And Elbow Surgeons Score Research Articles

Baseplate version in reverse shoulder arthroplasty: does excessive retroversion or anteversion affect functional activities of daily living?

While bone grafting and augmented components can help restore reverse shoulder arthroplasty (RSA) baseplate version close to neutral, the indication for version correction in RSA is unclear. The purpose of this study was to compare the clinical outcomes of RSA baseplates in high degrees of retroversion and anteversion to components in more neutral version. Patients who underwent RSA with minimum two year follow-up were identified from an institutional registry. An RSA system with a glenosphere that is two-thirds of a sphere was utilized. Post-operative radiographs were used to determine baseplate version, and patients were grouped into four categories: ≥ 10 degrees (moderate to severe anteversion; n = 14), 10 to -10 degrees (neutral; n = 69), -10 to -20 (moderate retroversion; n = 25), and ≤ -20 degrees (severe retroversion; n = 7). The outcomes of interest were ability to perform functions requiring internal rotation, external rotation and cross-body adduction, as well as complications and revisions. There were no differences in final Simple Shoulder Test (SST), final American Shoulder and Elbow Surgeons score (ASES) or change in SST from pre- to post-operative across the four version groups. There was no linear correlation between baseplate version and final SST. There were no statistically significant differences in difficulty performing tasks related to internal rotation, external rotation, and cross-body adduction among the four baseplate version groups; however, patients with moderate to severe anteversion had a greater frequency of difficulty putting on a coat (86%) compared to patients with neutral version (42%), moderate retroversion (45%) and severe retroversion (0%) (p = 0.021). There were no differences in rates of complications and revisions across the four groups. This study did not find evidence that high values of baseplate retroversion or anteversion were associated with inferior patient reported outcomes or functional rotation after reverse total shoulder arthroplasty. Level 3, retrospective comparative study.

Time Required to Achieve Clinically Significant Outcomes After Anteroinferior Arthroscopic Capsular Release for Shoulder Adhesive Capsulitis.

The specific time required to reach clinically significant outcomes for patient-reported outcome measures (PROMs) after arthroscopic capsular release (ACR) for the treatment of shoulder adhesive capsulitis remains unknown. To determine the time required to achieve the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) score thresholds after ACR for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), and Constant score and to identify patient factors associated with delayed achievement of these clinical benchmarks. Case series; Level of evidence, 4. A prospective analysis was performed of patients who underwent ACR for the treatment of idiopathic shoulder adhesive capsulitis between October 2019 and October2020. Patients completed PROMs preoperatively and at 1, 2, 4, 6, and 12 months postoperatively. Threshold values for MCID and PASS were obtained from previous literature for the VAS, ASES, SANE, and Constant scores. A total of 73 patients were included (mean age, 55.5 ± 9.3 years; body mass index [BMI], 26.6 ± 4.6 kg/m2). By 1-year follow-up, the cumulative percentage of patients achieving the MCID and PASS for VAS, ASES, SANE, and Constant scores was 98.6%, 100%, 100%, and 98.6%, and 95.8%, 91.7%, 98.6%, and 84.9%, respectively. The median time required to reach the MCID thresholds for VAS, ASES, SANE, and Constant scores was 1, 1, 2, and 1 month, respectively. The median time required to reach the PASS thresholds for VAS, ASES, SANE, and Constant scores was 4, 4, 4, and 2 months, respectively. Factors associated with delayed achievement of MCID for SANE included higher BMI (hazard ratio [HR], 0.94; 95% CI, 0.88-0.99) and diabetes (HR, 0.49; 95% CI, 0.2-0.99). Age was associated with delayed achievement of the PASS for VAS. Most patients undergoing ACR achieved clinically significant outcomes within a 4-month timeframe. The majority of patients reached MCID thresholds on outcome measures within 1 to 2 months and achieved satisfactory symptom states within 2 to 4 months postoperatively. By delineating the timeline of patient-perceived benefits, these results provide useful data to set appropriate expectations, guide rehabilitation, and optimize outcomes after ACR.

