular release with MUA from March 2011 until June 2013, with a minimum follow-up of 6 months from the index procedure. Outcome measures included pre- and postoperative Oxford Shoulder Score (OSS), range of motion and need for re-intervention. RESULTS Fifty-four procedures were performed in 52 patients. Mean age 50 years (range 42 years to 59 years); male: female ratio = 11: 41. There was a highly statistically significant improvement in both pain and function modules of the OSS (p < 0.005) and range of motion (p < 0.005) at 6 months. The median postoperative score was 41 from a maximum of 48 points, with an average mean improvement of 24 points. Seventeen patients were diabetics. There was no significant difference in pre-operative and postoperative OSS or range of motion between the diabetic group and the non-diabetic groups. No patients required surgical re-intervention. CONCLUSIONS A combination of limited capsular release and MUA for the treatment of primary frozen shoulder is a safe and effective procedure resulting in marked improvement in pain, function and range of motion.
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Affiliation(s)
| | - Alistair IW Mayne
- Alistair Mayne, Royal Liverpool & Broadgreen University Hospitals, Prescot Street, Liverpool L7 8XP, UK. Tel: 07940062214.
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30
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Abstract
Background: There is little information on the molecular factors important in healing and changes that occur in the glenoid labrum in response to injury. Using a novel animal model of acute anterior shoulder dislocation, this study characterizes the factors expressed in the glenoid labrum in response to injury and correlates their expression to glenohumeral stability. Purpose: To study the response of the glenoid labrum to injury both biomechanically and with immunohistochemical testing. Methods: An injury to the anteroinferior labrum was surgically induced in 50 male Lewis rats. Rats were sacrificed at 3, 7, 14, 28, or 42 days. Immunolocalization experiments were performed to localize the expression of growth factors and cytokines. For biomechanical testing, dynamic stiffness for anterior and posterior laxity, load to failure, stiffness, and maximum load were recorded. Statistical differences were determined at P < .05. Study Design: Descriptive laboratory study. Results: Expression of interleukin–1 beta (IL-1β), transforming growth factor–beta 1 (TGF-β1), matrix metalloproteinase 3 (MMP3), and matrix metalloproteinase 13 (MMP13) were increased in injured compared with uninjured specimens. Collagen III expression was increased early and decreased with time. Biomechanical testing verified instability by demonstrating increased anterior displacement and decreased stiffness in injured shoulders at all time points. Conclusion: This novel animal model of acute anterior shoulder dislocation showed increased expression of IL-1β, TGF-β1, MMP3, MMP13, and collagen III in the injured labral tissue at early time points. Increased anterior laxity and decreased stiffness and maximum load to failure were seen after anterior labral injury, supporting the model’s ability to re-create anterior glenohumeral instability. These data provide important information on the temporal changes occurring in a rat model of anterior glenohumeral dislocation. Clinical Relevance: Identification of factors expressed in the anterior capsule and glenoid labrum in response to injury may lead to the development of novel agents that can be used to augment glenoid labrum healing and ultimately improve both surgical and nonsurgical treatment of this common shoulder injury.
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Affiliation(s)
- Mary K Mulcahey
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
Background and Aims: Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway. Methods: We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema. Results: Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference. Conclusion: Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.
