American Shoulder Elbow Surgeons Research Articles

Clinical Results after Arthroscopic Treatment of Septic Shoulder with Proximal Bone Involvement.

If osteomyelitis is confined to the proximal humerus, arthroscopic debridement with multiple punctures at the infected bone might be sufficient to eradicate the septic shoulder with bone involvement. From 2005 to 2017, 15 patients received arthroscopic debridement with multiple punctures. We included patients with septic shoulder arthritis with proximal bone involvement and excluded patients with glenohumeral joint destruction or extension of bone involvement to the diaphysis of the humerus. We performed multiple punctures for drainage of proximal humerus after complete arthroscopic debridement of septic soft tissue. Infection laboratory studies and postoperative magnetic resonance image were evaluated. For clinical outcome measurements, range of motion, pain visual analog scale, functional visual analog scale, American shoulder elbow surgeon scores, constant scores, and simple shoulder test were evaluated. There were 11 males and 4 females with a mean age of 53years (range 28-73years). Mean follow-up was 32months (range 12-115months). There was no reinfection case. The postoperative C-reactive protein levels were normalized in all. The postoperative magnetic resonance image showed no bony involvement of the proximal humerus in all patients except one patient. The clinical scores and range of motion were significantly improved postoperatively. Six patients underwent secondary surgery for rotator cuff tear at a mean time period of 25months (range 4-104months) from the index period. Septic shoulder with proximal bone involvement can be successfully treated with arthroscopic debridement with multiple punctures. Level IV, treatment study.

Outcomes of Arthroscopic Biceps Tenodesis for the Treatment of Failed Type II SLAP Repair: A Minimum 2-Year Follow-Up.

To retrospectively review surgical outcomes of prospectively collected data on a series of patients who underwent revision of a type II SLAP repair to arthroscopic biceps tenodesis due to an unsuccessful outcome. A retrospective review was performed on a cohort of patients who underwent arthroscopic biceps tenodesis for a failed type II SLAP repair from 2010 to 2014. Range of motion (ROM) in four planes was measured pre-and postoperatively. In addition, all patients completed the American Shoulder Elbow Surgeons (ASES) standardized shoulder assessment form, the Visual Analogue Scale (VAS) for pain, and the Short Form-12 (SF-12) scores. Overall, 26 patients met inclusion criteria. All 26 patients were available for follow-up at a minimum of two years (100% follow-up). The mean age of the patients was 37(range 26-54), 85% were male, and 58% were overhead laborers. Clinical as well as statistical improvement was noted following tenodesis across all outcome measurements (P<0.01). Additionally, ROM improved in all four planes (P<0.01). The rate of return to work was 85% with workers' compensation status leading to inferior outcomes. Two complications were noted which required an additional surgery. Arthroscopic biceps tenodesis demonstrates to be an effective treatment for a failed type II SLAP repair with improved patient satisfaction, pain relief, and range of motion at two-years follow-up with a low complication rate.

Arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata

Objective To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata. Methods From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration. Results All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4). Conclusion Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction. Key words: Arthroscopy; Fascia lata; Reconstructive surgical procedures; Rotator cuff; Transplants

Modified keyhole technique for the treatment of biceps long head tendon rupture.

The present study aimed to assess a novel modified keyhole fixation technique to treat long head of biceps (LHB) rupture. From May 2015 to July 2017, a total of 9 patients with LHB rupture, decreased muscle strength and pop-eye sign were treated using the keyhole fixation technique combined with extramedullary cortical bone microplate-suspending fixation. Measurements of visual analog scale (VAS) score, elbow joint rotation, flexion strength, the Shoulder Score of the University of California Los Angeles (UCLA) and the Rating Scale of American Shoulder Elbow Surgeons (ASES) score were used to evaluate surgical outcomes prior to and following surgery. The 9 patients with LHB rupture included in the study were followed up for one year post-surgery. The supination and flexion elbow strength of all patients after 1 year was grade V and shoulder pain was relieved. The VAS, UCLA shoulder and ASES scores at one year post-surgery were significantly improved compared with those prior to surgery. In conclusion, modified keyhole fixation for LHB rupture features low difficulty of operation, high safety and reliable fixation, and is therefore a promising novel technique for the treatment of LHB rupture.