Clinical, Functional and Radiographic Outcomes of Inverted-Bearing Reverse Shoulder Arthroplasty at Minimum Two Year Follow-up

BackgroundInverted-Bearing Reverse Shoulder Arthroplasty (IB-RSA) is an alternative reverse bearing construct characterized by an ultra-high molecular weight polyethylene glenosphere combined with a CoCr metallic humeral liner. This concept was designed both to minimize bearing wear as well as reduce the potential for scapular notching seen with more traditional-bearing RSA systems. This study reports on clinical outcomes, functional scores, pain scores, and radiographic incidence of scapular notching in a series of IB-RSA at a minimum of two-year follow-up. MethodsA retrospective study was conducted on patients who underwent an IB-RSA between 2016 and 2019, with a minimum follow-up period of two years. Patients were evaluated clinically for DASH score (DS), American Shoulder and Elbow Surgeons score (ASES), EQ-5D Health Questionnaire (EQ-5D), Global Rating of Change score (GRC), Single Assessment Numeric Evaluation score (SANE) and range of motion (ROM). Presence and grade of radiographic scapular notching was assessed using the classification of Sirveaux at 6,12, 24 months and at the last x-ray available. Results61 consecutive patients were assessed at a mean postoperative follow-up of 37 months (range, 24-72 months). IB-RSA exhibited high overall outcome scores including DASH (38.3 +/-5), ASES (83 +/- 6), GRC (4 +/-0.6), and SANE (83 +/-11). ROM was assessed in 41 patients with 135 +- 21 of elevation, 23 +- 12 of external rotation and 5 +- 2 for internal rotation. Scapular notching was radiographically present in 23 (38%) patients (twenty grade 1, three grade 2) in the final follow-up, with all cases showing evidence of mechanical notching while no grade 3 or 4 cases were observed. The scapular notching didn’t progress in most of the patients after the first year (P>0.05). The presence of scapular notching did not influence on clinical outcome scores as DASH, ASES, EQ-5D, GRC, SANE (P>0.05) or active range of motion (P>0.05). ConclusionIB-RSA demonstrates high patient-reported and functional outcome scores at a minimum of two years follow-up. We report only low-grade scapular notching with little progression after the first year. There was no correlation between scapular notching and clinical outcomes.

The Use of a Suture Bridge Technique for Arthroscopic Rotator Cuff Repair in Patients Under 40 Years of Age Resulted in Successful Tendon Healing, Pain Relief, Improved Shoulder Function, and High Patient Satisfaction at a Minimum of 5-Year Follow-Up

PurposeThe purpose of this study was to evaluate the long-term clinical and imaging outcomes after arthroscopic repair of rotator cuff tear (RCT) using a suture bridge technique in patients under 40 years of age. MethodA consecutive series of patients who were treated arthroscopically for RCT by a single surgeon between 2016 and 2018 were retrospectively identified. Both full thickness tears and partial tears were included. Arthroscopic cuff repair employed a knotless double-row suture bridge technique, utilizing braided suture tapes. To assess clinical outcomes, we employed the Constant score, the American Shoulder and Elbow Surgeons score (ASES), a strength score, and a visual analog scale (VAS). Tendon healing was evaluated at 12 months using the Sugaya MRI classification. ResultsA total of 63 patients were included in the study. The mean age at the time of the surgery was 33.6 years (range, 21 to 40) and minimum follow up duration was 5 years. Thirty-nine patients reported occasional sports, eight were professional athletes, while sixteen reported no sportive activity prior to first symptoms. Mean follow-up duration was 66.8 months (range, 62.4 to 88.6 months). A significant improvement was observed in both the Constant score and ASES score. The mean Constant score increased significantly from 39.8 (range, 29 to 52) points to 88.9 (range, 34 to 100) points postoperatively (p < 0.001). Similarly, the ASES score improved significantly from 41.8 (range, 30 to 64) to 90.2 (range, 35 to 100, p < 0.001). Anterior flexion mean improved from 86° (range: 60° to 110°) to 137° (range, 90° to 180°, p < 0.001). Pain significantly decreased after the surgery, VAS descending from 6.3 (range, 3 to 10) to 1.3 (range, 0 to 9) postoperatively. The overall rate of return to previous activities in the cohort was 84% at an average of 10.1 months (range, 6 to 12 months) after surgery. Among the included patients, 85% engaging in occasional sports activities and 67% of elite athletes similarly returned to their pre-injury sports levels after 9.8 (range, 6 to 12) months and 10.7 months (range, 6 to 12) respectively. Two patients (3%) experienced cuff re-rupture, and tendon non-healing (Sugaya stage 3 and stage 4) was observed in five (7%) patients. At the final follow-up, 95% of patients were very satisfied or satisfied with their functional results. ConclusionThe use of a suture bridge technique in arthroscopic RCT repair for patients under 40 years of age resulted in excellent long-term outcomes, including successful tendon healing, pain relief, improved shoulder function, and high patient satisfaction.