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Affiliation(s)
- Shrividya Chellam
- Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India
| | | | - Ketaki Pathak
- Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India
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Miyazaki AN, Fregoneze M, da Silva LA, Sella GDV, Garotti JER, Checchia SL. Avaliação dos resultados do tratamento não artroplástico (artroscópico) da artrose do ombro. Rev Bras Ortop 2015; 50:389-394. [DOI: 10.1016/j.rbo.2014.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miyazaki AN, Fregoneze M, da Silva LA, do Val Sella G, Garotti JER, Checchia SL. Evaluation of the results from non-arthroplastic treatment (arthroscopy) for shoulder arthrosis. Rev Bras Ortop 2015; 50:389-94. [PMID: 26417567 PMCID: PMC4563078 DOI: 10.1016/j.rboe.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/19/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the functional results from patients with arthrosis who underwent an arthroscopic procedure, in an attempt to correlate these results with the patients' epidemiological profile, surgical technique used, possible complications and postoperative protocol. METHODS Between 1998 and 2011, 31 patients (32 shoulders) with shoulder arthrosis underwent arthroscopic treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology of Santa Casa de São Paulo. Primary or secondary cases of shoulder arthrosis under the age of 70 years, in which the rotator cuff was intact, were included. Furthermore, cases in which, despite an indication for an arthroplastic procedure, an attempt to perform an alternative procedure had been chosen, were also included. The following were evaluated: sex, age, dominance, comorbidities, length of time with complaint, associated lesions, etiology, previous treatment, operation performed, postoperative protocol and pre and postoperative active ranges of motion. The functional evaluation was conducted using the UCLA criteria, before and after the operation. The joint cartilage alterations were classified in accordance with Outerbridge and the arthrosis by means of Walch. RESULTS There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation (p < 0.001) and there was a tendency (p = 0.057) toward poor results with greater length of time with complaints before the surgery. The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed. CONCLUSION Arthroscopic treatment of glenohumeral arthrosis provided functional improvement of the glenohumeral joint, with significant gains in elevation and lateral and medial rotation, and improvements in function and pain. Greater length of time with complaints was a factor strongly suggestive of worse results.
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Affiliation(s)
| | | | - Luciana Andrade da Silva
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Abstract
A case is presented of an unusual complication of shoulder arthroscopy, which was caused by incorrect location of the posterior portal, inducing neurapraxia of both the axillary and radial nerves, with significant clinical and functional sequelae. A subsequent open surgical neurolysis was required to restore normal nerve function. This type of lesion has not been reported previously. Level of evidence V.
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Affiliation(s)
- Maurilio Bruno
- Istituto Ortopedico Galeazzi IRCCS, Via Galeazzi 4, 20161, Milan, Italy
| | - Vito Lavanga
- Istituto Ortopedico Galeazzi IRCCS, Via Galeazzi 4, 20161, Milan, Italy
- Orthopaedic Department, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milan, Italy
| | - Emanuele Maiorano
- Istituto Ortopedico Galeazzi IRCCS, Via Galeazzi 4, 20161, Milan, Italy
- Orthopaedic Department, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milan, Italy
| | - Valerio Sansone
- Istituto Ortopedico Galeazzi IRCCS, Via Galeazzi 4, 20161, Milan, Italy.
- Orthopaedic Department, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milan, Italy.
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Skelley NW, Namdari S, Chamberlain AM, Keener JD, Galatz LM, Yamaguchi K. Arthroscopic debridement and capsular release for the treatment of shoulder osteoarthritis. Arthroscopy 2015; 31:494-500. [PMID: 25442651 DOI: 10.1016/j.arthro.2014.08.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/27/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate patients who underwent isolated arthroscopic debridement and capsular release without any other procedures for primary glenohumeral osteoarthritis to determine clinical and functional outcomes and time until conversion to shoulder arthroplasty. METHODS We performed a retrospective review of 33 patients who underwent arthroscopic debridement and capsular release for shoulder osteoarthritis at our institution between 2006 and 2011. All procedures were performed by a single surgeon (K.Y.). Patients were evaluated for intraoperative arthritis grade, preoperative and postoperative range or motion, American Shoulder and Elbow Surgeons (ASES) score, pain score self-assessments, radiographic evaluation, and conversion to total shoulder arthroplasty. Clinical follow-up was on average 40.3 weeks postoperatively and telephone interview follow-up was performed at a minimum of 2 years postoperatively in all patients. RESULTS There was an initial improvement in range of motion and pain scores; however, patients in our study returned to preoperative levels approximately 3.8 months after debridement and capsular release. Twenty patients (60.6%) reported that they were not satisfied with the outcome of the procedure. Total shoulder arthroplasty was undertaken in 14 (42.4%) patients an average of 8.8 months after arthroscopy. Among the 19 (57.6%) patients who did not go on to have total shoulder arthroplasty, ASES scores (42.2 to 50.8; P = .41) and visual analog scale pain scores (7.8 to 7.4; P = .59) were similar preoperatively and at final telephone follow-up. CONCLUSIONS Isolated arthroscopic debridement and capsular release without any other procedures were associated with only temporary pain relief and improvement in motion. Although there are limited nonarthroplasty surgical options available for glenohumeral arthritis, isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Nathan W Skelley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A..
