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Petrie KA, Lowenstein NA, Collins JE, Matzkin EG. Increased patient resilience scores are related to positive postoperative outcomes in rotator cuff repairs. J Shoulder Elbow Surg 2024; 33:1068-1074. [PMID: 37866753 DOI: 10.1016/j.jse.2023.09.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/24/2023]
Abstract
HYPOTHESIS We sought to determine whether patients' preoperative resilience scores predict postoperative outcomes in arthroscopic rotator cuff repair surgery. METHODS Patients were prospectively enrolled and underwent data collection preoperatively and at 3, 6, 12, and 24 months postoperatively. Data collected included demographic characteristics and the Brief Resilience Scale (BRS) score, visual analog scale score, Veterans RAND 12-Item Health Survey scores (mental component [VR-12M] and physical component [VR-12P]), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single Assessment Numeric Evaluation score, and Simple Shoulder Test (SST) score. RESULTS In total, 131 patients had complete 1- or 2-year postoperative outcome measures. Female patients comprised 56.5% of our sample, and the average age was 57.6 years. Between the low, normal, and high resilience groups, there were significant differences in the VR-12M scores at 0, 12, and 24 months postoperatively (P < .01 for all). The VR-12P scores at 12 months were 44.2, 47.4, and 49.8 in the low, normal, and high resilience groups, respectively, showing a trend upward, but this failed to reach the level of significance (P = .08). The SST scores of the low, normal, and high resilience groups at 12 months were 69.1, 79.9, and 85.1, respectively, again showing a trend upward, but this failed to reach the level of significance (P = .07). The SST scores at 0 and 24 months did not differ between groups. There were no significant differences in American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores at 0, 12, or 24 months postoperatively. We found a significant positive correlation between the BRS score and SST score at 12 months (R = 0.18), VR-12M score at 12 months (R = 0.38), VR-12M score at 24 months (R = 0.31), and VR-12P score at 12 months (R = 0.21). CONCLUSIONS Our study provides evidence that BRS scores in patients undergoing arthroscopic rotator cuff repair are related to postoperative outcomes, measured through the VR-12M and SST scores at 2-year follow-up.
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Affiliation(s)
- Kyla A Petrie
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Jamie E Collins
- Department of Orthopaedic Surgery, Mass General Brigham, Boston, MA, USA
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Ranieri R, Illuminati M, Conti M, Delle Rose G, Minelli M, Castagna A. Surgical Treatment of Shoulder Pathologies in Professional Gymnasts: Findings, Treatment, and Clinical Outcomes. J Clin Med 2024; 13:2183. [PMID: 38673456 DOI: 10.3390/jcm13082183] [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: 01/25/2024] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: This study aims to investigate the impact of shoulder surgery on professional gymnasts through a case series, analyzing the mechanisms of injury and the shoulder lesion patterns, and reporting the clinical outcomes and return to sport. Methods: Twenty-nine surgically treated shoulders in twenty-seven professional gymnasts were retrospectively analyzed. Patients were stratified based on predominant symptoms and anatomical lesions in painful or unstable shoulders. Demographic and injury data, pathological findings, surgical procedure information, and data on time and level of return to sport were collected. Results: The average age of participants was 20.2 ± 3.8 years. Acute traumatic onset was reported in 51.8% of cases. Shoulders were categorized as painful in 13 cases and unstable in 16 cases. The most common pathologies were capsulolabral injuries (72%), biceps injuries (48%), and rotator cuff injuries (40%). All of the athletes returned to training within an average of 7.3 months, while the return to competition rate was 56%, achieved in an average of 10.3 months. The sport-specific subjective shoulder value was 84.8% ± 16.6%. Half of the patients who stopped competition reported reasons related to symptom persistence, while the other half reported personal reasons. No significant difference in the return to sport was reported in the cases of painful or unstable shoulder. Conclusions: Professional gymnasts requiring shoulder surgery commonly present multiple and complex lesions. Returning to training was possible in all cases; however, the possibility of persisting symptoms and other personal factors which may compromise the return to competition should be discussed with the athlete to give them insights into the possible outcomes.
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Affiliation(s)
- Riccardo Ranieri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Rozzano, Italy
| | - Matteo Illuminati
- Department of Orthopaedics and Traumatology, University Vita-Salute San Raffaele, IRCCS San Raffaele Hospital, Via Olgettina 58, 20132 Milan, Italy
| | - Marco Conti
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Italy
| | - Giacomo Delle Rose
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marco Minelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Rozzano, Italy
| | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Rozzano, Italy
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Italy
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Stambaugh JR, Bryan TP, Edmonds EW, Pennock AT. Arthroscopic Shoulder Stabilization in High School Football Players. Orthop J Sports Med 2024; 12:23259671241239334. [PMID: 38584991 PMCID: PMC10998486 DOI: 10.1177/23259671241239334] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 04/09/2024] Open
Abstract
Background Destabilizing shoulder injuries are common in high school American football players; however, the rate of recurrent glenohumeral instability and return to play after arthroscopic labral stabilization surgery remains unknown. Purpose/Hypothesis The purpose of this study was to determine the rate of recurrent instability on return to competitive high school football after arthroscopic shoulder labral stabilization and capsulorrhaphy procedures. It was hypothesized that the instability rate would be greater in players with more years of eligibility remaining (YER) to play at the high school level. Study Design Case series; Level of evidence, 4. Methods Consecutive male high school football players with at least 1 YER who sustained at least 1 anterior traumatic inseason shoulder instability episode and underwent arthroscopic stabilization between 2012 and 2017 were identified. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistical analysis was conducted using chi-square tests to compare recurrent shoulder instability with return to play and YER. Results A total of 45 football players aged 14 to 17 years were included, with a mean follow-up of 4.1 years. Most patients (60%) chose not to return to competitive football, due mainly to fear of recurrent injury. Overall, the recurrent instability rate was 15.6% (7/45). The instability rate in players who returned to football was 16.7%, with 66.7% requiring revision surgery. The instability rate in patients who did not return to football was 14.8%, with no revision procedures required. In players who returned to football, the instability rate in YER group 4 was significantly higher than that in YER groups 1 to 3 (42% vs 10.5%, respectively, P = .03), with each year of play conferring an additional 10% risk of reinjury. There was a significant difference in the type of recurrent instability in players who returned to any sport versus those who did not (P = .029). Conclusion High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their YER. Over half of the players chose not to return to football, with fear of reinjury being the most common reason.
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Affiliation(s)
- Jessica R. Stambaugh
- Department of Orthopedic Surgery, Naval Medical Center, San Diego, California, USA
| | - Tracey P. Bryan
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Eric W. Edmonds
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Andrew T. Pennock
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
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Ozdag Y, Hayes DS, Garcia VC, El Koussaify J, Manzar S, Vaughan AK, Davis DE, Grandizio LC. Surgeons Factors and Trends Associated with the Use of Subacromial Decompression at the Time of Rotator Cuff Repair. J Hand Surg Am 2024:S0363-5023(24)00056-X. [PMID: 38556963 DOI: 10.1016/j.jhsa.2024.02.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Subacromial decompression (SAD) has historically been described as an essential part of the surgical treatment of rotator cuff disorders. However, investigations throughout the 21st century have increasingly questioned the need for routine SAD during rotator cuff repair (RCR). Our purpose was to assess for changes in the incidence of SAD performed during RCR over a 12-year period. In addition, we aimed to characterize surgeon and practice factors associated with SAD use. METHODS Records from two large tertiary referral systems in the United States from 2010 to 2021 were reviewed. All cases of RCR with and without SAD were identified. The outcome of interest was the proportion of SAD performed during RCR across years and by surgeon. Surgeon-specific characteristics included institution, fellowship training, surgical volume, academic practice, and years in practice. Yearly trends were assessed using binomial logistic regression modeling, with a random effect accounting for surgeon-specific variability. RESULTS During the study period, 37,165 RCR surgeries were performed by 104 surgeons. Of these cases, 71% underwent SAD during RCR. SAD use decreased by 11%. The multivariable model found that surgeons in academic practice, those with lower surgical volume, and those with increasing years in practice were significantly associated with increased odds of performing SAD. Surgeons with fellowship training were significantly more likely to use SAD over time, with the greatest odds of SAD noted for sports medicine surgeons (odds ratio = 3.04). CONCLUSIONS Although SAD use during RCR appears to be decreasing, multiple surgeon and practice factors (years in practice, fellowship training, volume, and academic practice) are associated with a change in SAD use. CLINICAL RELEVANCE These data suggest that early-career surgeons entering practice are likely driving the trend of declining SAD. Despite evidence suggesting limited clinical benefits, SAD remains commonly performed; future studies should endeavor to determine factors associated with practice changes among surgeons.