Demographic-, Radiographic-, and Surgery-Related Factors Do Not Affect Functional Internal Rotation Following Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Study.

This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups ("IROgood" or "IRObad"). Patients were classified as having good fIR (≥8 points in the Constant-Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro-Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann-Whitney-U Test. Radiographic changes were compared using chi-square or Fisher's exact tests. The significance level was set at p < 0.05. Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5-57.5]) were included in the "IRObad" group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5-65.5]) were included in the "IROgood" group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort.

Home-Based or Supervised Physical Therapy Shows Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair

PurposeThis study aimed to compare postoperative clinical outcomes at the 3-month, 6-month, 12-month, and latest follow-up in patients undergoing supervised physical therapy (PT) or a home-based exercise program after arthroscopic repair (ARCR) of massive rotator cuff tears (MRCTs). MethodsA retrospective review was conducted on a prospectively maintained database of patients who underwent either supervised PT or home-based therapy after ARCR of MRCTs between January 2015 and December 2018 at a single center with a minimum 24-month follow-up. At their 2-week postoperative routine follow-up, patients are allowed to choose between home-based and supervised PT. Patient-reported outcomes (PROs) and range of motion (ROM) were collected and compared between cohorts preoperatively and at the 3-month, 6-month, 12-month, and latest follow-up. The percentage of patients reaching or exceeding the minimal clinically important difference (MCID) and patient accepted symptomatic state (PASS) for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon score (ASES), and Subjective Shoulder Value (SSV) were recorded for both cohorts at each time point. Complications, healing, satisfaction, and return to work were reported. Healing was evaluated via ultrasound at the latest follow-up. ResultsNinety-nine patients met the study criteria: 61 in the supervised PT cohort, and 38 in the home-based cohort. The supervised PT and home-based cohorts returned to clinic for their most recent follow-up at 53±20 and 55±16 months (p=0.496) after surgery, respectively. There was no difference when comparing tendon involvement (SS, p=0.574; IS, p=0.288; SSc p=0.592), tear retraction (p=0.603), or high-grade fatty infiltration (SS, p=0.684; IS, p-0.397; SSc p=0.473) based on preoperative MRI assessment and surgery-related factors, including anterior (p=0.473) or posterior (p=0.386) slides, fixation constructs (p=0.829), or complete repair (p=0.912). Both cohorts showed similar PROs and ROM at baseline. Postoperative PROs and ROM were similar among groups at the 3-month, 6-month, 12-month, and latest follow-up. However, ASES (71.4 vs 61.2; p = 0.013) and FF (135° vs 118°; p = 0.023) were significantly higher at 3-month follow-up in the home-based cohort. Both groups comparably achieved MCID and PASS for PROs at the 3-month, 6-month, and12-month follow-up. At the latest follow-up, the supervised PT and home-based cohort achieved MCID and PASS for VAS (75% vs 81%, p=0.573; 70% vs 72%, p=0.911), ASES (76% vs 74%, p=0.777; 72% vs 72%, p=0.873), and SSV (82% vs 84%, p=0.734; 72% vs 66%, p=0.489), respectively. Satisfaction, healing, complication, and return to work rates were similar. ConclusionPatients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. Although patients with home-based therapy achieved higher FF and ASES at the 3-month follow-up, these became comparable starting at the 6-month postoperative mark. MCID and PASS were achieved similarly for PROs at each time point.

Lateralization of the humerus in reverse total shoulder arthroplasty: can preoperative planning software predict postoperative lateralization and does lateralization influence outcomes?