| | - Surena Namdari
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Ken Yamaguchi
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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Li X, Eichinger JK, Hartshorn T, Zhou H, Matzkin EG, Warner JP. A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications. J Am Acad Orthop Surg 2015; 23:18-28. [PMID: 25538127 DOI: 10.5435/JAAOS-23-01-18] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Arthroscopic or open shoulder surgery can be performed using the lateral decubitus or beach-chair position. Advantages of the lateral decubitus position include better visualization and instrument access for certain procedures and decreased risk for cerebral hypoperfusion. Complications associated with this position include traction injuries, resulting in neurapraxia, thromboembolic events, difficulty with airway management, and the potential need to convert to an anterior open approach. One advantage of the beach-chair position is easier setup from a supine to upright position, which allows the surgeon the option to convert to an open procedure if necessary. Although rare, patients in this position may experience cerebral hypoperfusion and complications that range from cranial nerve injury to infarction. Other complications related to this position include cervical traction neurapraxia, blindness, and cardiac and embolic events. The surgeon must be cognizant of the complications associated with both positions and take extra care in the initial patient setup and coordination with the anesthesiologist to minimize the risk of complications and morbidity.
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Abstract
Arthroscopic shoulder surgery is considered a safe and effective method of treating a variety of shoulder pathologies and is associated with a low complication rate. The type and rate of complications can vary, depending on the procedure, positioning, surgical time, and anesthesia. Fortunately, neurovascular injuries occur infrequently. Numerous studies have described the proximity of neurovascular structures to portals placed in shoulder arthroscopy, in both the beach chair and the lateral decubitus positions. Accurate portal placement is important to avoid damage to adjacent neurovascular structures. Inaccurate placement of portals can lead to inadvertent damage to these structures and create more difficulty with visualization and angle of instrumentation, possibly compromising the success of the procedure. This article describes a 50-year-old man who underwent arthroscopic subacromial decompression and distal clavicle excision for persistent subacromial impingement and acromioclavicular arthritis. During postoperative follow-up, the patient had a small, bulging area located near the anterior portal site. Examination showed a well-healed anterior portal site with a small (approximately 2×2 cm), nontender, immobile mass located within the deep soft tissues just below the anterior portal incision. Ultrasound evaluation showed a pseudoaneurysm of a branch off the axillary artery. The patient underwent successful embolization of the pseudoaneurysm, with complete resolution of symptoms.
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Godinho GG, Santos FML, França FO, Freitas JMA, Mesquita FAS, Silva TSDA. Videoarthroscopic treatment of glenohumeral osteoarthritis. Rev Bras Ortop 2013; 48:69-79. [PMID: 31304114 PMCID: PMC6565914 DOI: 10.1016/j.rboe.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/28/2011] [Indexed: 11/20/2022] Open
Abstract
Objetive To evaluate possible benefits obtained through the use of surgical videoarthrosco- py in the management of glenohumeral osteoarthritis. Methods We evaluated 37 patients (38 shoulders) who underwent through surgical videoar- throscopy in the period between November 1999 and May 2009 (minimum follow-up of two years). Twenty five patients attend for revaluation and thirteen were interviewed by telephonic contact. Functional assessments were performed (UCLA, Constant, and measu- rement of range of motion -ROM-), as well as pre and post surgical radiographics. We eva- luated the influence of the following factors in the final results: the presence of chondral lesions, joint space narrowing, osteophyte presence, associated injuries (rotator cuff torn or instability), and follow-up. Among those patients interviewed by phone we evaluated the satisfaction level and if they would submit themselves again to the surgical procedure. Results It was observed significant gain towards to the function (UCLA) and the internal rotation, as well as the association between dissatisfaction and pre surgical joint space reduced. Among the operated patients, 84% were satisfied with the results and 86.6% would repeat the procedure. Conclusion Surgical videoarthroscopy presents a relevant role in management of the glenohumeral osteoarthritis, providing improvement of functional results and high levels of satisfaction.