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Affiliation(s)
- Yagiz Ozdag
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Daniel S Hayes
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Victoria C Garcia
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Jad El Koussaify
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Shahid Manzar
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | | | | | - Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Horan MP, Rupp MC, Millett PJ. Patient-reported outcomes of arthroscopic repair for partial or full-thickness upper third subscapularis tendon tears with open sub-pectoral biceps tenodesis: minimum 10-year outcomes. J Shoulder Elbow Surg 2024; 33:832-840. [PMID: 37659702 DOI: 10.1016/j.jse.2023.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Although short-term results are promising, there are limited data for long-term results of arthroscopic subscapularis (SSC) repair. The purpose of this study is to report minimum 10-year outcomes of primary arthroscopic repair of isolated partial or full-thickness tears of the upper third of the SSC tendon. METHODS Patients who underwent arthroscopic repair of isolated upper third SSC tears, Lafosse type I (>50% of tendon thickness) or type II were included. Surgeries were performed by a single surgeon between November 2005 and August 2011. Patient-reported outcome measures were prospectively collected and retrospectively reviewed at minimum follow-up of 10 years. Patient-reported outcomes utilized included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score (SANE), Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the Short Form 12 physical component summary, return to activity, and patient satisfaction. A subanalysis of patient age and outcomes was performed. Retears, revision surgeries, and surgical complications were recorded. RESULTS In total, 29 patients with isolated upper third SSC repairs were identified. After application of exclusion criteria, 14 patients were included in the final analysis. Follow-up could be obtained from 11 patients. The mean age at surgery was 52.7 years (range: 36-72) and the mean follow-up was 12 years (range 10-15 years). The American Shoulder and Elbow Surgeons score improved from 52.9 ± 21.8 preoperatively to 92.2 ± 13.7 postoperatively (P < .001). Regarding the SANE and QuickDASH scores, only postoperative data were available. Mean postoperative SANE, QuickDASH, and Short Form 12 physical component summary scores were 90.27 ± 10.5, 14.6 ± 15.5, and 49.2 ± 6.6, respectively. Median patient satisfaction was 10 (range 6-10). Patients reported improvements in sleep, activities of daily living, and sports. There was no correlation between patient age and clinical outcome (P > .05). No patients underwent revision surgery for a SSC retear. CONCLUSION Arthroscopic repair of upper third SSC tendon tears leads to improved clinical scores and high patient satisfaction at minimum 10-year follow-up. The procedure is durable, with no failures in the presented cohort.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, CO, USA; Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Maria E Dey Hazra
- Steadman Philippon Research Institute, Vail, CO, USA; Private Practice, Dr. Ulf Kuhlee, Berlin, Berlin, Germany
| | | | | | | | - Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopaedic Sports Medicine, Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Baum C, Audigé L, Stojanov T, Müller SA, Candrian C, Müller AM, Rosso C, Fankhauser L, Willscheid G, Moroder P, Akgün D, Danzinger V, Gebauer H, Imiolczyk JP, Karpinski K, Lacheta L, Minkus M, Paksoy A, Samaniego E, Thiele K, Weiss I, Suter T, Müller-Lebschi J, Mueller S, Saner M, Haag-Schumacher C, Tamborrini-Schütz G, Trong MLD, Buitrago-Tellez C, Hasler J, Riede U, Weber S, Moor B, Biner M, Fournier S, Gallusser N, Marietan D, Pawlak S, Spormann C, Hansen B, Mamisch N, Durchholz H, Bräm J, Cunningham G, Kourhani A, Ossipow S, Simao P, Lädermann A, Egli R, Erdbrink S, Flückiger R, Lombardo P, Pinworasarn T, Scacchi P, Weihs J, Zumstein M, Flury M, Berther R, Ehrmann C, Hübscher L, Schwappach D, Eid K, Bensler S, Fritz Y, Grünberger N, Kriechling P, Langthaler D, Niehaus R, Nobs R, Benninger E, de Groot Q, Doert A, Ebert S, Grimm P, Mottier F, Pisan M, Schätz J, Schwank A, Wiedenbach J, Scheibel M, Audigé L, Bellmann F, Brune D, de Jong M, Diermayr S, Endell D, Etter M, Freislederer F, Gkikopoulos N, Glanzmann M, Grobet C, Jung C, Moro F, Moroder P, Ringer R, Schätz J, Schwyzer HK, Weber B, Wehrli M, Wirth B, Nötzli M, Franz A, Oswald J, Steiger B, Ameziane Y, Child C, Spagna G, Candrian C, Del Grande F, Feltri P, Filardo G, Marbach F, Schönweger F, Jost B, Badulescu M, Lüscher S, Napieralski F, Öhrström L, Olach M, Rechsteiner J, Scheler J, Spross C, Zdravkovic V, Zumstein MA, Chlasta A, Gerber K, Hayoz A, Müller-Lebschi J, Schuster F, Wieser K, Borbas P, Bouaicha S, Camenzind R, Catanzaro S, Gerber C, Grubhofer F, Hasler A, Hochreiter B, Marcus R, Selman F, Sutter R, Wyss S, Appenzeller-Herzog C, Aghlmandi S, Ahlborn I, Baum C, Eckers F, Grezda K, Hatz S, Hunziker S, Stojanov T, Taha M, Tamborrini-Schütz G, Mueller AM. Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon. Am J Sports Med 2024; 52:441-450. [PMID: 38259113 PMCID: PMC10838469 DOI: 10.1177/03635465231219253] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/02/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.
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Affiliation(s)
- Cornelia Baum
- Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Thomas Stojanov
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Sebastian A. Müller
- Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Candrian
- Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Andreas M. Müller
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandra Weber
- Hôpital du Valais–Centre Hospitalier du Valais Romand, Martigny, CH
| | | | | | | | | | | | | | | | | | | | | | - Jakob Bräm
- Hirslanden Clinique la Colline, Geneva, CH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Larissa Hübscher
- Institute of Social and Preventive Medicine, University of Bern, Bern, CH
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- University Library Basel, University of Basel, Basel, CH
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Scanaliato JP, Dunn JC, Polmear MM, Czajkowski H, Green CK, Tomaino MM, Parnes N. Acromial Morphology Does Not Correlate with Age at Time of Rotator Cuff Tear: A Cross-Sectional Study. Shoulder Elbow 2023; 15:40-45. [PMID: 37974607 PMCID: PMC10649486 DOI: 10.1177/17585732221077944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2023]
Abstract
Background The purpose of this study was to determine if scapular anatomy differs between younger and older patients with atraumatic full-thickness supraspinatus tears. Methods The critical shoulder angle, acromial index and lateral acromial angle were measured on standardized radiographs of two groups of patients who underwent arthroscopic repair of full-thickness degenerative supraspinatus tears. Group 1 included 61 patients under the age of 50 years while Group 2 included 45 patients over the age of 70 years. The mean critical shoulder angle, acromial index, and lateral acromial angle were then compared. Results There was no significant difference between groups for the critical shoulder angle (p = .433), acromial index (p = .881) or lateral acromial angle (p = .263). Interobserver reliability for critical shoulder angle, acromial index, and lateral acromial angle was nearly perfect (interclass correlation coefficient 0.996, 0.996, 0.998, respectively). No significant correlation existed between age and critical shoulder angle (p = .309), acromial index (p = .484) or lateral acromial angle (p = .685). Discussion While the critical shoulder angle and acromial index were found to be high and in the typical range for patients with rotator cuff tears in both groups, there were no significant differences in acromial morphology between Groups 1 and 2.
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Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, TX
| | | | | | - Clare K Green
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew M Tomaino
- Tomaino Orthopaedic Care for Shoulder, Hand and Elbow, Rochester, NY
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Strony JT, Raji Y, Trivedi NN, McMellen CJ, Yu J, Calcei JG, Voos JE, Gillespie RJ. Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy. Orthop J Sports Med 2023; 11:23259671231202242. [PMID: 38021300 PMCID: PMC10664433 DOI: 10.1177/23259671231202242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures. Purpose To (1) determine the effect of Ohio's legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing. Study Design Cohort study; Level of evidence, 3. Methods We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing. Results Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) (P < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period (P < .001). Consumption of preoperative opioid (β = 1682.5; P < .001), benzodiazepine (β = 468.09; P < .001), and GABA analogue (β = 251.37; P = .04) was associated with an increase in the cumulative MME prescribed. Conclusion Opioid prescription-limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.
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Affiliation(s)
- John T. Strony
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yazdan Raji
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nikunj N. Trivedi
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher J. McMellen
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jiao Yu
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Jacob G. Calcei
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James E. Voos
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert J. Gillespie
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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9
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Khalil LS, Castle JP, Akioyamen NO, Corsi MP, Cominos ND, Dubé M, Lynch TS. What are patients asking and reading online? An analysis of online patient searches for rotator cuff repair. J Shoulder Elbow Surg 2023; 32:2245-2255. [PMID: 37263485 DOI: 10.1016/j.jse.2023.04.021] [Citation(s) in RCA: 2] [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: 01/06/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients undergoing rotator cuff surgery often search the internet for information regarding the procedure. One popular source, Google, compiles frequently asked questions and links to websites that may provide answers. This study provides an analysis of the most frequently searched questions associated with rotator cuff surgery. We hypothesize that there will be distinct search patterns associated with online queries about rotator cuff surgery that could provide unique insights into patient concerns. METHODS A set of search terms were entered into Google Web Search using a clean-install Google Chrome browser. Frequently associated questions and their webpages were extracted to a database via a data mining extension. Questions were categorized by topics relevant for rotator cuff arthroscopy. Websites were categorized by source and scored for quality using the JAMA Benchmark Criteria. Pearson's χ2 tests were used to analyze nominal data. Student t tests were performed to compare JAMA Benchmark Scores. RESULTS Of the 595 questions generated from the initial search, 372 unique questions associated with 293 websites were extracted and categorized. The most popular question topics were activities/restrictions (20.7%), pain (18.8%), and indications/management (13.2%). The 2 most common websites searched were academic (35.2%) and medical practice (27.4%). Commercial websites were significantly more likely to be associated with questions about cost (57.1% of all cost questions, P = .01), anatomy/function (62.5%, P = .001), and evaluation of surgery (47.6%, P < .001). Academic websites were more likely to be associated with questions about technical details of surgery (58.1%, P < .001). Medical practice and social media websites were more likely associated with activities/restrictions (48.1%, P < .001, and 15.6%, P < .001, respectively). Government websites were more likely associated with timeline of recovery (12.8%, P = .01). On a scale of 0-4, commercial and academic websites had the highest JAMA scores (3.06 and 2.39, respectively). CONCLUSION Patients seeking information regarding rotator cuff repair primarily use the Google search engine to ask questions regarding postoperative activity and restrictions, followed by pain, indications, and management. Academic websites, which were associated with technical details of surgery, and medical practice websites, which were associated with activities/restrictions, were the 2 most commonly searched resources. These results emphasize the need for orthopedic surgeons to provide detailed and informative instructions to patients undergoing rotator cuff repair, especially in the postoperative setting.
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Affiliation(s)
- Lafi S Khalil
- McLaren Flint Hospital, Department of Orthopaedic Surgery, Flint, MI, USA.
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Noel O Akioyamen
- Department of Orthopaedic Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | | | | | - Michael Dubé
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - T Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
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10
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Amaral S, Arsky Lombardi R, Medeiros H, Nogueira A, Gadsden J. Superior Trunk Block Is an Effective Phrenic-Sparing Alternative to Interscalene Block for Shoulder Arthroscopy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48217. [PMID: 38050517 PMCID: PMC10693833 DOI: 10.7759/cureus.48217] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
The interscalene block (ISB) is the standard regional anesthesia for shoulder arthroscopy. However, the superior trunk block (STB) is an alternative with a potentially safer profile. This meta-analysis aimed to compare the incidence and degree of hemidiaphragmatic paralysis and block efficacy of these techniques. We searched MEDLINE, EMBASE, Scopus, and Cochrane databases to identify randomized controlled trials (RCTs). The main outcome was total hemidiaphragmatic paralysis. We used the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of evidence. Four RCTs and 359 patients were included. The STB group showed lower total hemidiaphragmatic paralysis (RR 0.07; 95% CI 0.04 to 0.14; p<0.0001). The incidence of subjective dyspnea (p = 0.002) and Horner's syndrome (p<0.001) was significantly lower with STB relative to ISB. There was no significant difference between groups in block duration (p = 0.67). There was a high certainty of evidence in the main outcome as per the GRADE framework. Our findings suggest that STB has a better safety profile than ISB, resulting in lower rates of hemidiaphragmatic paralysis and dyspnea while providing a similar block. Therefore, STB could be preferred to ISB, especially in patients susceptible to phrenic nerve paralysis complications.