Decreased complication profile and improved clinical outcomes of primary reverse total shoulder arthroplasty after 2010: A systematic review.

The purpose of this review was to update the complication profile of reverse total shoulder arthroplasty (rTSA) post-2010, given greater procedural familiarity, improved learning curves, enhanced implant designs, and increased attention to the nuances of patient selection. Three electronic databases were searched and screened in duplicate from 1 January 2010 to 16 December 2018 based on predetermined criteria. Twenty-two studies examining 1455 patients (26% male; mean age: 73.4 ± 3.6; mean follow-up: 23.4 ± 14.3 months) were reviewed. Post-operative motion ranged a mean 122.4° ± 11.5° flexion, 109° ± 19.4° abduction, and 33° ± 11.2°/41° ± 5° external/internal rotation. Post-operative mean Constant score was 58.9 ± 10.1, American Shoulder Elbow Surgeon score was 73.4 ± 6.1, Simple Shoulder Test score was 63.5 ± 6.5, and a Visual Analog Scale pain score was 1.6 ± 0.9. The overall complication rate was 18.2% and major complication rate was 15.4%. Compared to pre-2010, the overall complication rate of 18.2% is lower than previous rates of 19%-68%, with the rate of "major" complications dropping three-fold from 15.4% to 4.6%. The data suggest that rTSA is a safe and efficacious alternative to aTSA and HA, and the "stale" nature of previous complication profiles are points fundamental to perioperative discussions surrounding rTSA.

The clinical effects of reverse shoulder arthroplasty for the patients with the cuff tear arthritis

Objective: To analyze the clinical effects of reverse shoulder arthroplasty (RSA) for the patients with the cuff tear arthritis(CTA). Methods: A retrospective analysis of 12 patients who had underwent primary RSA for treatment of CTA from January 2012 to June 2017 in Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University. There were 8 males and 4 females, aged 69.4 years (range: 64-73 years). The operation was performed in a conventional manner, the subscapularis and biceps tendon were repaired separately.The preoperative and postoperative American shoulder elbow surgeons score and university of California at LosAngeles score of patients were recorded. The complications and the images of radiological examinations were collected. Data were analyzed by paired-samples t-test. Results: At mean follow-up of (34.7±18.1) months (range:3-66 months), the preoperative ASEA score improved from 58.2±8.2 to 92.9±2.9 (t=14.32, P=0.00) and UCLA score improved from 13.2±1.5 to 30.8±1.7(t=23.14, P=0.00). No complications like loosening of prosthesis, superficial wound infection and shoulder dislocation were noted. Conclusion: Reverse shoulder arthroplasty have satisfactory effect for the patients with the cuff tear arthritis.

Functional Recovery of the Shoulder after Arthroscopic Treatment for Chronic Calcific Tendinitis.

BackgroundWe investigated the resolution of pain and functional recovery of shoulder after arthroscopic removal of calcific deposits in patients with chronic calcific tendinitis.MethodsWe enrolled 39 patients who were treated arthroscopically for chronic calcific tendinitis that had been non-responsive to at least 6 months of conservative treatment. We evaluated clinical outcome in terms of the American Shoulder Elbow Surgeons (ASES), the Constant score, the visual analogue score (VAS) for pain. We used plain radiography to measure the size of the calcific deposits. We also analyzed the clinical outcomes in terms of whether or not a cuff repair was performed or the degree of removal of calcific deposits.ResultsWe found that complete resolution of pain took on average 5.7 months after the arthroscopic treatment. The ASES and the Constant score significantly improved from the 3-month follow-up, however it took 6 months until the scores reached on average 80 points or above. We found that these clinical outcomes at the final follow-up did not significantly differ by whether or not cuff repair was performed. Similarly, we found that the clinical outcomes did not significantly differ by the degree of calcium removal.ConclusionsWe found that arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis. However, our findings show it takes at least 6 months for the clinical improvement to become statistically significant. We also found that concomitant cuff repairs or the degree of removal of calcification does not affect the clinical outcome of the arthroscopic treatment.

Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20%

To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%. A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented. The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P= .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P= .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P=.01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P= .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I. Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level. Level III, retrospective comparative study.