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Affiliation(s)
- Glaydson Gomes Godinho
- Head of the Shoulder Surgery and Rehabilitation Service, Orthopedic Hospital (HO), Hospital Belo Horizonte (HBH) and Lifecenter Hospital (HLC), Belo Horizonte, MG, Brazil
- Corresponding author. Rua Prof. Otávio Coelho de Magalhães, 111, bl. C, 2° piso, Mangabeiras, CEP: 30210-300, Belo Horizonte, MG, Brazil.
| | | | - Flavio Oliveira França
- Surgeon in the Shoulder Surgery and Rehabilitation Service, HO and HLC, Belo Horizonte, MG, Brazil
| | | | | | - Thiago Serpa de Azevedo Silva
- Resident Physician (R4) in the Shoulder Surgery and Rehabilitation Service, HO, HBH and HLC, Belo Horizonte, MG, Brazil
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Williot A, Favard L. Surgical management of rotator cuff tears in adults: Prospective study of 50 consecutive patients and professional practice self-assessment. Orthop Traumatol Surg Res 2013; 99:S259-66. [PMID: 23623440 DOI: 10.1016/j.otsr.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As part of quality-improvement efforts, we self-assessed our professional practices regarding the surgical management of rotator cuff tears comparatively to recommendations issued by the French National Authority for Health (HAS). MATERIAL AND METHODS An independent observer prospectively evaluated 50 consecutive patients with rotator cuff tears treated surgically over a 1-year period. For each patient, we identified divergences with the 20 relevant HAS recommendations. RESULTS Initially, 54% of practices were found to diverge from HAS recommendations, 10% regarding the preoperative work-up, 14% the duration of initial medical treatment, and 30% the nature of the surgical procedure. DISCUSSION A review of the data showed that 26% of practices diverged from recommendations, 10% regarding the preoperative work-up, 2% the duration of initial medical treatment, and 14% the nature of the surgical procedure. Overall, for the 26% of divergent practices, 10% were related to judgement or evaluation errors and 16% to a deliberate and substantiated decision made by the surgeons. CONCLUSION The clinical practice guidelines issued by the HAS, although useful and necessary, were shown by our study to exhibit a number of limitations. Thus, our data illustrate the complexity of surgical management decisions. LEVEL OF EVIDENCE Level IV (cases series).
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Affiliation(s)
- A Williot
- Service de chirurgie orthopédique 1, hôpital Trousseau, CHU de Tours, avenue de la République, Chambray-lès-Tours, Tours, France
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Verma NN, Harris JD. Surgery: Preserving shoulder movement in advanced OA--yes we CAM! Nat Rev Rheumatol 2013; 9:386-8. [PMID: 23689229 DOI: 10.1038/nrrheum.2013.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nikhil N Verma
- Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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Godinho GG, Santos FML, França FO, Freitas JMA, Mesquita FAS, Silva TSDA. Tratamento Videoartroscópico da Osteoartrite Glenoumeral. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gross CE, Chalmers PN, Chahal J, Van Thiel G, Bach BR Jr, Cole BJ, Romeo AA. Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy 2012; 28:1889-901. [PMID: 22796143 DOI: 10.1016/j.arthro.2012.03.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/17/2012] [Accepted: 03/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this study were to conduct a systematic review of clinical outcomes after cartilage restorative and reparative procedures in the glenohumeral joint, to identify prognostic factors that predict clinical outcomes, to provide treatment recommendations based on the best available evidence, and to highlight literature gaps that require future research. METHODS We searched Medline (1948 to week 1 of February 2012) and Embase (1980 to week 5 of 2012) for studies evaluating the results of arthroscopic debridement, microfracture, osteochondral autograft or allograft transplants, and autologous chondrocyte implantation for glenohumeral chondral lesions. Other inclusion criteria included minimum 8 months' follow-up. The Oxford Level of Evidence Guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were used to rate the quality of evidence and to make treatment recommendations. RESULTS Twelve articles met our inclusion criteria, which resulted in a total of 315 patients. Six articles pertained to arthroscopic debridement (n = 249), 3 to microfracture (n = 47), 2 to osteochondral autograft transplantation (n = 15), and 1 to autologous chondrocyte implantation (n = 5). Whereas most studies reported favorable results, sample heterogeneity and differences in the use of functional and