IntroductionReverse total shoulder arthroplasty (RTSA) can result in varying amounts of humeral medialization or lateralization. The amount of medial or lateral change-in-arm-position can be predicted using 3D CT planning software. It is not clear if the preoperatively-predicted change-in-arm-position correlates with the actual, radiographically-measured change-in-arm-position or if predicted or actual change-in-arm-position correlates with patient-reported outcomes or complications. MethodsPatients undergoing RTSA underwent preoperative 3D CT planning to predict the postoperative medial-to-lateral change-in-arm-position (PCAP). Preoperative and postoperative radiographs were used to calculate the actual medial-to-lateral change-in-arm-position using the measurement of the lateral edge of the greater tuberosity to the lateral edge of the acromion (RCAP-LHO). The Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score (ASES) and Single Assessment Numeric Evaluation (SANE) were recorded at baseline, 1-year, and 2-years. Rates of complications were recorded. ResultsTwo-hundred-and-fifty patients were eligible for this study including 189 patients reaching the one-year clinical follow-up point and 144 patients reaching the two-year clinical follow-up point. One-year and two-year follow-up rates were 89 percent and 91 percent, respectively. The mean PCAP was 3+5 mm and RCAP-LHO was 1+8 mm. There was moderate correlation between PCAP and RCAP-LHO. There was weak correlation between increased PCAP lateralization and higher WOOS and ASES at two years and improvement from baseline to 2 years in WOOS. There was very weak correlation between increased PCAP lateralization and improvement compared to baseline in 1 year SANE and improvement compared to baseline in 2 year SANE. There was weak correlation between lateralized RCAP-LHO and 2 year postoperative SANE. There was superior 2-year WOOS, ASES, and SANE, and improvement in SANE at 1-year compared to baseline in patients with a lateralized PCAP compared to a medialized or neutral PCAP. There was superior 2-year WOOS, improvement in WOOS from baseline to 2-year follow-up, and SANE at 2-years in patients with a lateralized RCAP-LHO compared to a medialized or neutral RCAP-LHO. Overall complication rates were similar between groups although the dislocation rate in shoulders with a lateralized change-in-arm-position was significantly less compared to shoulders with a medial or neutral change-in-arm-position. ConclusionsPCAP correlated with actual RCAP-LHO. Correlations exist with increased humeral lateralization and improved patient-determined outcomes. Patient-determined outcomes were the same or better in patients with a lateralized change-in-arm-position compared to those that were medialized or remained neutral. A lateralized change-in-arm-position did not result in increased overall complications and was protective against postoperative instability.

Reaching Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptomatic State for Patient-Reported Outcome Measures following Arthroscopic Rotator Cuff Repair Does Not Correlate with Patient Satisfaction.

Purpose: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) serve as metrics to gauge orthopedic treatment efficacy based on anchoring questions that do not account for a patient's satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons score (ASES), Single Alpha Numeric Evaluation (SANE), Simple Shoulder Test (SST), and Visual Analog Score (VAS) for pain following arthroscopic rotator cuff repair (RCR) correlates with overall patient satisfaction. Methods: This was a single-institution, retrospective study of patients who underwent RCR from 2015 to 2019. Pre-operative and 2 year postoperative ASES, SANE, SST, and VAS scores were recorded. Patients underwent a survey to assess: (1) what is your overall satisfaction with your surgical outcome? (scale 1 to 10); (2) if you could go back in time, would you undergo this operation again? (yes/no); (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess relationship between reaching MCID, SCB, or PASS and satisfaction. Results: Ninety-two patients were included. Mean preoperative ASES was 51.1 ± 16.9, SANE was 43.3 ± 20.9, SST was 5.4 ± 2.9, and VAS was 4.6 ± 2.1. Mean 2 year ASES was 83.9 ± 18.5, SANE was 81.7 ± 27.0, SST was 9.8 ± 3.2, and VAS was 1.4 ± 1.9. Mean patient satisfaction was 9.0 ± 1.9; 89 (96.7%) patients would undergo surgery again and recommend surgery. Correlation for reaching PASS for SANE and satisfaction was moderate. Correlation coefficients were very weak for all other outcome metrics. Conclusions: Reaching MCID, SCB, and PASS in ASES, SANE, SST, or VAS following RCR did not correlate with a patient's overall satisfaction or willingness to undergo surgery again or recommend surgery. Further investigation into the statistical credibility and overall clinical value of MCID, SCB, and PASS is necessary.

The Use of Glenoid Structural Allografts for Glenoid Bone Defects in Reverse Shoulder Arthroplasty.

Background: The use of reverse shoulder arthroplasty as a primary and revision implant is increasing. Advances in implant design and preoperative surgical planning allow the management of complex glenoid defects. As the demand for treating severe bone loss increases, custom allograft composites are needed to match the premorbid anatomy. Baseplate composite structural allografts are used in patients with eccentric and centric defects to restore the glenoid joint line. Preserving bone stock is important in younger patients where a revision surgery is expected. The aim of this article is to present the assessment, planning, and indications of femoral head allografting for bony defects of the glenoid. Methods: The preoperative surgical planning and the surgical technique to execute the plan with a baseplate composite graft are detailed. The preliminary clinical and radiological results of 29 shoulders which have undergone this graft planning and surgical technique are discussed. Clinical outcomes included visual analogue score of pain (VAS), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score (CS), satisfaction before and after operation, and active range of motion. Radiological outcomes included graft healing and presence of osteolysis or loosening. Results: The use of composite grafts in this series has shown excellent clinical outcomes, with an overall graft complication rate in complex bone loss cases of 8%. Conclusion: Femoral head structural allografting is a valid and viable surgical option for glenoid bone defects in reverse shoulder arthroplasty.