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Affiliation(s)
- Sara Amaral
- Anesthesiology, Hospital Regional Deputado Afonso Guizzo, Ararangua, BRA
| | | | - Heitor Medeiros
- Anesthesiology, Hospital Universitário Onofre Lopes, Natal, BRA
| | - Alleh Nogueira
- Anesthesiology, Escola Bahiana de Medicina e Saúde Pública, Salvador, BRA
| | - Jeff Gadsden
- Anesthesiology, Duke University Medical Center, Durham, USA
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11
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Kiliç E, Bingöl O, Özdemir G, Halit Keskin Ö, Deveci A. The effect of reduced acromiohumeral distance and increased acromial thickness on the risk of rotator cuff tear. Acta Orthop Traumatol Turc 2023; 57:348-351. [PMID: 38454214 PMCID: PMC10837597 DOI: 10.5152/j.aott.2023.23033] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 12/01/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT). METHODS Patients aged 25-70 were included in this retrospective study. Patients who were operated on for RCT between January 2019 and December 2021 were included in group 1, and patients who applied to the outpatient clinic in the same period with a complaint of shoulder pain and no problem on magnetic resonance imaging (MRI) were included in group 2. Three researchers performed AHD and AT measurements on the same true anteroposterior (AP) shoulder radiographs. The second measurement was performed 1 month later when, the first measurements were completed. RESULTS Radiographs of 284 patients in group 1 and 234 patients in group 2 were evaluated. In group 1, the mean AHD measurement was 8.25 ± 1.73 mm, and the AT measurement was 8.58 ± 1.06 mm. In group 2, the mean AHD measurement was 10.25 ± 1.4 mm, and the AT measurement was 8.35 ± 0.92 mm. A significant relationship was determined between the RCT and the AHD (P < .001). Also, RCT and AT have a significant relationship (P < .001). The authors determined that the risk of RCT increased 3.45 times when patients with AHD 6-10 mm were compared with patients with AHD >10 mm. In addition, all patients with AHD < 6mm had RCT, and the risk of RCT increased 1.42 times when patients with AT > 8 mm were compared with patients with AT < 8 mm. CONCLUSION Acromiohumeral distance and AT measurements are practical, inexpensive, and valuable in evaluating RCT. Decreased AHD and increased AT increase the risk of RCT.
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Affiliation(s)
- Enver Kiliç
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Olgun Bingöl
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Güzelali Özdemir
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ömer Halit Keskin
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Alper Deveci
- Department of Orthopedics and Traumatology, Private Ortadoğu Hospital, Ankara, Turkey
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12
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Kilbasanli S, Kaçmaz M. General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial. Medicine (Baltimore) 2023; 102:e35522. [PMID: 37861492 PMCID: PMC10589582 DOI: 10.1097/md.0000000000035522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair. METHODS 70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups. RESULTS While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05). CONCLUSION SUBSECTIONS In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.
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Affiliation(s)
- Seval Kilbasanli
- Department of Anesthesiology, Training and Research Hospital, Nigde, Turkey
| | - Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey
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13
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Green CK, Scanaliato JP, Sandler AB, Wynkoop EI, Goldman A, Turner RC, Czajkowski H, Rolf RH, Parnes N. Risk Factors for Glenoid Bone Loss in the Setting of Posterior Glenohumeral Instability. Orthop J Sports Med 2023; 11:23259671231202301. [PMID: 37859754 PMCID: PMC10583519 DOI: 10.1177/23259671231202301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 10/21/2023] Open
Abstract
Background Posterior instability has been reported to account for up to 24% of cases of shoulder instability in certain active populations. However, there is a paucity of data available regarding the risk factors associated with posterior glenoid bone loss. Purpose To characterize the epidemiology of, and risk factors associated with, glenoid bone loss within a cohort of patients who underwent primary arthroscopic shoulder stabilization for isolated posterior-type glenohumeral instability. Study Design Cross-sectional study; Level of evidence, 3. Methods This was a retrospective analysis of patients who underwent primary arthroscopic shoulder stabilization for posterior-type instability between January 2011 and December 2019. Preoperative magnetic resonance arthrograms were used to calculate posterior glenoid bone loss using a perfect circle technique. Patient characteristics and revision rates were obtained. Bone loss (both in millimeters and as a percentage) was compared between patients based on sex, age, arm dominance, sports participation, time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair. Results Included were 112 patients with a mean age of 28.66 ± 10.07 years; 91 patients (81.25%) were found to have measurable bone loss. The mean bone loss was 2.46 ± 1.68 mm (8.98% ± 6.12%). Significantly greater bone loss was found in athletes versus nonathletes (10.09% ± 6.86 vs 7.44% ± 4.56; P = .0232), female versus male patients (11.17% ± 6.53 vs 8.17% ± 5.80; P = .0212), and patients dominant arm involvement versus nondominant arm involvement (10.26% ± 5.63 vs 7.07% ± 6.38; P = .0064). Multivariate regression analysis identified dominant arm involvement as an independent risk factor for bone loss (P = .0033), and dominant arm involvement (P = .0024) and athlete status (P = .0133) as risk factors for bone loss >13.5%. At the conclusion of the study period, 7 patients had experienced recurrent instability (6.25%). Conclusion The findings of this study are in alignment with existing data suggesting that posterior glenoid bone loss is highly prevalent in patients undergoing primary arthroscopic stabilization for posterior-type shoulder instability. Our results suggest that patients with dominant arm involvement are at risk for greater posterior glenoid bone loss. Athlete status and dominant arm involvement were identified as independent risk factors for bone loss >13.5%.
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Affiliation(s)
- Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | | | - Adam Goldman
- Beacon Orthopaedics & Sports Medicine, Cincinnati, Ohio, USA
| | - Robert C. Turner
- Department of Orthopaedic Surgery, Fort Drum, Fort Drum, New York, USA
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Claxton-Hepburn Medical Center, Carthage, New York, USA
| | - Robert H. Rolf
- Beacon Orthopaedics & Sports Medicine, Cincinnati, Ohio, USA
- Department of Orthopaedic Surgery, TriHealth Hospital System, Cincinnati, Ohio, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Claxton-Hepburn Medical Center, Carthage, New York, USA
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14
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Mayer EN, Gajewski CR, Bernthal NM, Jensen AR. Arthroscopic debridement for acute hemorrhagic subacromial bursitis following COVID-19 vaccine administration: A case report. Shoulder Elbow 2023; 15:527-533. [PMID: 37811386 PMCID: PMC8977431 DOI: 10.1177/17585732221090821] [Citation(s) in RCA: 1] [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] [Received: 01/04/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 10/10/2023]
Abstract
The rapid rollout of vaccinations in response to the COVID-19 pandemic has led to their widespread distribution and administration throughout the world. The benefit of these vaccinations in preventing the spread of the disease and diminishing symptoms in patients who contract COVID-19 has been fervently studied and reported. While vaccinations remain an effective and generally safe method of limiting disease transmission and virus-related mortality, vaccine administration is not completely without risk. Shoulder injuries related to vaccine administration (SIRVA) have been described with previously available vaccines but have yet to be widely reported in the COVID-19 vaccination population. We present a case report of a young, high-functioning patient who presented with acute subacromial bursitis after COVID-19 vaccine administration due to improper vaccination technique. The patient was treated with arthroscopic shoulder surgery and had near immediate relief of shoulder symptoms.
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Affiliation(s)
- Erik N Mayer
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Christopher R Gajewski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Andrew R Jensen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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15
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Kosior M, Sibilska A, Piwnik M, Borowski A, Prusaczyk S, Rogers J, Struzik S, Kwapisz A. Time of Return to Work (RTW) May Not Correlate with Patient-Reported Outcomes Measurements (PROM) at Minimum One Year Post Arthroscopic Bankart Repair. J Clin Med 2023; 12:5794. [PMID: 37762735 PMCID: PMC10532194 DOI: 10.3390/jcm12185794] [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: 08/15/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239).
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Affiliation(s)
- Mateusz Kosior
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
| | - Aleksandra Sibilska
- Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland (S.S.)
| | | | - Andrzej Borowski
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
| | - Szymon Prusaczyk
- Department of Orthopedics and Traumatology, Radomsko Community Hospital, 97-500 Radomsko, Poland
| | - Jason Rogers
- EmergeOrtho Triad Region, Greeensboro, NC 27408, USA;
| | - Sławomir Struzik
- Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland (S.S.)
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
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16
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Akhtar M, Wen J, Razick D, Shehabat M, Saeed A, Baig O, Asim M, Tokhi I, Aamer S, Akhtar MB. Mid- to Long-Term Outcomes of Arthroscopic Shoulder Stabilization in Athletes: A Systematic Review. J Clin Med 2023; 12:5730. [PMID: 37685797 PMCID: PMC10488802 DOI: 10.3390/jcm12175730] [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: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
There exists a considerable amount of evidence regarding short-term outcomes of shoulder arthroscopy in athletes; however, mid- to long-term data are limited. Therefore, the purpose of this review is to evaluate studies assessing mid- to long-term outcomes and rates of return to sport in athletes undergoing primary shoulder arthroscopy. A search for the systematic review was performed in PubMed, Scopus, and Embase on 14 March 2023. Study parameters, as well as their respective outcomes, were described in detail and compiled into diagrams. Five studies were included, which contained data on a total of 307 shoulders in patients with mean ages ranging from 20.3 to 26.9 years and mean follow-up times ranging from 6.3 to 14 years. The arthroscopic Bankart repair was the primary surgical intervention performed in all five studies. The overall rate of return to sport was 84% (range, 70-100%) across the studies. The rate of return to sport at pre-injury level was 65.2% (range, 40-82.6%) across four studies. The overall rate of recurrent instability was 17.3%, with redislocation specifically occurring in 13.7% of patients across all studies. The overall rate of revision surgery was 11.1%. Athletes who underwent primary shoulder arthroscopy demonstrated favorable outcomes and a high rate of RTS at a minimum follow-up of 5 years. However, rates of recurrent instability, redislocation, and revision surgery occurred at less than favorable numbers, which emphasizes the importance of proper patient selection when considering candidates for arthroscopic versus open repairs.
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Affiliation(s)
- Muzammil Akhtar
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Jimmy Wen
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Daniel Razick
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Mouhamad Shehabat
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Ali Saeed
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA;
| | - Osamah Baig
- Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA;
| | - Maaz Asim
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Ilham Tokhi
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (J.W.); (D.R.); (M.S.); (M.A.); (I.T.)
| | - Sonia Aamer
- Southern California Orthopedic Institute, Bakersfield, CA 93309, USA;
| | - Muhammad Bilal Akhtar
- Department of Occupational Therapy, University of St. Augustine for Health Sciences, San Marcos, CA 92069, USA;
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17
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Du W, Mo Y, Dong Y, He C, Zhou F, Zhu F. The clinical diagnosis and treatment of the shoulder terrible tetrad: a case report and literature review. J Surg Case Rep 2023; 2023:rjad499. [PMID: 37701445 PMCID: PMC10493127 DOI: 10.1093/jscr/rjad499] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
Traumatic anterior dislocation of the shoulder is often associated with anterior glenoid fracture or bankart injury. It can also be associated with rotator cuff injury, humeral greater tuberosity fracture, or brachial plexus injury. However, there are few clinical reports of all the above-mentioned injuries at the same time. We report a case of the left "Shoulder terrible tetrad." After closed reduction of the left shoulder dislocation, we performed one-stage arthroscopic massive rotator cuff repair (Chinese-Way technique) and anchor repair of the bony bankart injury. After 2 years follow-up, the left shoulder function recovered well and the range of motion was satisfactory. A detailed physical examination and electromyography (EMG) examination should be performed in time to avoid misdiagnosis and missed diagnosis, when the clinical manifestation of brachial plexus nerve injury appears after shoulder dislocation. The repairable rotator cuffs tears and bankart injuries can be repaired under shoulder arthroscopy in one stage.