radiographic outcomes precluded a meta-analysis. Several positive and negative prognostic factors were identified. All of the eligible studies were observational, retrospective case series without control groups; the quality of evidence available for the use of the aforementioned procedures is considered "very low" and "any estimate of effect is very uncertain." CONCLUSIONS More research is necessary to determine which treatment for chondral pathology in the shoulder provides the best long-term outcomes. We encourage centers to establish the necessary alliances to conduct blinded, randomized clinical trials and prospective, comparative cohort studies necessary to rigorously determine which treatments result in the most optimal outcomes. At this time, high-quality evidence is lacking to make strong recommendations, and decision making in this patient population is performed on a case-by-case basis. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Ahn KS, Kang CH, Oh YW, Jeong WK. Correlation between magnetic resonance imaging and clinical impairment in patients with adhesive capsulitis. Skeletal Radiol 2012; 41:1301-8. [PMID: 22430562 DOI: 10.1007/s00256-012-1391-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/23/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between clinical impairment and MRI findings in patients with adhesive capsulitis. MATERIALS AND METHODS Contrast-enhanced MRI of 97 patients with a clinical diagnosis of adhesive capsulitis (AC) were retrospectively reviewed. Specific MRI criteria, including thickness and gadolinium enhancement of the joint capsule in the axillary recess and subcoracoid fat obliteration in the rotator interval, were correlated with limited range of motion (ROM) and pain. Other variables considered in this study were rotator cuff pathology, arm dominance, diabetes mellitus, age, and gender. Statistical analysis was performed using logistic and linear regression analysis. RESULTS Thickening of the joint capsule in the axillary recess correlated with limited external rotation (p < 0.01), gender (p < 0.01) and arm dominance (p < 0.05). Gadolinium enhancement of the joint capsule in the axillary recess correlated with pain intensity (p < 0.05). Subcoracoid fat obliteration in the rotator interval was not correlated with limited ROM or pain. CONCLUSIONS MRI can be a useful technique to assess several clinical impairment measures in patients with adhesive capsulitis. Thickening and gadolinium enhancement of the joint capsule in the axillary recess on MRI are associated with limited ROM and pain.
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Oh JH, Oh CH, Kim SH, Kim JH, Yoon JP, Jung JH. Clinical features of partial anterior bursal-sided supraspinatus tendon (PABST) lesions. J Shoulder Elbow Surg 2012; 21:295-303. [PMID: 22036541 DOI: 10.1016/j.jse.2011.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 07/03/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND We characterized partial anterior and bursal supraspinatus tendon (PABST) lesions and compared their clinical features, postoperative functional scores, and healing rate with full-thickness rotator cuff tears (FTRCTs) and small FTRCTs. MATERIALS AND METHODS There were 31 PABST lesions (6.2%), 392 FTRCTs, and 32 small FTRCTs among 495 shoulders with rotator cuff disorders. The mean patient age was 52.7 years in the PABST group, 60.1 years in the FTRCT group, and 56.9 years in the small FTRCT group. Functional and clinical variables were compared between the groups, and cuff healing was evaluated with computed tomography arthrography or ultrasonography. RESULTS The mean patient age was statistically lower, the mean symptom duration was shorter, and trauma was more frequent in the PABST group compared with the FTRCT and small FTRCT groups. Coronal acromial spurs were found more frequently in the PABST group than in the FTRCT group. In all groups, range of motion, visual analog scale for pain, and functional scores improved continuously throughout the follow-up. There were 2 unhealed cuffs (10.5%) in the PABST group, 72 (35.6%) in the FTRCT group (P = .146), and 5 (25%) in the small FTRCT group (P = .238). CONCLUSIONS We characterized PABST lesions that may be overlooked because of their peculiar location in the far anterolateral insertional section of the supraspinatus tendon at the bursal side. PABST lesions usually occur in younger patients, and trauma is frequently associated with acute symptom onset. Surgical treatment was effective for pain reduction and functional improvement.