Dermal Allograft Augmentation for Large and Massive Rotator Cuff Tears and Revisions: A Case Series.

Introduction Arthroscopic advancements have notably improved rotator cuff repair, yet the healing of tendons and retear risks still pose significant challenges, especially with massive and large tears. These larger tears have shown a quadruple increase in retear rate when the tear size grows from 1-3 cm. The prevalent cause of failure, particularly in tears with fatty degeneration, is suture tearing.As such, techniques that enhance tendon healing are pivotal due to their correlation with improved functional outcomes. Dermal allograft augmentation (DAA) is one method that has demonstrated improvements in rotator cuff repair biomechanics, as well as the promotion of vascularization and neotendon formation. This study evaluates the efficacy of DAA in the postoperative healing of large and massive rotator cuff tears, assessed through patient-reported outcomes and functional range of motion. Methods This retrospective study reviewed a single surgeon's database, selecting patients who underwent arthroscopic surgery for full-thickness rotator cuff tears measuring at least 3 cm, or those with maximum stage II fatty infiltration of the supraspinatus or infraspinatus muscle on MRI. We used three validated patient-reported outcome (PRO) measures, American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST), alongside a range of motion metrics, external rotation (ER), and forward flexion (FF). These were recorded pre-operatively and, at minimum, one year post-operatively, with a standard student t-test employed for comparative analysis. Results Out of 18 total patients, the average age was 61 years, and 83% were male. The cause of injury was mostly traumatic in nature (n=11), with the remainder being chronic (n=7). All three PROs (n=11) demonstrated a statistically significant increase in score including ASES (p=0.003), SANE (p=0.004), and SST (p=0.039). External rotation also significantly improved pre- to post-operative function (46 vs 58, p=0.049).Three patients (17%) suffered from a retear within three months of their rotator cuff repair. Two patients (11%) required a reverse shoulder arthroplasty within a year. Conclusion Our study demonstrated that DAA in rotator cuff repair yielded notable functional and clinical advancements, with a moderately low retear rate as confirmed by ultrasound. These outcomes suggest that DAA is a promising intervention for large and historically difficult rotator cuff tears, offering significant implications for future treatment protocols.

Anatomic shoulder arthroplasty: the correlation between patient resilience, mental health, and outcome

Recovery from anatomic shoulder arthroplasty may be enhanced in patients with good mental health and the resilience to participate in the prescribed postoperative rehabilitation program. To test this concept, we utilized validated and reliable scales in determining whether resilience and mental health are associated with the outcome of anatomic arthroplasty. 399 patients (195 ream and run (RnR) and 204 anatomic total shoulder (aTSA)) were surveyed at a mean follow-up of 6.3 ± 3.3 years. Preoperative variables included age, sex, body mass index (BMI), history of prior shoulder surgery, diabetes, visual analog scale for pain (VAS), Simple Shoulder Test (SST) scores, and Veteran's RAND-12 Mental Component Score (VR-12 MCS). Outcomes collected included the SST, American Shoulder and Elbow Surgeons Score (ASES), revision rate, and patient satisfaction. Resilience was documented using the Connor Davidson Resilience Scale-10 (CD RISC-10) at latest follow-up. Univariable and multivariable regression analyses were used to identify factors significantly associated with follow-up postoperative SST, ASES and satisfaction. In the univariable analysis, CD RISC-10 was positively correlated with postoperative SST, ASES and satisfaction after both RnR and aTSA. Mean CD RISC-10 scores were higher in the RnR cohort (34.3 ± 4.8 vs. 32.5 ± 6.2 for aTSA, p<0.001). Male sex and lower preoperative VAS were correlated with higher ASES after RnR; VR-12 MCS was positively correlated with all outcomes except SST after RnR. In the multivariable linear regression analysis, CD RISC-10 was independently associated with postoperative SST, ASES and satisfaction scores in aTSA patients. In the RnR cohort, CD RISC-10 was only correlated with satisfaction. VR-12 MCS was correlated with ASES and satisfaction after RnR. In this study of anatomic arthroplasties, increased resilience and better mental health were correlated with better outcomes. RnR patients had higher resilience than aTSA patients. Greater resilience was associated with better outcomes after anatomic total shoulder arthroplasty. Better mental health was associated with superior outcomes after the ream and run procedure.