Clinical treatment of suprascapular nerve compression syndromes via posterior portal by arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve

Objective To investigate the clinical outcomes of arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve in treating suprascapular nerve compression syndromes via posterior portal. Methods Eleven patients from January 2010 to January 2017 with spinoglenoid notch cysts complicated suprascapular nerve compression syndromes were included. There were 7 males and 4 females with the average age of 41.5±5.3 years old (range 29-56 years) with 3 patients left side involved and 8 right side. All patients were diagnosed with MRI and EMG. The surgical procedure began with posterior capsule arthroscopic releasement from the labrum, then found the spinoglenoid notch cyst. Split of the cyst was made for internal drainage, then found the suprascapular nerve and vessel bundle for clearing the bursal tissue with probe, decompressed the suprascapular nerve finally. Mecobalamin was taken (0.5 mg, tid) until 3 months postoperatively. The patients were evaluated by functional scores from American Shoulder Elbow Surgeons (ASES) and Constant-Murley preoperatively and postoperatively. Statistical analysis was conducted by student t-test. Results All patients were followed up at 7-15 months (with an average of 10 months). The mean preoperative ASES score increased from 46.5±3.7 to 93.8±2.2 at the time of final follow-up with the significant difference (t=3.359, P<0.05). Preoperative ASES score were good in 5 cases, fair in 4 cases and poor in 2 cases. The postoperative score were excellent in all patients. The Constant-Murley score was 47.3±4.2 preoperatively and 94.0±1.8 postoperatively with significant difference (t=4.776, P<0.05). Preoperative score were good in 6 cases and fair in 5 cases. The postoperative score were excellent in all patients. These patients had no recurrence of cyst after surgery and returned to work. Conclusion Arthroscopic decompression of spinlglenoid notch cyst and suprascapular nerve release via posterior portal can successfully treat suprascapular nerve compression syndrome resulting in spinoglenoid notch cyst. Key words: Shoulder; Arthroscopy; Cysts; Nerve compression syndromes

The role of teriparatide in tuberosity healing after reverse shoulder arthroplasty in complex proximal humeral fragility fracture.

Tuberosity healing is known to be one of the factors that increase functional outcome in Reverse Total Shoulder Arthroplasty (rTSA). In fragility fractures, tuberosity healing is difficult to be achieved. The fragment stability and bone-forming agent application become strategies to overcome this problem. The purpose of this study was to evaluate the benefit of teriparatide application to promote tuberosity union in rTSA on four-part proximal humeral fractures to achieve better functional outcome. A retrospective study of a prospectively collected shoulder arthroplasty medical record was performed. Eleven patients were included in this analysis and consisted of two groups, teriparatide and no-teriparatide groups. Patients were evaluated on the range of motions and clinical outcome using the American Shoulder Elbow Surgeon (ASES) Shoulder Score and X-ray to determine tuberosity union. The group differences were analyzed by t-test or Mann-Whitney U test with SPSS version 20.0 for Windows. The statistical analysis revealed no significant differences in mean age in both the groups. There were significant differences between teriparatide and no-teriparatide groups in external rotation (29.5° vs. 7.5°; p = 0.004), external rotation in 90° abduction (55° vs. 12.5°; p < 0.020), forward flexion (120° vs. 105°; p = 0.002) range of motions, and ASES (84.5 vs. 74.6; p = 0.019). We found clinical difference between teriparatide and no-teriparatide groups in time to achieve the initial callus (33 ± 18.3 days vs. 150 ± 42.4 days) and tuberosity consolidation (165.8 ± 70.3 days vs. 315 ± 106.1 days). Teriparatide administration supports tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after rTSA in acute complex proximal humeral fractures.