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Duralde XA, McClelland WB. The clinical results of arthroscopic transtendinous repair of grade III partial articular-sided supraspinatus tendon tears. Arthroscopy 2012; 28:160-8. [PMID: 22078003 DOI: 10.1016/j.arthro.2011.08.286] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 08/09/2011] [Accepted: 08/09/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical results of arthroscopic transtendinous repair of deep partial articular-sided rotator cuff tears. METHODS We retrospectively evaluated the results of 53 patients who underwent arthroscopic transtendinous repair for Ellman grade III articular-sided rotator cuff tears (>50% of the thickness of the rotator cuff). The intact bursal side of the cuff was not detached, and all associated pathology was treated. Fifty patients available for follow-up were evaluated with the American Shoulder and Elbow Surgeons (ASES) questionnaire. RESULTS American Shoulder and Elbow Surgeons scores improved from a mean of 48.0 to 89.4 (+41.4) (P < .0001). Pain scores on a visual analog scale improved from 5.7 to 1.0 (P < .0001). Ninety-eight percent of patients were satisfied with the results of surgery. Results for the 50 patients available for follow-up were excellent in 32 (64%), good in 6 (12%), fair in 6 (12%), and poor in 6 (12%). Articular-sided rotator cuff tears rarely occurred in isolation but were typically found in association with coexisting pathology suggestive of the tears' etiology. Most common were impingement lesions, seen in 94% of patients, and instability lesions such as labral tears, seen in 30% of patients. Associated procedures included acromioplasty in 47, distal clavicle resection in 29, treatment of biceps pathology in 7, and instability repair in 15. One patient sustained a postoperative pulmonary embolism, which represented the only complication. Tears varied in size from 50% to 90% of the thickness of the cuff insertion. Significant differences were identified in the results of Workers' Compensation patients. Preoperative magnetic resonance imaging and magnetic resonance arthrography were accurate in identifying a partial-thickness rotator cuff tear in less than 40% of cases. CONCLUSIONS Arthroscopic transtendinous repair of partial articular-sided rotator cuff tears is a safe and effective treatment that allows identification of commonly associated pathology and reliable improvement in pain and function. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Koh KH, Shon MS, Lim TK, Yoo JC. Clinical and magnetic resonance imaging results of arthroscopic full-layer repair of bursal-side partial-thickness rotator cuff tears. Am J Sports Med 2011; 39:1660-7. [PMID: 21737830 DOI: 10.1177/0363546511412165] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Partial rotator cuff tears are being diagnosed more often because of high-resolution magnetic resonance imaging (MRI). Articular-side partial tears are much more common than bursal-side tears, and all-inside or PASTA repairs that preserve the bursal tissue have gained popularity. In contrast, there have been few reports about preserving the articular tissue during bursal tear repair. PURPOSE To report clinical and radiological results of bursal-side partial-thickness rotator cuff tear (PTRCT) repair with preservation of as much of the intact articular-side tendon as possible. STUDY DESIGN Case series; Level of evidence, 4. METHODS From May 2006 to March 2008, 109 patients with PTRCT underwent arthroscopic repair. Among them, 38 consecutive patients who received a full-layer repair on the bursal side for greater than 50% thickness PTRCT were retrospectively evaluated. All repairs were performed with a technique that preserved intact articular fibers. To assess the outcome, pain visual analog scale (PVAS), American Shoulder and Elbow Surgeon (ASES) score, and Constant score were evaluated at final follow-up. Postoperative MRI at least 6 months after surgery was evaluated for repair integrity. RESULTS All 38 patients (21 men and 17 women) were available for final follow-up. The mean age at surgery was 50.8 years (range, 30-58 years), and the mean follow-up time was 26.9 months (range, 24-41 months). There were 21 right shoulders and 17 left shoulders, for which the mean time from the onset of symptoms to surgery was 47.0 months (±83.3 months). The PVAS improved from 5.2 (±2.5) to 1.6 (±1.5), and mean ASES and Constant scores improved from 53.1 (±20.4) and 59.9 (±15.3) to 87.2 (±9.4) and 83.2 (±12.0), respectively. Postoperative MRI was available in 33 patients at a mean 8.2 months after surgery. Twenty-nine shoulders (87.9%) had an intact repaired tendon, while 3 patients had shown partial-thickness delaminated retears, and 1 patient demonstrated a full-thickness retear on postoperative MRI. CONCLUSION For bursal-side PTRCT, clinical outcomes and tendon healing showed good results at a minimum 2 years after surgery, with minimal damage to intact articular tendon fibers on postoperative MRIs.