Acromioclavicular Joint Reconstruction with Modified Weaver–Dunn Operation Versus Hamstring Tendon Autograft Comparative Study

Abstract Background: The dislocation of the acromioclavicular joint (ACJ) is recognized as one of the most frequently occurring injuries most often after either direct or indirect force is applied to the affected shoulder. The best method of AC reconstruction is still controversial. Modified Weaver–Dunn operation (WD) is one of the popular operations. Recent ACJ reconstruction methods include the usage of the gracilis, semitendinosus auto grafts, synthetic grafts, end buttons, nonabsorbable sutures, suture anchors, and tight-rope system. Aim and Objectives: Clinical and radiological results of hamstring autograft versus modified WD operation for reconsrtuction of coracoclavicular and acromioclavicular ligaments. Patients and Methods: This prospective study was carried out at the orthopedic department of Benha University Hospital carried out on 30 cases with chronic ACJ dislocation. They divided into two groups. The modified WD technique was employed on 15 patients, whereas an autogenous semitendinosus tendon graft was used on the other 15. There was a comparison of radiographs taken before and after surgery. Results: Mean surgical time and coracoclavicular (CC) distance differed statistically between groups. Neither demographic data nor postoperative information (pain, range of motion, and postop) showed a difference of statistical significance between the groups. Constant score and post operative American Shoulder and Elbow Surgeons Score (ASES) and post operative complications show no statistically significant difference. Conclusion: Both AC and CC reconstruction by hamstring tendon autograft showed good-to-excellent outcomes with no implant-related complications as some other treatment methods, also more anatomical procedure more than WD operation with better biomechanical vertical and horizontal stability.

Short-term comparative outcomes of LIMA hybrid, metal-backed, and all cemented polyethylene glenoids

BackgroundThis study aims to compare short-term functional outcomes and conversion rates to reverse shoulder arthroplasty between patients who underwent total shoulder arthroplasty (TSA) using a modular metal-backed glenoid component, a hybrid glenoid component, and an all-polyethylene component. MethodsA retrospective review of individuals undergoing TSA between October 2014 and December 2020 was performed. Inclusion criteria included patients undergoing primary TSA for osteoarthritis during this time frame by 1 surgeon. Preoperative and postoperative variables included demographic information, American Shoulder and Elbow Surgeons score (ASES), and range of motion. Revision rates were also documented. Summary statistics were performed, using a 1-way analysis of variance with Tukey post hoc pairwise comparisons when the outcome reached significance. ResultsFifty-two patients were included with age averaging 68 ± 8.1 years, with body mass index of 31 ± 5.8. 54% of patients were female with 12% having diabetes and only 2% were smokers. Follow-up averaged 42 months with patients undergoing metal-backed glenoid having longer follow-up at 56.5 months (P < .001). ASES, forward elevation, and external rotation (ER) for every implant type improved significantly postoperatively (P < .001) besides internal rotation and ER within the poly group (P = .072). No difference was found between the 3 groups for preoperative and postoperative ASES scores, forward elevation, internal rotation, and ER (P > .05). Two patients within the poly group required revision due to rotator cuff tear (P = .225). ConclusionAt 2 years, functional outcomes and patient-reported outcomes are similar in all 3 glenoid groups. There were slightly higher revision rates within the all-polyethylene group. If outcomes are similar among all groups, modular implant systems may be favorable to make conversion to revision TSA easier.

Current Concepts in Management of Acromioclavicular Joint Injury.