Clinical and MRI results of arthroscopic repair for massive rotator cuff tear

Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive rotator cuff tear at minimum 2 years after surgery. Methods From October, 2010 to March, 2013, data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed. There were 42 male (44 shoulders) and 35 female (35 shoulders). The average age before surgery was 57.4 years (43.1-80.4 years). There were 64 right shoulders and 15 left shoulders. The dominate side were involved in 70 cases. A trauma history was documented in 52 shoulders. The symptoms persisted less than 3 months in 42 shoulders, between 3 and 6 months in 11 shoulders, between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders. No revision case was included. The clinical results (range of motion, forward elevation strength, external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected. Results All 77 cases were followed up more than 2 years. The forward elevation (156.9°±20.0° to 103.2°±54.5°), external rotation (40.6°±15.5° to 32.0°±21.4°), internal rotation (L1 to L2), forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb), external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2±17.4) were all improved significantly at the latest follow-up. During the surgery, complete repair were achieved in 68 shoulders. The forward elevation (146.4°±31.4° to 110.0°±56.7°), external rotation (45.0°±14.8° to 34.1°±20.8°) and ASES score (78.6±14.9 to 54.5±13.9) were all improved significantly at the latest follow-up in patients with partial repair during the surgery. But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair. In 68 shoulders with complete repair during the surgery, 20 shoulders were found to have rotator cuff re-tear. The re-tear rate was 29.4%. But none of the patient with postoperative re-tear received revision surgery. The forward elevation (152.0±23.3 to 103.5±60.5), forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon. But the forward elevation (161.4°±13.4° to 152.0°±23.3°), forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb), external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group. Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery. The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group. Key words: Shoulder joint; Arthroscopy; Soft tissue injuries

A comparison study of phlios plate and multiloc nail in treatment of proximal humerus fractures

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures. Methods From February 2013 to December 2015, data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed. In group one (Phlios plate), there were 10 males and 8 females, with an average age of 56.3±5.8 years, including 7 cases of Neer 2-part surgical neck fracture, 6 cases of Neer 3-part fracture, 4 cases of Neer 4-part fracture, and 1 case of fracture-dislocation. In group two (Multiloc nail), there were 8 males and 11 females, with an average age of 57.2±7.4 years, including 8 cases of Neer 2-part surgical neck fracture, 9 cases of Neer 3-part fracture, 1 case of Neer 4-part fracture, and 1 case of fracture-dislocation. Operation time, range of motion of shoulder joint, visual analogue scale (VAS) pain score, American Shoulder & Elbow Surgeon (ASES) score and Constant-Murley score were collected. Results All 37 patients were followed up for an average period of 15.5 months (range, 12-36 months). The average bone healing time were 2.5±0.5 months (range, 2-3 months) and 2.2±0.5 months (range, 1.5-3 months) in the plate and nail group respectively. At the latest follow-up, average VAS score was 0.4±0.6 (range, 0-2), the ASES score averaged 85.4±6.8 points (range, 73-96), Constant-Murley score averaged 83.4±7.3 points (range, 71-94), and external rotation averaged 30.8°±10.0° (range, 10°-50°) in plate group, while average VAS score was 0.2±0.4 (range, 0-1), ASES score averaged 89.7±5.6 points (range, 80-98), Constant-Murley score averaged 88.5±6.8 points (range, 76-98), and external rotation averaged 40.3°±7.9° (range, 20°-50°) in the intramedullary nailing group. One case had partial necrosis of humeral head in the plate group, while 1 case suffered absorption of the greater tuberosity in the nail group, with the complication rate of 5.6% (1/18) and 5.3% (1/19) respectively, without significant difference. The internal and external rotation degrees, ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures, while the forward elevation and abduction degrees were similar. Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail. The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures. Key words: Shoulder fractures; Internal fixators; Fracture fixation, intramedullary

The Mini-Open Modified Bristow-Latarjet Procedure for Anterior Shoulder Instability: A 15-Year Study on the Results of 90 Cases

The described procedure is a reproducible and effective technique used to restore joint stability in patients who have incurred anterior recurrent shoulder dislocation. This study presents the middle time results of Modified Bristow–Latarjet consisting of the association of 2 procedures, the congruent glenoid reconstruction with two headless screws fixtion of the standing coracoid and the rotator interval approach ensuring the intactness of subscapularis muscle in the treatment of traumatic anterior shoulder instability. Ninety patients were enrolled in this retrospective case-series study with 2 to 15 years’ follow-up. Preoperatively and postoperatively all patients underwent a computed tomography scan to assess the percentage of glenoid bone loss and the glenoid cavity reconstruction respectively. The rate of recurrent of shoulder instability, Glenohumeral osteoarthritis,bone-healing, bone position and loss of external motion was evaluated. Rowe, ASES (American-Shoulder-Elbow-Surgeons), Constant-Murley, and DASH scores, were used to assess the shoulder function. The mean length of follow-up was 5.6 years (range, 2-15 years). None patients had shoulder redislocation and none reported shoulder indisability. All patients get bone-union in 6 months. The arthropathy of the shoulder, 82(92%)were classified as normal, 6(6%) as mild, 2(2%)as moderate, and none as severe according to Samilson-Prieto classification. The mean loss of external rotation was 11.6°(95%CI, 9.9-13.2) with the arm at the side of the body, and the mean deficit was 12.4°(95%CI, 10.8-14.0) with the arm on abduction 90°. The Rowe, ASES, Constant-Murley and DASH scores showed significant improvements(p<0.001): The Rowe score increased from 45.6 to 92.6, the ASES score increased from 62.0 to 93.9, the Constant-Murley score increase from 58.2 to 90.8,and the DASH score deceased from 15.9 to 5.0. The described procedure is a reproducible and effective technique used to restore joint stability in patients who have incurred anterior recurrent shoulder dislocation.