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Affiliation(s)
- Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Samsung Medical Center, SungKyunkwan University School of Medicine, Seoul, Korea
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Abstract
OBJECTIVE To determine if microfracture is successful in treating chondral lesions of the shoulder. DESIGN Case series. SETTING Tertiary referral practice. PATIENTS From June 2005 to November 2006, eight patients underwent shoulder arthroscopy with arthroscopic microfracture to treat full-thickness chondral lesions of less than 4 cm(2) size. The study group consisted of six men and two women. The mean age at surgery was 37 years (range: 27-55 years). One patient (12.5%) had an isolated chondral defect and seven patients (87.5%) had associated conditions treated simultaneously: two patients had arthroscopic subacromial decompressions, two had capsular plications for multidirectional instability, and three had anterior stabilization done (one with an associated superior labrum anterior to posterior repair and one with repair of a small rotator cuff tear). Five patients had humeral head defects and three had glenoid defects. INTERVENTION Microfracture. MAIN OUTCOME MEASURES Constant score and Oxford score. RESULTS The mean follow-up period was 15.4 months, with a range of 12-27 months. The mean preoperative Constant score was 43.88 (range: 28-70) and at final follow-up the mean Constant score was 90.25 (range: 85-100); this difference was significant (P<0.005). The mean preoperative Oxford score was 25.75 (range: 12-37) and the mean postoperative Oxford score at final follow-up was 17 (range: 11-27); the difference was significant (P<0.005). There were no complications. Two patients underwent reoperation which allowed assessment of the lesion; in both cases the lesions showed good filling with fibrocartilage. CONCLUSION Microfracture has been shown to be a reliable method of treatment for chondral lesions within the knee. We believe that this technique may also be applied to the shoulder; however, further study is required to assess its efficacy in this joint. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Martyn Snow
- Department of Orthopaedics Wrightington Hospital, Lancashire, England, UK
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Garofalo R, Pouliart N, Vinci E, Franceschi G, Aldegheri R, Castagna A. Anterosuperior labral tear without biceps anchor involvement: a subtle isolated cause of a painful shoulder. Arthroscopy 2011; 27:17-23. [PMID: 20950986 DOI: 10.1016/j.arthro.2010.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to determine common clinical symptoms related to an anterosuperior labral tear without biceps anchor involvement and to establish the outcome of arthroscopic management of this injury. METHODS In our database of arthroscopic procedures we identified 23 patients with an isolated anterosuperior labral tear. The mean age at the time of surgery was 38.3 ± 6.8 years (range, 18 to 59 years). The preoperative clinical diagnosis varied, but an anterosuperior labral isolated lesion was not detected before surgery. The diagnosis of anterosuperior labral tear was made arthroscopically, and the lesion was fixed with a suture anchor technique, by use of 1 single bioabsorbable anchor. Patients were reviewed after a minimum of 2.5 years of follow-up. Clinical outcome was evaluated with the Rowe score, American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and visual analog scale score. RESULTS History, clinical examination, and preoperative imaging usually failed to indicate the presence of an isolated anterosuperior labral tear as the cause of shoulder pain in our patients. Repair of the labral lesions yielded good to excellent results with normalization of the range of motion and a significant improvement in shoulder scores (Rowe, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale). CONCLUSIONS Isolated tears of the anterosuperior labrum represent a subtle cause of shoulder pain and dysfunction. The lesion is very difficult to diagnose clinically. Arthroscopic repair is a reliable procedure providing a good outcome in terms of pain relief, patient satisfaction, and shoulder scores. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Raffaele Garofalo
- Orthopedic Unit, F. Miulli Hospital, Acquaviva delle Fonti, Bari, Italy.
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Abstract
The successful diagnosis and treatment of glenohumeral arthrosis in the young and active patient can be challenging to even the most experienced of clinicians. A thorough preoperative evaluation, including a detailed understanding of patient expectations, facilitates the selection of a treatment strategy. Arthroscopy is the gold standard for detecting chondral injuries, and it is increasingly used as an effective first line of management. In patients who fail arthroscopic debridement and reparative techniques, further treatment should proceed with an algorithmic decision-making approach encompassing patient-based and disease-based factors. Restorative and reconstructive techniques may provide improvements in pain and functional outcome while delaying the need for total shoulder arthroplasty, although the longevity of these treatments has yet to be established in the literature. Hemiarthroplasty and total shoulder arthroplasty have historically proven to be the most durable and reliable options in properly selected patients. However, concerns about progressive glenoid erosion and glenoid component loosening have led many to pursue alternative nonarthroplasty techniques for the management of arthrosis in active young individuals.
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Affiliation(s)
- Karen J Boselli
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, New York, USA
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