Background: The management of acromioclavicular joint injuries requires a thorough understanding of the anatomy and biomechanics of the joint, as well as knowledge of the pertinent physical exam findings and classification to determine an appropriate treatment approach, whether operative or nonoperative. In this article, we present a narrative review of the current state of understanding surrounding these issues. Although there are a large number of options for operative intervention, we additionally present our experience with anatomic coracoclavicular ligament reconstruction (ACCR) with imbrication of the deltoid fascia. Methods: A retrospective review of prospectively collected data on a total of 45 patients who had undergone ACCR between 2003 and 2016 were collected. Results: We found that improvements were seen in American Shoulder and Elbow Surgeons Score (ASES) (53 ± 19 to 81 ± 23), Simple Shoulder Test (SST) (6 ± 3 to 12 ± 13), Constant-Murley (CM) (60 ± 18 to 92 ± 8), and Rowe (67 ± 14 to 89 ± 11) and the mean post-operative SANE score was 86 ± 17. Conclusions: ACCR has the advantage of addressing both horizontal and vertical stability with good outcomes.

Pain scores and functional outcomes of patients with shoulder labral repair using all-suture anchors versus conventional anchors.

The purpose of this study was to compare PROMs in patients undergoing anterior glenoid labral repair using all-suture versus conventional anchors. We hypothesized PROMs would be similar between groups. We performed a retrospective review of the Arthrex Global Surgical Outcomes System (SOS) database, querying patients who underwent arthroscopic glenoid labral repair between 01/01/2015 and 12/31/2020. Patients aged 18-100, who had isolated glenoid labrum repair with at least 12-month follow-up were included. The visual analog pain scale (VAS), Western Ontario Shoulder Instability Index, Veteran's RAND 12-items health survey, single assessment numeric evaluation and the American Shoulder and Elbow Surgeons score (ASES) were compared preoperatively, 3months, 6months, 1year and 2years postoperatively in patients who received all-suture anchors versus conventional anchors in the setting of anterior glenoid labrum repair. Our primary aim was comparison of PROMs between patients receiving all-suture versus conventional suture anchors. Secondarily, a sub-analysis was performed comparing outcomes based on anchor utilization for patients with noted anterior instability. We evaluated 566 patients, 54 patients receiving all-suture anchors and 512 patients receiving conventional anchors. At two-year follow-up there was no significant difference between the two groups in PROMs. In a sub-analysis of isolated anterior labrum repair, there was an improvement in ASES (P = 0.034) and VAS (P = 0.039) with the all-suture anchor at two-year follow-up. All-suture anchors provide similar or superior pain and functional outcome scores up to 2years postoperatively compared to conventional anchors. As all-suture anchors gain popularity among surgeons, this is the largest scale study to date validating their use in the setting of glenoid labrum repair. Institutional Review Board (IRB): IRB202102550.

Does subscapularis tears combined with supraspinatus tears affect postoperative functional outcomes?

Aims: Roughly 50% of rotator cuff tears includes a tear in the subscapularis tendon. We conducted a comparative analysis of the functional outcomes following arthroscopic repair in patients with a tear in both the supraspinatus and subscapularis tendons, as well as those with a rupture solely in the supraspinatus tendon. Our hypothesis posits that the functional outcomes after surgery for rotator cuff tears, specifically those with tears including subscapularis tendon, are inferior compared to tears that only involve the supraspinatus tendon. Methods: We classified patients who had arthroscopic repair for a rotator cuff tear in our clinic from January 2017 to April 2022 into two groups. The study comprised patients who received arthroscopic surgery for a diagnosed rotator cuff injury. The study excluded individuals who were younger than 18, individuals with large tears that could not be repaired, individuals with paralabral cysts, individuals with glenohumeral arthritis, individuals who had undergone labrum tear repair or slap lesion repair, individuals with concomitant neurovascular damage, and individuals who had a follow-up period of less than 6 months, patients who benefit from physiotherapy and medical treatment for 6 months. Following the application of exclusion criteria, a total of 39 patients were selected to participate in the study. The presence of a rotator cuff injury was verified through arthroscopy after being detected using clinical tests such as Jobe, drop arm test, Neer sign, lift-off and belly-press tests, and radiographic evidence such as magnetic resonance imaging. Patients who received subscapularis repair together with a supraspinatus tear were categorised as Group 1 (n=14), while those who just had supraspinatus surgery without any subscapularis tears were categorized as Group 2 (n=25). We recorded the demographic information. At the last postoperative outpatient clinic follow-up, both groups were compared in terms of mortality, laboratory parameters, radiological findings, visual analogue scale (VAS), Constant-Murley score1, American Shoulder and Elbow Surgeons score (ASES)2, and University of California Los Angeles (UCLA) scores.3 Postoperative satisfaction levels were categorised into four groups: very satisfied, satisfied, undecided, and dissatisfied. Results: The groups did not show any significant differences in terms of age, gender distribution, and follow-up periods (p&amp;gt;0.05). There was no statistically significant disparity observed between the groups in relation to VAS, Constant-Murley score, ASES, and UCLA ratings assessed during the final postoperative outpatient clinic follow-up (p&amp;gt;0.05). There were no instances of re-rupture observed in any patient throughout the postoperative follow-up period. The postoperative satisfaction ratings show no significant difference between the two groups (p&amp;gt;0.05). Conclusion: Our findings indicate that the outcomes of patients who received a surgical repair of rotator cuff tendons including subscapularis were at least as successful as those who underwent surgery for just supraspinatus tendon rupture. There is no basis to believe that arthroscopic repair will have a detrimental impact on the functional outcomes of individuals with rotator cuff tears which includes subscapularis tendon tears.