Effect of Bone Marrow Aspirate Concentrate-Platelet-Rich Plasma on Tendon-Derived Stem Cells and Rotator Cuff Tendon Tear

Bone marrow aspirate concentrates (BMACs) and platelet-rich plasma (PRP) are good sources to control the differentiation of tendon-derived stem cells (TDSCs), but there has been no study about the effect of the BMAC–PRP complex on TDSCs and tendinopathy. The aim of this study was to investigate the effect of BMAC–PRP on the TDSCs and to find the therapeutic effect of BMAC–PRP on the rotator cuff tendon tear. The chondrogenic and osteogenic potential of TDSCs decreased, but the adipogenic potential of TDSCs revealed no significant difference when they were cocultured with BMAC–PRP. Cell proliferation was significantly greater in TDSCs cocultured with BMAC–PRP than in TDSCs. The degree of wound closure (percentage) was different between TDSCs and TDSCs with BMAC–PRP. There was no significant difference in expression of collagen type I and type III in immunocytochemical staining in the presence of BMAC–PRP. Initial visual analog scale (VAS) score was 5.8±1.9, which changed to 5.0±2.3 at 3 weeks and 2.8±2.3 at 3 months after the BMAC–PRP injection (p<0.01). The American Shoulder Elbow Surgeon score changed from 39.4±13.0 at baseline to 52.9±22.9 at 3 weeks and 71.8±19.7 at 3 months after the injection (p<0.01). The initial torn area of the rotator cuff tendon was 30.2±24.5 mm2, and this area was reduced to 22.5±18.9 mm2 at 3 months, but the change was not significant (p > 0.05). The data indicate that BMAC–PRP enhances the proliferation and migration of TDSCs and prevents the aberrant chondrogenic and osteogenic differentiation of TDSCs, which might provide a mechanistic basis for the therapeutic benefits of BMAC–PRP for rotator cuff tendon tear.

Posterior Distal Clavicle Beveling for Chronic Nonincarcerated Type IV Acromioclavicular Separations: Surgical Technique and Early Clinical Outcomes

To describe the arthroscopic partial posterior distal clavicle beveling technique for treatment of chronic nonincarcerated type IV acromioclavicular (AC) separations and report clinical outcomes and return to sport. All patients who underwent the arthroscopic partial distal clavicle beveling technique and met eligibility criteria were identified and retrospectively reviewed. Inclusion criteria included the clinical diagnosis of a chronic nonincarcerated type IV AC separation and a minimum follow-up period of 24months. Subjects completed the American Shoulder Elbow Surgeons shoulder assessment and a study-designed questionnaire. Radiographic images and clinical charts were also reviewed. This study identified 15 consecutive patients with 2 lost to follow-up, resulting in inclusion of 13 subjects (9 males and 4 females). Dominant arm was involved in 77% of cases. Mean age at operation was 33.2years (range, 19-56years). The mean period between injury and operation was 12.5months (range, 3-37months), and follow-up was 48.5months (range, 24-126months). The mean preoperative ASES score was 46.6 ± 16.9 (range, 33-68), and the mean postoperative ASES score was 87.3 ± 17.4 (range, 50-100) (P < .0001). All 9 athletes in the study returned to competition with a mean recovery period of 2.3months (range, 2weeks to 4months). Mean timeframe for return to work was 2weeks (range, 1day to 2months). One subject underwent a subsequent coracoclavicular ligament reconstruction for continued pain. The mean satisfaction level was 4.3 out of 5, and 91% would choose to have the surgery again. One subject indicated dissatisfaction with shoulder appearance. The arthroscopic partial distal clavicle beveling procedure for nonincarcerated type IV AC separations resulted in a significant reduction in pain, improved daily function, and early return to sport. Level IV, therapeutic case series.