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Affiliation(s)
- Weibin Du
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou 312001, Zhejiang, China
- Department of Orthopaedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 312001, Zhejiang, China
| | - Yafeng Mo
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou 312001, Zhejiang, China
- Department of Orthopaedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 312001, Zhejiang, China
| | - Yi Dong
- Department of Orthopaedics, Shaoxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing 312000, Zhejiang, China
| | - Chun He
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou 312001, Zhejiang, China
- Department of Orthopaedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 312001, Zhejiang, China
| | - Fengzhen Zhou
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou 312001, Zhejiang, China
- Department of Orthopaedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 312001, Zhejiang, China
| | - Fangbing Zhu
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou 312001, Zhejiang, China
- Department of Orthopaedics, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 312001, Zhejiang, China
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18
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Green CK, Scanaliato JP, Turner RC, Sandler AB, Dunn JC, Parnes N. Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients. Orthop J Sports Med 2023; 11:23259671231181906. [PMID: 37435424 PMCID: PMC10331190 DOI: 10.1177/23259671231181906] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background US military servicemembers experience higher rates of posterior and combined-type instability as compared with their nonmilitary peers. Purpose (1) To determine the prevalence of glenoid bone loss (GBL) in young, active-duty military patients with combined-type shoulder instability who underwent operative shoulder stabilization; (2) to evaluate whether GBL is associated with differences in postoperative outcomes; and (3) to identify factors associated with larger defects. Study Design Case series; Level of evidence, 4. Methods This study included active-duty military patients who underwent primary surgical shoulder stabilization for combined anterior and posterior capsulolabral tears between January 2012 and December 2018. Preoperative magnetic resonance arthrograms were used to calculate anterior, posterior, and total GBL using the "perfect circle" technique. We recorded patient characteristics, revisions, complications, return to duty, range of motion, and scores on multiple outcome measures (visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Rowe). GBL prevalence was compared by time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair. Outcome scores, return to active duty, and revision procedures were compared by degree of anterior or posterior GBL: <13.5% (mild) versus ≥13.5% (subcritical). Results GBL was noted in 28 (77.8%) of the 36 patients. Nineteen (52.8%) patients had anterior GBL, 18 (50.0%) had posterior, and 9 (25.0%) had combined. Four (11.1%) patients had subcritical anterior or posterior GBL. Increased posterior GBL was associated with history of trauma (P = .041), time to surgery >12 months (P = .024), and glenoid retroversion ≥9° (P = .010); increased total GBL was associated with longer time to surgery (P = .023) and labral repair requiring >4 anchors (P = .012); and increased anterior GBL was associated with labral repair requiring >4 anchors (P = .011). There were statistically significant improvements on all outcome measures, with no changes in range of motion postoperatively. No significant difference on any outcome score was observed between patients with mild and subcritical GBL. Conclusion In our analysis, 78% of patients had appreciable GBL, suggesting that GBL is highly prevalent in this patient population. Longer time to surgery, traumatic cause, significant glenoid retroversion, and large labral tears were identified as risk factors for increased GBL.
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Affiliation(s)
- Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert C. Turner
- Department of Orthopaedic Surgery, Fort Drum, Fort Drum, New York, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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19
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Kim KT, Kim GH, Cha DH, Lee JH, Lee YB. A Comparison of Clinical Outcomes in Rotator Cuff Re-Tear Patients Who Had Either an Arthroscopic Primary Repair or Arthroscopic Patch Augmentation for Large-to-Massive Rotator Cuff Tears. Diagnostics (Basel) 2023; 13:diagnostics13111961. [PMID: 37296813 DOI: 10.3390/diagnostics13111961] [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: 04/25/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Despite the prevalent incidence of re-tear following rotator cuff repair, there is a notable lack of comparative studies investigating the outcomes between patients with re-tear who underwent primary repair versus those who received patch augmentation for large-to-massive tears. We assessed clinical outcomes of these techniques through a retrospective, randomized controlled trial. METHODS 134 patients diagnosed with large-to-massive rotator cuff tears from 2018 to 2021 underwent surgery; 65 had primary repair and 69 had patch augmentation. A total of 31 patients with re-tears were included, split into two groups; Group A (primary repair, 12 patients) and Group B (patch augmentation, 19 patients). Outcomes were evaluated using several clinical scales and MRI imaging. RESULTS Most clinical scores improved postoperatively in both groups. No significant difference in clinical outcomes was observed between groups, except for pain visual analog scale (P-VAS) scores. P-VAS scores showed greater decrease in the patch-augmentation group, a statistically significant difference. CONCLUSIONS for large-to-massive rotator cuff tears, patch augmentation led to greater decreases in pain than primary repair, despite similar radiographic and clinical results. Greater tuberosity coverage of the supraspinatus tendon footprint may impact P-VAS scores.
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Affiliation(s)
- Ki-Tae Kim
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Gwan-Ho Kim
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Dong-Heon Cha
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Jae-Hoo Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Yong-Beom Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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20
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Johnson AH, Brennan JC, Lashgari CJ, Petre BM, Turcotte JJ, Redziniak DE. Clinical Results of Knot-tying Versus Knotless Suture Anchors in Arthroscopic Anteroinferior Labral Repair. Cureus 2023; 15:e40292. [PMID: 37448384 PMCID: PMC10337236 DOI: 10.7759/cureus.40292] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Background Arthroscopic repair of glenohumeral instability is becoming an increasingly common procedure. These repairs can be undertaken using knot-tying and knotless suture anchors; there is currently no clear consensus in the literature about what type of repair is most cost-effective and provides superior outcomes. The purpose of this study is to examine postoperative outcomes of patients undergoing arthroscopic anteroinferior labral repair (AALR) with either knot-tying or knotless anchors. Methods A single institution retrospective observational cohort study of 122 patients undergoing AALR from January 2014 to June 2021 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes between repair types; multivariate analysis was used to evaluate risk factors for recurrent instability and reoperation. Results Patients undergoing AALR with knotless anchors had a shorter case duration than those with knot-tying anchors (112.64 vs. 89.86 minutes, p<0.001). There were no significant differences between groups in the size of labral tear, presence of a glenoid bone defect, or Hill-Sachs lesion. After controlling for age, BMI, sex, glenoid bone defect, number of preoperative dislocations, and fixation type, only age (OR=0.896, p=0.010) and female sex (OR=5.341, p=0.008) were independent risk factors for recurrent instability and no factors were independent predictors of reoperation. Conclusion Patients undergoing AALR experienced similar rates of reoperation and recurrent instability regardless of whether a knot-tying or knotless repair was performed. The use of knotless suture anchors may improve cost-effectiveness due to decreased surgical time without diminishing postoperative outcomes.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
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21
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Karakus O, Oztermeli A. Bankart repair with subscapularis augmentation: A case control study. Medicine (Baltimore) 2023; 102:e33720. [PMID: 37144987 PMCID: PMC10158921 DOI: 10.1097/md.0000000000033720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
To examine the effect on functional shoulder scores of Bankart repair with arthroscopic subscapularis tendon augmentation applied to cases of anterior shoulder instability with < 25% glenoid defect and ligament-labral failure. A total of 83 patients underwent Bankart repair with subscapularis tendon augmentation between 2015 and 2021. The range of movement of the patients was measured by 2 doctors using a goniometer. The Constant Murley score, American Shoulder and Elbow Surgeons score, Rowe score, and the University of California at Los Angeles scores were recorded preoperatively and postoperatively. Statistically significant increases were determined in the postoperative functional scores compared to the preoperative values as mean 41.4 ± 2.08 unit increase in the Constant Murley score, mean 41.4 ± 1.8 unit increase in the American Shoulder and Elbow Surgeons score, mean 13.8 ± 1.45 unit increase in the University of California at Los Angeles and mean 49.3 ± 7.45 unit increase in the Rowe score (P = .001; P < .01). Compared with the preoperative evaluation, there was found to be a postoperative statistically significant unit decrease of 10.2 ± 1.47 in the external rotation measurement (P = .001; P < .01). The number of dislocations was determined to have a negative correlation with the internal rotation measurements (r = -0.305; P = .005; P < .01), and a weak negative statistically significant relationship with external rotation measurements (r = -0.329; P = .002; P < .01). Unlike other techniques, as this repair technique includes both the tendon and the capsule as a single piece, it was seen to be a sufficient and reliable technique that is easy-to apply.
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Affiliation(s)
- Ozgun Karakus
- Ortopedic and Traumatology Specialist, Balikesir Ataturk Hospital, Balikesir, Türkiye
| | - Ahmet Oztermeli
- Ortopedic and Traumatology Specialist, Gebze Fatih State Hospital, Kocaeli, Türkiye
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22
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Highland KB, Parry J, Kent M, Patzkowski JC, Patzkowski MS, Herrera G, Kane A, Giordano NA. Lagged effect of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance on subacute postsurgical PROMIS Pain Behavior. J Orthop Res 2023; 41:711-717. [PMID: 35803596 DOI: 10.1002/jor.25412] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/07/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
Sleep disturbance is a modifiable risk factor that, when reduced, may improve subacute postsurgical outcomes (e.g., pain-related impact). Evidence also indicates that pain and sleep may have a bidirectional longitudinal relationship before to (sub) acutely after surgery. The objective of the present study is to examine the degree to which sleep disturbances and pain behavior have uni- or bidirectional relationships in a sample of patients undergoing sports orthopedic surgery. In this observational, longitudinal cohort study, participants ( = 296) were adult (ages 18+) active duty service members who underwent open or arthroscopic shoulder or knee surgery at Walter Reed National Military Medical Center. Participants were asked to complete PROMIS Sleep Disturbance and Pain Behavior computer adaptive testing item banks before surgery, 6 weeks postsurgery, and 3 months postsurgery. Patient-level covariates were analyzed for interrelationships using nonparametric bivariate statistics. Autoregressive and cross-lagged structural equation modeling examined the bidirectional relationships of patient-level covariates and PROMIS outcomes. When controlling for patient-level covariates, sleep disturbance at presurgical and 2-week postsurgical timepoints were positively associated with both sleep disturbance and pain behavior at the subsequent timepoint. Sleep disturbance may contribute to pain-related functioning and quality of life after sports orthopedic surgery. Future studies utilizing multidimensional patient report outcomes and robust analytics are needed to better understand whether sleep-targeted interventions can improve subacute and long-term orthopedic sports surgery outcomes.
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Affiliation(s)
- Krista B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation For the Advancement of Military Medicine, Rockville, Maryland, USA
| | - James Parry
- School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Michael Kent
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeanne C Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.,Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA
| | - Michael S Patzkowski
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Germaine Herrera
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation For the Advancement of Military Medicine, Rockville, Maryland, USA
| | - Alexandra Kane
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation For the Advancement of Military Medicine, Rockville, Maryland, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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23
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Biagini EK, Peebles LA, Higgins M, Stamm M, Lefante JJ, Mulcahey MK. Return to Play After Shoulder Arthroscopy in Major League Baseball Pitchers vs Position Players. Orthop J Sports Med 2023; 11:23259671221150782. [PMID: 36762205 PMCID: PMC9905020 DOI: 10.1177/23259671221150782] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background Recovery from shoulder arthroscopy may vary between professional pitchers and position players in Major League Baseball (MLB). The time that it takes to return to play (RTP) and the level of skills to be regained after surgery are important factors for an athlete to consider when making career decisions. Purpose To identify MLB players who had arthroscopic shoulder surgery and observe their rates of RTP to MLB and the minor league, as well as to compare pre- and postinjury performance statistics and career metrics. Study Design Descriptive epidemiology study. Methods Public records (press releases, http://www.prosportstransactions.com, http://www.baseball-reference.com) were searched and analyzed to determine the number of days from shoulder arthroscopy to RTP and pre- and postinjury statistics for pitchers and position players in the MLB and minor league from 1998 to 2018. To meet inclusion criteria, a player must have undergone shoulder arthroscopy after having played at least 1 game in the MLB and had no identifiable concomitant injuries. Results Of 134 players, 89 (66.4%) returned to MLB. Fifty-four of 89 pitchers (60.7%) and 35 of 45 position players (77.8%) returned to MLB (P = .048). Forty-nine of 54 pitchers (90.7%) and 23 of 35 position players (65.7%) who returned to MLB returned to the minor league first. The mean time to RTP was 469.6 days (range, 100-1079 days) for pitchers and 301.6 days (range, 94-1488) for position players (P = .002). The WAR statistic (wins above replacement) for the pitchers decreased significantly (P = .004) after shoulder arthroscopy. Conclusion MLB position players returned to play at higher rates and more quickly than did pitchers. The WAR statistic declined in pitchers during the first season of RTP. Players undergoing arthroscopic shoulder surgery should be aware of these possible outcomes in time to RTP and postoperative performance.
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Affiliation(s)
- Emily K. Biagini
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Liam A. Peebles
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret Higgins
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Michaela Stamm
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - John J. Lefante
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mary K. Mulcahey
- School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Mary K. Mulcahey, MD, School of Medicine, Tulane University, 1430 Tulane Ave, #8632, New Orleans, LA 70112, USA () (Twitter: @marykmulcaheymd)
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24
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Bildik C, Pehlivanoglu T. Arthroscopic rotator cuff repair performed with intra-articular tranexamic acid: could it provide improved visual clarity and less postoperative pain? A prospective, double-blind, randomized study of 63 patients. J Shoulder Elbow Surg 2023; 32:223-231. [PMID: 36403924 DOI: 10.1016/j.jse.2022.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/13/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) has been widely used in orthopedic surgery with the aim of reducing intraoperative and postoperative bleeding, as well as bleeding-related complications. The purpose of this study was to assess whether intra-articular use of TXA during arthroscopic rotator cuff tear (RCT) repair could improve visual clarity, shorten the duration of the operation, and provide superior pain management as compared with placebo. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled study. Patients aged ≥18 years with a magnetic resonance imaging-confirmed RCT and a history of failed conservative treatment for ≥6 months were included. Patients with a history of coagulopathy; a history of cardiac, renal, or hepatic disease; a history of conservative treatment for <6 months; and/or acute RCTs were excluded. Visual clarity as the primary outcome was assessed using an arthroscopic visual scale comprising 5 grades-ranging from grade 1, best visual clarity, to grade 5, worst visual clarity (requiring conversion to open surgery)-after the procedure by the operating surgeon every 10 minutes throughout the video of the operation. Secondary outcomes were operative duration and postoperative pain scores. RESULTS A total of 63 patients with similar demographic data (age and sex) and intraoperative mean arterial pressure were enrolled and randomized into 2 groups: The TXA group comprised 32 patients with a mean age of 56.46 years, and the placebo group comprised 31 patients with a mean age of 57.83 years. The TXA group was reported to have significantly superior visual clarity (mean arthroscopic visual scale score, 1.5 ± 0.5 vs. 2.86 ± 1.7; P < .001), with a significantly higher percentage of grade 1 visual clarity (78.1% vs. 32.2%, P < .001) and a significantly lower percentage of grade 4 visual clarity (0% vs. 3.2%, P = .003). Grade 5 visual clarity was not recorded in any patient in either group. The TXA group showed a significantly shorter operative duration (55.73 minutes vs. 67.26 minutes, P = .001) and superior pain scores at 8 hours (2.3 vs. 3.6, P = .002) and 24 hours (1.6 vs. 2.4, P < .001) postoperatively. No complications were recorded in either group. CONCLUSIONS This study showed that during arthroscopic rotator cuff repair procedures, intra-articular use of TXA was able to provide superior arthroscopic visual clarity while shortening the total operative duration significantly and providing significantly superior pain management in the first 8 and 24 hours postoperatively as compared with placebo. This study underlines the safety and efficacy of intra-articular TXA use in arthroscopic rotator cuff repair.
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Affiliation(s)
- Celaleddin Bildik
- Orthopedic Surgery and Traumatology, Faculty of Health Sciences, Yeni Yüzyıl University, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- Orthopedic Surgery and Traumatology, Faculty of Health Sciences, Yeni Yüzyıl University, Istanbul, Turkey; Department of Orthopaedic Surgery, Liv Hospital Ulus, Istanbul, Turkey.
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25
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Wu EB, Hsiao CC, Hung KC, Hung CT, Chen CC, Wu SC, Chin JC, Chen IW, Luo SD. Opioid-Sparing Analgesic Effects from Interscalene Block Impact Anesthetic Management During Shoulder Arthroscopy: A Retrospective Observational Study. J Pain Res 2023; 16:119-128. [PMID: 36660557 PMCID: PMC9844143 DOI: 10.2147/jpr.s397282] [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: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Purpose Ultrasound-guided interscalene nerve block (UISB) is commonly used to alleviate postoperative pain during shoulder arthroscopy. This retrospective observational study aimed to evaluate the intraoperative advantages and analgesic effects of preoperative UISB. Patients and Methods In this retrospective observational study, a total of 170 patients underwent shoulder arthroscopy at a tertiary medical center in southern Taiwan throughout 2019. After applying the exclusion criteria, 142 of these cases were included, with 74 and 68 in the UISB group and control groups, respectively. The primary outcome was the evaluation of intraoperative morphine milligram equivalent (MME) consumption. Secondary outcomes were sevoflurane consumption, the use of intraoperative antihypertensive drugs, and postoperative visual analog scale (VAS) scores in the post-anesthesia care unit (PACU) and in the ward at 24 h after surgery. Results Preoperative UISB effectively reduced opioids and volatile gases during surgery, supported by a 48.1% and 14.8% reduction in the median intraoperative MME and sevoflurane concentrations, respectively, and showed less need for antihypertensive drugs. The preoperative UISB group also showed significantly better performance on the VAS in both the PACU and ward. Conclusion Taken together, the preoperative UISB reduced not only intraoperative MME and sevoflurane consumption but also had satisfactory VAS scores in both the PACU and ward without any symptomatic respiratory complications. In summary, preoperative UISB is a reliable adjuvant analgesic technique and a key factor in achieving opioid-sparing and sevoflurane-sparing anesthesia and multimodal analgesia during shoulder arthroscopy.
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Affiliation(s)
- En-Bo Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Chi Hsiao
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chao-Ting Hung
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chun Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jo-Chi Chin
- Department of Anesthesiology, Park One International Hospital, Kaohsiung, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan,I-Wen Chen, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan, Tel +886-6-2812811, Email
| | - Sheng-Dean Luo
- Division of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Kaohsiung, Taiwan,Correspondence: Sheng-Dean Luo, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 (ext. 2788), Email
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26
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Gruskay JA, Rakowski DR, Woolson TE, Horan MP, Millett PJ. Clinical Outcomes After Arthroscopic Pancapsular Shift for the Treatment of Multidirectional Glenohumeral Instability at a Mean Follow-up of 9 Years. Am J Sports Med 2022; 50:3897-3906. [PMID: 36322393 DOI: 10.1177/03635465221127293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arthroscopic treatment of multidirectional instability (MDI) of the shoulder is being increasingly performed, but there is a paucity of studies with minimum 5-year follow-up. PURPOSE To report on survivorship and patient-reported outcomes (PROs) after arthroscopic pancapsulorraphy (APC) for MDI with a minimum 5-year follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Institutional review board approval was obtained before initiation of this retrospective review of prospectively collected data. Patients were included if they had a minimum of follow-up 5 years after APC for MDI. PROs included the 12-Item Short Form Health Survey Physical Component Summary; American Shoulder and Elbow Surgeons; Single Assessment Numeric Evaluation; shortened version of Disabilities of the Arm, Shoulder and Hand; and patient satisfaction. Preoperative, short-term (1-2 years), and final follow-up PROs were compared. Recurrent instability, dislocation, and reoperation were collected, and survivorship analysis was performed. RESULTS A total of 49 shoulders in 44 patients (15 male, 29 female) treated between October 2005 and November 2015 were included in the study. MDI onset was atraumatic in 27 shoulders and traumatic in 22. Rotator interval closure was performed in 17 patients. Overall, 14 of 49 (29%) patients reported feelings of instability in the shoulder, of whom 5 (10.2%) underwent revision surgery at a mean of 1.5 years. Kaplan-Meier analysis demonstrated a survivorship rate of 88% at 5 years and 82% at 8 years, with failure defined as requiring revision surgery or postoperative feelings of instability with ASES score <65. Final outcome analysis was performed on 41 shoulders with a mean follow-up of 9.0 years (range, 5.1-14.6 years). All PROs demonstrated significant improvement from preoperative baseline (P < .05) and remained significantly improved at both short-term and long-term final follow-up. There was no difference in PROs based on \\ atraumatic versus traumatic onset, or patients treated with a rotator interval closure. There was a significant difference in PROs between patients who had continued instability. CONCLUSION APC for the treatment of MDI provided reasonable, durable long-term PROs that persisted from short-term follow-up. Although 29% of patients experienced feelings of instability at final follow-up, most of these patients still had high postoperative satisfaction and acceptable PROs.
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Affiliation(s)
- Jordan A Gruskay
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | | | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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27
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Llinás PJ, Bailie DS, Sanchez DA, Chica J, Londono JF, Herrera GA. Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate. Am J Sports Med 2022; 50:3064-3072. [PMID: 35983981 DOI: 10.1177/03635465221112659] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.
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Affiliation(s)
- Paulo J Llinás
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
| | - David S Bailie
- Arizona Institute for Sports, Knees, and Shoulders, LLC, Scottsdale, Arizona, USA
| | | | - Julian Chica
- Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Juan Francisco Londono
- Fundación Valle del Lili, Cali, Colombia.,Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Gilberto A Herrera
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
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Dolan MT, Lowenstein NA, Collins JE, Matzkin EG. Majority of patients find sleep patterns return to normal 6 months following rotator cuff repair. J Shoulder Elbow Surg 2022; 31:1687-1695. [PMID: 35219845 DOI: 10.1016/j.jse.2022.01.122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Rotator cuff tears have a wide variability in presentation, with some causing pain and reduced function but others remaining completely asymptomatic. Sleep disturbances are a primary driver for patients with rotator cuff tears to see a physician, and one of the main goals of rotator cuff repair (RCR) surgery is to restore normal sleep patterns in these patients. The primary purpose of this study aimed to determine the percentage of patients undergoing RCR who report preoperative sleep disturbances. Second, this study sought to identify at what postoperative follow-up intervals patients stopped reporting sleep disturbances and how the percentages change over time. It was hypothesized that the majority of patients undergoing arthroscopic RCR would report preoperative and initial postoperative sleep disturbances and that 75% of patients would report resolution of sleep disturbances by 1 year postoperatively. METHODS A total of 326 patients undergoing primary arthroscopic RCR were prospectively enrolled in this study. Validated patient-reported outcome measures were obtained preoperatively and postoperatively, including the visual analog pain scale score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Simple Shoulder Test (SST) score, and Veterans RAND 12-Item Health Survey physical and mental component scores. RESULTS According to question 2 of the SST, 291 patients (89%) reported preoperative sleep disturbances. Within the cohort of patients who reported resolution of sleep disturbances, 46% reported resolution by 3 months postoperatively; an additional 31%, by 6 months; a further 14%, by 12 months; and the final 8%, by 24 months. Age ≥ 65 years was significantly associated with increased reporting of resolution compared with age < 65 years. All patient-reported outcome measures, including the visual analog pain scale score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, SST score, and Veterans RAND 12-Item Health Survey (physical component) score, showed statistically significant improvements after surgery. CONCLUSIONS Eighty-nine percent of patients reported preoperative sleep disturbances. Seventy-seven percent of patients reported resolution of sleep disturbances by 6 months postoperatively, and 81% of patients reported resolution of sleep disturbances by 2 years postoperatively.
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Affiliation(s)
- Martine T Dolan
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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29
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Kaisidis A, Pantos P, Bochlos D. The subacromial spacer system for irreparable posterosuperior rotator cuff tears: A retrospective study of 47 patients with a two-year follow-up. Shoulder Elbow 2022; 14:76-82. [PMID: 35845623 PMCID: PMC9284253 DOI: 10.1177/1758573220960468] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Numerous surgical options are available for the management of massive irreparable rotator cuff tears, but there are no current definitive guidelines concerning the optimal treatment modality. The purpose of this study was to evaluate the efficacy and safety of a biodegradable subacromial spacer (InSpace) implantation in patients with irreparable rotator cuff tears. METHODS A retrospective study was conducted involving 47 patients treated with the InSpace balloon between 2016 and 2018. Shoulder function was assessed using Constant Score. Pain was scored using a visual analogue scale, with scores ranging from 0 to 10. RESULTS At an average follow-up of 24.6 months (range 12-38), the Constant Score had improved from 39.4 to 71.5 points (p < 0.0001). The range of motion, a main component of Constant Score, was improved after two years, from 27.6 to 42.2 points (p < .001). The visual analogue scale score decreased from 6.32 at baseline to a mean score of 2.7 points (p < 0.0001). DISCUSSION Arthroscopic deployment of the InSpace device was found to be a safe, reliable treatment option in patients with painful irreparable rotator cuff tears, with meaningful improvement in shoulder function without serious complications.
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Affiliation(s)
| | - Panagiotis Pantos
- Panagiotis Pantos, Clinic Maingau, Rotes
Kreuz, Schoeffelstrasse 2-14, Frankfurt, Hessen 60318, Germany.
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30
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Leow JM, Krahelski O, Keenan OJF, Clement ND, McBirnie JM. Functional outcome following arthroscopic repair of massive rotator cuff tears is equal to smaller rotator cuff tears: a retrospective case-control study. Shoulder Elbow 2022; 14:52-58. [PMID: 35845624 PMCID: PMC9284260 DOI: 10.1177/1758573220925040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/17/2020] [Accepted: 04/15/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of studies comparing patient-reported outcomes of arthroscopic massive rotator cuff repairs against non-massive rotator cuff repairs. The aim of this study is to assess the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Oxford Shoulder Score at a minimum of one-year follow-up according to the size of the rotator cuff tear. METHODS A retrospective case-control study was undertaken. All patients underwent rotator cuff repairs using the same technique by a single surgeon. Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Oxford Shoulder Score were collected pre-operatively and at final review with a minimum follow-up of one year. Patients with massive rotator cuff repairs were compared to patients who had non-massive rotator cuff repairs. RESULTS Eighty-two patients were included in the study of which 42 (51%) underwent massive rotator cuff repair. The mean follow-up period was 17.5 months. Quick Disabilities of the Arm, Shoulder and Hand questionnaire improved significantly (p < 0.001) from 46.1 pre-operatively to 15.6 at final follow-up for massive rotator cuff repairs. Oxford Shoulder Score improved significantly (p < 0.001) from 26.9 pre-operatively to 41.4 at final follow-up for massive rotator cuff repairs. There was no significant difference in the final Quick Disabilities of the Arm, Shoulder and Hand questionnaire (p = 0.35) or Oxford Shoulder Score (p = 0.45) between the groups. No revision surgery was required within the follow-up period. CONCLUSION Arthroscopic massive rotator cuff repairs have comparable functional outcome to smaller rotator cuff repair in the short-term and should be considered in a selected group of patients.
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Affiliation(s)
- Jun M Leow
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK,Jun M Leow, Department of Orthopaedics and
Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK.
| | - Oliver Krahelski
- College of Medicine and Veterinary
Medicine, University of Edinburgh, Edinburgh, UK
| | - Oisin JF Keenan
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas D Clement
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
| | - Julie M McBirnie
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
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31
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Chen AZ, Greaves KM, deMeireles AJ, Fortney TA, Saltzman BM, Trofa DP. Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review. Am J Sports Med 2022:3635465221094832. [PMID: 35749344 DOI: 10.1177/03635465221094832] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair. PURPOSE To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated. RESULTS In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290). CONCLUSION Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
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Affiliation(s)
- Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kaylre M Greaves
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas A Fortney
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute (MSKI), Charlotte, North Carolina, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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32
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Yildirim K, Pehlivanoglu T, Tandogan RN, Beyzadeoglu T. Safety, Efficacy, and Cost-Effectiveness of Simultaneous Bilateral Arthroscopic Bankart Repair for Bilateral Shoulder Instability. Orthop J Sports Med 2022; 10:23259671221098435. [PMID: 35647212 PMCID: PMC9134442 DOI: 10.1177/23259671221098435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Bilateral shoulder instability and Bankart lesions are not rare and
frequently require surgical treatment. Bilateral instability may be treated
with either a single-stage, simultaneous bilateral Bankart repair or 2-stage
surgery. Purpose/Hypothesis: To compare simultaneous bilateral arthroscopic Bankart repair to 2-stage
repair in terms of clinical outcomes and hospitalization costs. It was
hypothesized that simultaneous repair would provide clinical outcomes
similar to those of 2-stage Bankart repair while yielding lower
hospitalization costs. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent simultaneous bilateral arthroscopic Bankart repair
(group 1) were matched by age, sex, and injury type to control patients who
had unilateral Bankart repair (group 2). All patients were operated on by
the same surgeon in the same institution between 2007 and 2017 and had a
minimum follow-up duration of 24 months. Patients with inflammatory
arthritis, metabolic/malignant disease, previous shoulder surgery, a glenoid
bone loss ≥25%, or off-track Hill-Sachs lesion were excluded. The 2 groups
were compared in terms of pre- and postoperative Western Ontario Shoulder
Instability Index (WOSI) scores, hospitalization costs, complications, and
recurrent instability. The hospitalization cost of group 2 was multiplied by
2 to create a projection of the estimated cost of 2 sequential unilateral
Bankart repairs. Results: The study population comprised 48 patients (38 men [79.17%] and 10 women
[20.83%]; mean age, 25.5 years at surgery and 22.75 years at first
dislocation). Group 1 included 32 shoulders in 16 patients, while group 2
consisted of 32 shoulders in 32 patients. The mean hospitalization cost (in
2020 US dollars) was $26,010 ± $1455 for group 1 and $33,591 ± $1574 for
group 2 (P < .001). Both groups had improved WOSI scores
after surgery and achieved similar scores at the latest follow-up. There was
1 redislocation in each group (3.13%). No surgery- or
anesthesia-related/medical complications were recorded in either group. Conclusion: For bilateral shoulder instability, clinical outcomes of simultaneous
bilateral arthroscopic Bankart repair were similar to those of 2-stage
repair; however, lower hospitalization costs were seen after simultaneous
bilateral repair compared with 2-stage surgery.
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Affiliation(s)
- Kerem Yildirim
- Department of Orthopaedics and Traumatology, Beyzadeoglu Clinic, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- School of Health Sciences, Yeni Yuzyil University, Istanbul, Turkey.,Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
| | - Reha N Tandogan
- Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey.,Department of Orthopaedics and Traumatology, Ortoklinik and Cankaya Orthopedics, Ankara, Turkey
| | - Tahsin Beyzadeoglu
- Department of Orthopaedics and Traumatology, Beyzadeoglu Clinic, Istanbul, Turkey.,Faculty of Health Sciences, Halic University, Istanbul, Turkey
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33
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Min JJ, Jeon YD, Kim SW, Kang Y, Oh JH. Pseudoaneurysm of the posterior circumflex humeral artery after arthroscopic rotator cuff repair: a case report. J Shoulder Elbow Surg 2022; 31:e308-13. [PMID: 35248704 DOI: 10.1016/j.jse.2022.01.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
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Eren İ, Büyükdogan K, Yürük B, Aslan L, Birsel O, Demirhan M. Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years. J Shoulder Elbow Surg 2022; 31:978-983. [PMID: 34871729 DOI: 10.1016/j.jse.2021.10.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years. METHODS We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded. RESULTS The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 ± 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 ± 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3° ± 12.4° and 39.2° ± 11°, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 ± 1.4, 91 ± 11.9, and 88 ± 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively). CONCLUSIONS Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections.
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Affiliation(s)
- İlker Eren
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey.
| | - Kadir Büyükdogan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Batuhan Yürük
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
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Green CK, Scanaliato JP, Fares AB, Czajkowski H, Dunn JC, Parnes N. Midterm Outcomes After Arthroscopic Repair of Type VIII SLAP Lesions in Active Duty Military Patients Younger Than 35 Years. Orthop J Sports Med 2022; 10:23259671221095908. [PMID: 35601738 PMCID: PMC9118435 DOI: 10.1177/23259671221095908] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Superior labrum from anterior to posterior (SLAP) lesions represent a significant cause of shoulder pain and disability among active duty members of the US military. However, few data exist regarding the surgical management of type VIII SLAP lesions. Hypothesis We hypothesized that arthroscopic repair would decrease pain and increase function at the midterm follow-up and allow for a high rate of maintenance of active duty status. Study Design Case series; Level of evidence, 4. Methods Consecutive active duty military patients were identified from January 2011 through June 2015 who underwent arthroscopic repair of type VIII SLAP lesions performed by a single surgeon. Patients were excluded if they underwent glenoid microfracture, other capsulolabral repair, or rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up: pain visual analog scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, and Rowe instability score. Results A total of 30 patients met the inclusion criteria for the study. The mean ± SD follow-up was 96.60 ± 10.91 months. At final follow-up, the mean visual analog scale score improved from 8.17 ± 1.6 to 1.63 ± 1.90 (P < .0001), the Single Assessment Numeric Evaluation score from 41.65 ± 16.78 to 87.63 ± 13.02 (P < .0001), the American Shoulder and Elbow Surgeons score from 36.47 ± 10.26 to 88.07 ± 13.94 (P < .0001), and the Rowe score from 35.33 ± 6.56 to 90.00 ± 14.68 (P < .0001). Three patients reported postoperative complications, and 1 progressed to further surgery. Overall, 90% of patients remained on active duty military service and were able to return to preinjury levels of work and recreational activity. The failure rate, defined as persistent instability or activity-limiting pain, was 10%. Conclusion The results of this study demonstrated favorable outcomes for the majority of patients after arthroscopic repair of type VIII SLAP lesions at midterm follow-up, supporting repair as a viable treatment option for type VIII SLAP tears in this patient population.
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Affiliation(s)
- Clare K. Green
- School of Medicine, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Ruder JA, Young BL, Connor PM. Distal clavicle "A-frame" morphology: a reliable intraoperative guide for arthroscopic distal clavicle excision. J Shoulder Elbow Surg 2022; 31:688-693. [PMID: 34774778 DOI: 10.1016/j.jse.2021.10.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this cadaveric study was to describe the characteristics of the "A-frame" morphology of the distal clavicle via computed tomography (CT) to determine whether it can be used as a reliable intraoperative guide for arthroscopic distal clavicle excision. METHODS Twenty-eight fresh-frozen human cadaveric clavicles underwent a 3-dimensional CT scan using 1.0-mm cuts. The distance from the most lateral aspect of the clavicle to the point at which the superior cortex of the clavicle paralleled the inferior cortex was measured. Measurements were performed in a blinded fashion by a single author on 2 separate occasions. RESULTS The A-frame was present in all specimens (28 of 28). On the first measurement, the mean distance from the distal clavicle to the point at which the A-frame disappeared was 1.00 cm (range, 0.90-1.08 cm; standard deviation, 0.5 mm). On the second measurement, the mean distance was 1.02 cm (range, 0.90-1.11 cm; standard deviation, 0.6 mm). The intrarater reliability between measurement occasions was 0.65 (95% confidence interval, 0.36-0.82; P < .001). CONCLUSIONS This study demonstrated that the cross-sectional A-frame morphology of the distal clavicle was consistently visualized on CT scans. The A-frame disappeared 1.00-1.02 cm medial to the most lateral extent of the clavicle on CT scans. The disappearance of the A-frame morphology of the distal clavicle can serve as a reliable intraoperative guide for arthroscopic distal clavicle excision.
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Affiliation(s)
- John A Ruder
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - Bradley L Young
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - Patrick M Connor
- The Sports Medicine Center, The Shoulder and Elbow Center, OrthoCarolina, Charlotte, NC, USA.
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37
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Popescu IA, Neculau DC, Simion C, Popescu D. Modified Dynamic Anterior Stabilization (DAS) and Hill-Sachs Remplissage for the Treatment of Recurrent Anterior Shoulder Dislocation. Arthrosc Tech 2022; 11:e147-e152. [PMID: 35155106 PMCID: PMC8821041 DOI: 10.1016/j.eats.2021.10.004] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023] Open
Abstract
The optimal treatment for recurrent glenohumeral instability is a subject under debate. The recently described arthroscopic technique for dynamic anterior stabilization (DAS) fills the treatment indication gap between reconstructive bony procedures and soft tissue stabilization. However, indications for DAS are considered limited or not appropriate for patients with recurrent shoulder dislocations caused by severe bone defects. In this Technical Note, we present a modified all-arthroscopic DAS technique with added infraspinatus and posterior capsule remplissage to correct the extra-articular Hill-Sachs defect in a patient with recurrent dislocations and off-track bony lesions. The patient requested an alternative treatment option, other than the complication-prone Latarjet procedure.
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Affiliation(s)
- Ion-Andrei Popescu
- Romanian Shoulder Institute, ORTOPEDICUM- Orthopaedic Surgery & Sports Clinic, Bucharest, Romania,SportsOrtho Department, Zetta Hospital, Bucharest, Romania,Address correspondence to Ion-Andrei Popescu, M.D., M.H.B.A., Romanian Shoulder Institute, ORTOPEDICUM - Orthopaedic Surgery & Sports Clinic, Bucharest 011663, Romania.
| | - Diana Cosmina Neculau
- Romanian Shoulder Institute, ORTOPEDICUM- Orthopaedic Surgery & Sports Clinic, Bucharest, Romania,SportsOrtho Department, Zetta Hospital, Bucharest, Romania,University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
| | - Cosmin Simion
- Romanian Shoulder Institute, ORTOPEDICUM- Orthopaedic Surgery & Sports Clinic, Bucharest, Romania,SportsOrtho Department, Zetta Hospital, Bucharest, Romania
| | - Dragos Popescu
- Romanian Shoulder Institute, ORTOPEDICUM- Orthopaedic Surgery & Sports Clinic, Bucharest, Romania
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Haskel JD, Wang KH, Hurley ET, Markus DH, Campbell KA, Alaia MJ, Millett PJ, Jazrawi LM. Clinical outcomes of revision arthroscopic Bankart repair for anterior shoulder instability: a systematic review of studies. J Shoulder Elbow Surg 2022; 31:209-216. [PMID: 34358668 DOI: 10.1016/j.jse.2021.06.021] [Citation(s) in RCA: 2] [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] [Received: 03/22/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following revision arthroscopic Bankart repair. METHODS Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the Embase, MEDLINE, and Cochrane Library databases. Studies in which arthroscopic Bankart repair was performed as a revision procedure were included. The clinical outcomes extracted and analyzed were functional outcomes, return to play, and recurrent instability. RESULTS Fourteen studies with 433 patients met the inclusion criteria. The majority of patients were male patients (63.7%); the average age was 26.1 years (range, 14-58 years), and the mean follow-up period was 37.6 months (range, 10-144 months). The mean Rowe score was 84.2, and 79.7% of patients had good to excellent outcomes. The rate of return to play was 78.5%, with 47.5% of patients returning to their preinjury level of play across 10 studies. The rate of recurrent instability was reported in 12 studies, with 328 shoulders demonstrating 86 instability events (26.2%). The rate of recurrent instability due to dislocation was reported in 7 studies (n = 176), with 19 events (10.8%), whereas the rate of subluxation was reported in 4 studies (n = 76), with 6 events (7.9%). CONCLUSIONS Revision arthroscopic Bankart repair for anterior shoulder instability was shown to result in a high rate of recurrent shoulder instability. There was a relatively poor rate of return to sport among athletes, and only about half of the patients were able to return at or above their preoperative level of ability.
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Affiliation(s)
- Jonathan D Haskel
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Karina H Wang
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Danielle H Markus
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Day Hazra RO, Ernat JJ, Rakowski DR, Boykin RE, Millett PJ. The Evolution of Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211050899. [PMID: 34901288 PMCID: PMC8652190 DOI: 10.1177/23259671211050899] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
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Affiliation(s)
- Rony-Orijit Day Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | | | - Robert E Boykin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,EmergeOrtho, Asheville, North Carolina, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Baron JE, Parker EA, Wolf BR, Duchman KR, Westermann RW. PROMIS Versus Legacy Patient-Reported Outcome Measures for Sports Medicine Patients Undergoing Arthroscopic Knee, Shoulder, and Hip Interventions: A Systematic Review. Iowa Orthop J 2021; 41:58-71. [PMID: 34924871 PMCID: PMC8662933] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS®) was designed to monitor the global wellbeing of patients, with the Physical Function Computer-Adaptive Test (PF-CAT) component focused specifically on functional outcome. PROMIS aims for increased item-bank accuracy, lower administrative burden, and decreased floor and ceiling effects compared to legacy patient-reported outcome measures (PROMs). Our primary research outcomes focused on sports medicine surgical populations, which may skew younger or have wide-ranging functional statuses. Specifically, for this population, we questioned if PROMIS PF-CAT was equal to legacy PROMs in (1) construct validity and (2) convergent/divergent validities; and superior to legacy PROMs with respect to (3) survey burden and (4) floor and ceiling effects. METHODS Searches were performed in April 2019 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing PubMed, Cochrane Central, and Embase databases for Level I-III evidence. This resulted in 541 records, yielding 12 studies for inclusion. PROM data was available for patients undergoing arthroscopic orthopaedic procedures of the knee, shoulder, and hip. Measures of construct validity, convergent/divergent validity, survey burden, and floor/ceiling effects were evaluated for PROMIS PF-CAT versus legacy PROMs. RESULTS PROMIS PF-CAT demonstrated excellent or excellent-good correlation with legacy PROMS for physical function and quality of life for patients undergoing arthroscopic interventions of the knee, shoulder, and hip. Compared to legacy PROM instruments, PROMIS PF-CAT demonstrated the lowest overall survey burden and had the lowest overall number of floor or ceiling effects across participants. CONCLUSION PROMIS PF-CAT is an accurate, efficient evaluation tool for sports medicine surgical patients. PROMIS PF-CAT strongly correlates with legacy physical function PROMs while having a lower test burden and less incidence of floor and ceiling effects. PROMIS PF-CAT may be an optimal alternative for traditional physical function PROMs in sports medicine patients undergoing arthroscopic procedures. Further studies are required to extend the generalizability of these findings to patients during postoperative timepoints after shoulder and hip interventionsLevel of Evidence: III.
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Affiliation(s)
- Jacqueline E. Baron
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Emily A. Parker
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Brian R. Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Kyle R. Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Robert W. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Abstract
The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.
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Affiliation(s)
- Krystian Kazubski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, 49576University of Opole, Opole, Poland
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, 49645Poznan University of Life Sciences, Poznan, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, 49576University of Opole, Opole, Poland
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Niehaus R, Urbanschitz L, Schumann J, Lenz CG, Frank FA, Ehrendorfer S, Eid K. Non-Adherence to Pain Medication Increases Risk of Postoperative Frozen Shoulder. Int J Prev Med 2021; 12:115. [PMID: 34760126 PMCID: PMC8551781 DOI: 10.4103/ijpvm.ijpvm_499_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Postoperative frozen shoulder (FS) or adhesive capsulitis is a relatively frequent complication (5-20%), even after simple arthroscopic shoulder surgeries. The pathophysiology is still unclear, but psychological factors may play a pivotal role. From clinical experience, we hypothesized that patients, who are reluctant to take medications, particularly "pain-killers," have an increased incidence of postoperative FS. Methods We identified twenty patients who underwent limited arthroscopic operations of the shoulder and developed postoperative FS. Twenty patients with matching type of surgery, age, and gender served as control group (n = 20). All patients were at least one year postoperative and asymptomatic at the time of examination. Demographic data, the patient's adherence to self-medication (including self-medicating scale, SMS), development the Quality of life (QoL), and depression scale (PHQ-4-questionnaire) were assessed. Results Patients with FS had a 2-fold longer rehabilitation and 3-fold longer work inability compared to the patients without FS (P < 0.009 and P < 0.003, respectively). Subjective shoulder value SSV (P = 0.075) and post-operative improvement of QoL (P = 0.292) did not differ among the groups. There was a trend-but not significant-toward less coherence to self-medication in the FS-group (26.50 vs. 29.50; P = 0.094). Patients with postoperative FS significantly more often stated not to have "taken pain-killers as prescribed" (P = 0.003). Conclusions Patients reporting unwillingness to take the prescribed pain medications had a significantly higher incidence of postoperative FS. It remains unclear whether the increased risk of developing FS is due to reduced postoperative analgesia or a critical attitude toward taking medication. However, patients who are reluctant to take painkillers should strongly be encouraged to take medications as prescribed.
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Affiliation(s)
- Richard Niehaus
- Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Lukas Urbanschitz
- Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Jakob Schumann
- Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Christopher G Lenz
- Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
| | - Florian A Frank
- Department of Orthopedic Surgery, Kantonsspital Aarau, Tellstrasse 25, Aarau, Switzerland
| | | | - Karim Eid
- Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, Switzerland
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Gendre P, Boileau P. The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions. Orthop J Sports Med 2021; 9:23259671211043449. [PMID: 34631906 PMCID: PMC8493315 DOI: 10.1177/23259671211043449] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. PURPOSE To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. STUDY DESIGN Case series; Level of evidence, 4. METHODS Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. RESULTS The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts' shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. CONCLUSION The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.
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Liu C, Cheng L, Du B, Cheng S, Jiang Y, Tan X, Qian K. The analgesic efficacy of pregabalin for shoulder arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26695. [PMID: 34559094 PMCID: PMC8462647 DOI: 10.1097/md.0000000000026695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/19/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model. RESULTS Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = -0.57; 95% CI = -1.04 to -0.09; P = .02) and 12 hours (Std. MD = -0.37; 95% CI = -0.72 to -0.02; P = .04), as well as analgesic consumption (Std. MD = -1.84; 95% CI = -2.24 to -1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = -0.54; 95% CI = -1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53-1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89-1.47; P = .30). CONCLUSIONS Pregabalin may benefit to pain control after shoulder arthroscopy.
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Affiliation(s)
- Chunhong Liu
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Ling Cheng
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Bo Du
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Shuang Cheng
- Department of Surgery, The TCM Hospital of Kaizhou District, Chongqing, China
| | - Yangming Jiang
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Xiaohong Tan
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Ke Qian
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
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Coşarcan SK, Gurkan Y, Doğan AT, Koyuncu Ö, Erçelen Ö. Could Interscalene Block Possibly be Protective Against Cerebral Ischemia During Shoulder Surgery in a Beach Chair Position? Cureus 2021; 13:e16773. [PMID: 34476141 PMCID: PMC8404480 DOI: 10.7759/cureus.16773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOSTM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.
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Affiliation(s)
| | | | | | - Özgür Koyuncu
- Orthopaedics and Traumatology, VKV American Hospital, Istanbul, TUR
| | - Ömür Erçelen
- Anesthesiology, VKV American Hospital, Istanbul, TUR
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Abstract
BACKGROUND Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery. PURPOSE To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non-bleeding-related outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate. RESULTS Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, -209.66 mL; 95% CI, -389.11 to -30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, -84.8 mL; 95% CI, -140.04 to -29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, -0.33 g/dL; 95% CI -0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures. CONCLUSION This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required. CLINICAL RELEVANCE TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.
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Affiliation(s)
| | - Kar H. Teoh
- Princess Alexandra Hospital, Harlow,
Essex, UK
| | - Mustafa S. Rashid
- Nuffield Department of Orthopaedics,
Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Mustafa S. Rashid, MB ChB,
MSc, PhD, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal
Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK (
)
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Fitzgerald EM, Kavanagh RG, O'Connor OJ, Morrissey DI. Determining the accurate placement of a posterior portal in shoulder arthroscopy with the use of computerized tomography images. JSES Rev Rep Tech 2021; 1:236-241. [PMID: 37588964 PMCID: PMC10426646 DOI: 10.1016/j.xrrt.2021.04.017] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Portal placement is an important factor in performing a successful shoulder arthroscopy. Recent cadaveric studies have found variance in the anatomy of the glenohumeral joint. Our aim was to determine if computerized tomography (CT) images could be used to map the trajectory of the posterior portal objectively and then measure the distance between this trajectory and palpable landmarks to apply this knowledge to clinical practice. Methods Two-dimensional multiplanar reformatted CT images were generated using OsiriX (Pixmeo, Switzerland) from CT images performed in a tertiary hospital over a 1-month period. The center of the glenoid was identified and a trajectory through it radiologically mapped. Horizontal and lateral measurements were taken from this trajectory to both the posterolateral edge of the acromion and tip of the coracoid. Results Following application of inclusion and exclusion criteria, 226 shoulders were analyzed. Fifty scans were selected at random and re-reviewed by the primary examiner to assess intra-rater reliability which showed strong correlation and no significant differences between first and second measurements (P < .01, r > 0.6). The mean distance from acromion to portal trajectory was 1.39 cm inferiorly (95% confidence interval [CI] 1.31-1.48, standard deviation [SD] 0.65 cm) and 1.44 cm medially (95% CI 1.35-1.53, SD 0.71 cm). The mean distance from the coracoid to the trajectory was 1.71 cm inferiorly (95% CI 1.64-1.78, SD 0.55 cm) and 1.26 cm medially (95% CI 1-2-1.31, SD 0.45 cm). Paired t-test analysis between right and left shoulders within the same subject, where these data were available (n = 81), showed no significant difference (P > .05) between sides. Subset analysis was also performed between males and females, but only showed a significant difference between the vertical distance from the coracoid process to the center of the glenohumeral joint. This distance was shorter in females compared to males (1.56 cm in females compared to 1.84 cm in males, P < .001). Conclusions Knowledge of shoulder anatomy is vital to the placement of arthroscopic portals, yet research on this topic has been based primarily on surface anatomy, small sample sized cadaveric studies or expert opinion alone. Our study shows that posterior portal placement in shoulder arthroscopy can be measured objectively using CT scanning.
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Affiliation(s)
- Eilis M. Fitzgerald
- Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Owen J. O'Connor
- Senior Lecturer and Consultant Radiologist, Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - David I. Morrissey
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
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Abstract
Shoulder instability in hypermobile Ehlers-Danlos syndrome can result in lifelong pain and functional disability. Treatment in this population is complicated by the severe degree of instability as well as the underlying abnormalities of the joint connective tissue. Appropriate care for these patients requires a thorough understanding of the natural history of their disease, knowledge of the available treatment options, and certain special considerations. This article reviews the pathoanatomy, recognition, and management of shoulder instability in the patient with hypermobile Ehlers-Danlos syndrome.
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Affiliation(s)
- Samuel E. Broida
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Aidan P. Sweeney
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Eric R. Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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49
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Abstract
Introduction: Retained bullets in joint spaces have been shown to cause both mechanical and chemical damage to the joint surfaces, leading to the risk of arthritis if untreated. Case Report: A case of arthroscopic treatment for a gunshot to the shoulder with a retained bullet embedded in the glenoid is presented. The patient presented with multiple gunshots to his back and extremities, including gunshot to the left leg with popliteal vein injury, gunshot to the back with lumbar level laminar fractures and acute spinal cord injury, and gunshot to the left shoulder with a retained bullet in the posterior superior glenoid. Conclusion: Shoulder arthroscopy can be successfully employed to retrieve larger embedded bullet or foreign body with the help of tools such as laparoscopic graspers. Even with significant glenoid bone defect, the stability of the shoulder joint does not get compromised if the bone defects are located posterosuperiorly.
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Affiliation(s)
- Jonathan Guevara
- Department of Orthopedics, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | | | - Sivashanmugam Raju
- Department of Orthopedics, St. Louis University School of Medicine, St. Louis, Missouri, USA
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50
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Vattigunta S, Weiner S, Nayar SK, Jenkins S, Srikumaran U. Opioid consumption following orthopedic shoulder surgery: a retrospective analysis. J Shoulder Elbow Surg 2021; 30:S153-S158. [PMID: 33892118 DOI: 10.1016/j.jse.2021.04.005] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prescription opioid misuse has become an epidemic in the United States and is a leading cause of death in Americans. Postoperative opioid prescriptions are a significant contributor to the opioid epidemic, with orthopedic surgeons being the third highest prescribers of opioid prescriptions among physicians across all specialties. Our aim was to retrospectively evaluate overall opioid consumption patterns following surgical treatment for shoulder pathology and recommend evidence-based guidelines for standardized postoperative opioid prescriptions. METHODS We conducted a retrospective chart review of patients who underwent shoulder arthroscopy or arthroplasty from a single shoulder/elbow fellowship-trained surgeon (principal investigator). Patient and surgery characteristics were summarized for the entire sample and further stratified by surgery type. Total opioid consumption at the time of the first postoperative visit and refill patterns were compared between each surgery group. Opioid consumption was analyzed in morphine milligram equivalents (MMEs) and is reported in the equivalent number of 5-mg oxycodone tablets. RESULTS A total of 119 patients were included in our analysis. The average age was 58 ± 13 years, and 59% of patients were male. Rotator cuff repair was the most frequent surgery (n = 52), followed by arthroplasty (n = 35) and arthroscopy (n = 28). On average, the patients in the study used 82.5 ± 233 MME units, equivalent to 11 ± 31.067 tablets of 5-mg oxycodone. Sixteen percent of patients did not use any opioids. There was no significant difference in opioid consumption or refills across surgery type. In the bivariate analysis for the entire sample, age was the only predictor that was statistically significantly associated with the amount of opioid consumption. In the multivariable model for patient demographics, significant predictors of opioid consumption were age, gender, and pain scores. In the multivariate analysis by surgery type, significant predictors of higher opioid consumption were age, gender, pain score, and surgery performed on the dominant side. CONCLUSION On the basis of the consumption patterns observed in our patient cohort, we recommend prescribing 112.5 MME (15 tablets of 5-mg oxycodone) for arthroscopic shoulder procedures, and 75 MME (10 tablets of 5-mg oxycodone) for shoulder arthroplasties.
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Affiliation(s)
- Saisanjana Vattigunta
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott Weiner
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sabrina Jenkins
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Umasuthan Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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