Outcomes of initial nonoperative treatment of traumatic full-thickness rotator cuff tears

IntroductionNon-surgical management of chronic, degenerative rotator cuff tears (RCT) can be an effective treatment strategy, but there is limited evidence to support conservative treatment for acute, traumatic RCTs. The objective of this study is to assess clinical outcomes and predictors of treatment success for patients with traumatic RCTs who elected for initial non-operative treatment. MethodsPatients from a single institution were retrospectively identified using diagnostic codes for traumatic RCT followed by confirmed initial treatment with at least 2 months of physical therapy. Exclusion criteria included surgery within 2 months of injury and greater than grade I fatty infiltration on MRI. At minimum 2-year follow-up, patients were contacted by phone to collect interval surgical history and standardized patient reported outcomes. All those who had surgical treatment and those with satisfaction ratings of “moderately dissatisfied” and “very dissatisfied” were considered to have failed physical therapy. ResultsFollow-up outcomes were obtained in forty of 49 patients (82%) with an average follow-up time of 4.2 years. Nine RCTs (22%) were small (< 1cm), 22 (54%) were medium (>1 and < 3cm), and 9 (22%) were large (> 3 cm and < 5cm). Grade I fatty infiltration was seen on 25% (n=10) of MRIs. Eighteen patients (45%) underwent rotator cuff repair following an average 6 months (R: 3-12) of nonoperative treatment. In total, 23 of 40 patients (58%) were determined to have failed nonoperative treatment. Patients with multiple tendons torn were more likely to fail conservative management (p=0.014). Tear size and retraction were not significantly different between patents who had surgery and those who did not. Patients who underwent surgical management had 83% satisfaction rate at final follow-up compared to 55% satisfaction for patients who had no surgery (p=0.054). There was no statistical difference in the ASES (American Shoulder and Elbow Surgeons score) and VAS (Visual Analog Scale) between these groups. While patients who had surgery had a higher mean SANE (Single Alpha Numeric Evaluation) (86.3 vs. 75.1; p=0.041), this difference was below the previously established minimally clinically important difference. ConclusionNon-operative treatment remains a viable option for certain patients with traumatic RCTs; however, the results of our study demonstrate a considerable early failure rate. This study further supports historical literature demonstrating reliably successful outcomes with surgical treatment of acute, traumatic RCTs. Level of EvidenceLevel IV; Case Series; Treatment Study

Arthroscopic assistance of latissimus dorsi tendon transposition for the treatment of unrepairable rotator cuff tear

To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears (IRCT). From May 2015 to May 2018, 23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer, and 21 patients were followed up finally, including 8 males and 13 females, aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of (14.0±6.4) months. American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up. All 21 patients were followed up for 36 to 54 months with an average of (39.4±4.4) months. Axillary incision of 1 patient was redness, swelling and exudation after surgery, which healed after 3 weeks of dressing change, and exudate culture was negative. At the latest follow-up, MRI showed partial tearing of the metastatic tendon in 2 patients, but pain and movement of the affected shoulder were still better than before surgery. ASES increased from preoperative (41.0±9.6) scores to the latest follow-up (75.6±14.0) scores, and had statistical difference (t=10.50, P<0.01). Constant-Murley score increased from (49.8±7.1) scores before operation to (67.5±11.6) scores at the latest follow-up (t=11.27, P<0.01). Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint, thus achieving the stability of the shoulder joint, relieving shoulder pain and improving shoulder joint function.

Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge

To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge. The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up. All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied. Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Treatment of Ideberg type Ⅱ scapular glenoid fracture with compression screw combined with Buttress plate through direct axillary approach

To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. A retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05). Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.