Clavicle Nonunion: Matchstick Bone-grafting and Osteosynthesis

Background: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. Methods: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3–4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. Results: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7–32 months). The mean follow-up period was 20.1 months (8–56 months), and the mean duration until union was 11.2 weeks (8–16 weeks). All clinical scores were improved at the final follow-up (p Conclusions: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.

Functional and radiologic outcomes of uncemented reverse shoulder arthroplasty in proximal humeral fractures: cementing the humeral component is not necessary

Our aim was to determine the radiologic and functional outcomes of patients who underwent reverse shoulder arthroplasty (RSA) for proximal humeral fractures and to assess whether the uncemented humeral components put them at risk for early loosening and failure. Thirty-three patients were identified in our hospital database (January 2004-December 2012). Twenty patients were assessed using American Shoulder Elbow Surgeons (ASES) score, Constant Shoulder Score (CSS), and the Oxford Shoulder Score (OSS). Up-to-date shoulder radiographs were evaluated for evidence of radiologic loosening. The mean follow-up period was 3.0years (range, 2.5-7.8years), and the mean age at the time of surgery was 76.5years (range, 62-87years). The mean ASES was 75.9 of 100 (range, 55-98.3), with a mean visual analog scale pain score of 2 of 10. The mean OSS was 42.5 of 48 (range, 35-48), and the mean CSS was 54.1 of 100 (range, 32-72). Upon radiographic assessment of the humeral component, 6 patients (30%) had 3 or more lucent zones, and 12 patients (60%) had a lucent zone measuring more than 2mm in width; however, only 2 patients (10%) had 3 or more lucent zones measuring 2mm or more in width and were identified as "at risk of loosening." No patients had tilt or subsidence of the humeral prosthesis. Our study demonstrated satisfactory functional and radiologic outcomes of patients compared with other studies, suggesting that RSA is a good management option for elderly patients with these fractures. The uncemented nature of the humeral component did not result in early loosening or failure.

Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow: a multicenter study

Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis has recently been developed for the treatment of lateral elbow arthritis. However, few data have been published on LRE results. A prospective multicenter study was designed to assess LRE preliminary results. There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11 and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis. Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score (MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months. At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P = .001) and 34 (P= .001) respectively; the average Quick DASH decreased by 29 (P = .001). Average range of motion was improved by 35° (P = .001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in 3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant survival rate was 100%. LRE showed promising results in this prospective investigation. Most patients had an uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional recovery at short-term follow-up. Further studies with longer follow-up are warranted.

불안정성 쇄골 원위부 골절에서의 Endobutton을 이용한 오구 쇄골 인대 보강술 - 예비 보고 -

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after operative treatment using endobuttons for unstable distal clavicle fractures. Materials and Methods: Between October 2007 and September 2009, 9 consecutive patients who were followed up for at least more than 12 months after operative treatment using a TightRope were studied. The radiologic results on the serial plain radiographs and the clinical results according to the American Shoulder Elbow Surgeons (ASES) score were analyzed. Result: Bony union was shown in 8 cases (88.9%) and the average time to union was 12.9 (range: 9~16) weeks. The average coracoclavicular distances at the postoperative and final follow-up were 5.6 mm and 6.2 mm, respectively, with no statistically significant difference (p>0.05). The average ASES score was 90.3 (range: 78~96) and the clinical outcomes were 6 excellent, 2 good and one fair. There were no complications such as implant failure or infection except for one case of nonunion due to loss of the initial reduction. Conclusion: A major advantage of TightRope fixation for unstable distal clavicle fractures is that no further surgery is needed to remove the implant. We suggest that this technique provides an alternative for fracture with a distal fragment, which is difficult to fix.

Disability and satisfaction after Rotator Cuff decompression or repair: a sex and gender analysis

BackgroundRotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery.MethodsPatients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment.Results and DiscussionOne hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength.ConclusionsThe results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals.