Constant-Murley Shoulder Score Research Articles

Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery.

Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries (RCIs). Although this procedure has certain clinical advantages, it requires rehabilitation management interventions to ensure therapeutic efficacy. To investigate the effect of integrated traditional Chinese medicine and Western medicine (TCM-WM) under the multidisciplinary team (MDT) model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs. This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024. They were divided into a control group (n = 48) that received routine rehabilitation treatment and an experimental group (n = 52) that received TCM-WM under the MDT model (e.g., acupuncture, TCM traumatology and orthopedics, and rehabilitation). The results of the Constant-Murley Shoulder Score (CMS), Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI), muscular strength evaluation, and shoulder range of motion (ROM) assessments were analyzed. After treatment, the experimental group showed significantly higher CMS scores in terms of pain, functional activity, shoulder joint mobility, and muscular strength than the baseline and those of the control group. The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group. In addition, the experimental group showed significantly enhanced muscular strength (forward flexor and external and internal rotator muscles) and shoulder ROM (forward flexion, abduction, and lateral abduction) after treatment compared with the control group. TCM-WM under the MDT model improved shoulder joint function, relieved postoperative pain, promoted postoperative functional recovery, and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.

Safety and efficacy of second-generation all-suture anchors in labral tear arthroscopic repairs: prospective, multicenter, 1-year follow-up study

BackgroundThis study’s primary aim was to assess the safety and performance of second-generation all-soft suture anchors following arthroscopic labral tear repair. MethodsThis prospective, multicenter study was conducted by 6 surgeons at 6 sites in Europe and the United States between November 2018 and August 2020. Patients who required shoulder arthroscopic repair, for a range of labral injuries, were treated with a second-generation all-soft suture anchor. The primary outcome was clinical success rate (percentage of patients without signs of failure and/or re-intervention) at 6 months. Secondary outcomes included clinical success rate at 12 months, intraoperative anchor deployment success rate, and patient-reported outcomes (PROs) at 6 and 12 months, including visual analog scale (VAS) pain assessment, VAS satisfaction assessment, EQ-5D-5L Index Score, EQ-5D-5L VAS Health Score, Rowe Shoulder Score for Instability, American Shoulder and Elbow Surgeons score, and Constant-Murley Shoulder (CMS) Score. Serious adverse events (SAE) and serious adverse device effects (SADE) were collected throughout the study. ResultsForty-one patients were enrolled (mean age, 28.2 years; 87.8% male, 12.2% female). Clinical success was achieved in 27/28 and 31/32 patients at 6 months and 12 months, respectively. Anchor deployment had a 100% success rate. Significant improvements over baseline were reported for all PROs except CMS (6 months) and VAS Satisfaction Score (12 months). One patient experienced 1 SAE and 1 patient experienced 1 SADE. ConclusionSecond-generation all-soft suture anchors used in this study demonstrated a high clinical success rate, a favorable safety profile, and patients exhibited significant improvement in PROs.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR. We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR. Randomized controlled single-blind study. Level 1B. A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality. There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05). A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.

Relationship between the preoperative grip strength and postoperative shoulder strength of patients treated via reverse shoulder arthroplasty.

Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle disorder) is common in elderly people, but its effect on patients after RSA is not clear. We hypothesized that the preoperative sarcopenia indices of grip strength and general skeletal muscle mass would correlate with the clinical outcomes of RSA. Grip strength and general skeletal muscle mass were measured in patients scheduled (between 2016 and 2021) for primary RSA to treat cuff tear arthropathy, an unrepairable cuff tear, or osteoarthritis with a large cuff tear. Before surgery, grip strength was measured using a hydraulic dynamometer and general skeletal muscle mass was calculated from the appendicular relative skeletal muscle mass index (aRSMI) using dual-energy X-ray absorptiometry. In all, 58 patients were included; the minimal follow-up duration was 12months. The postoperative clinical results (pain, active range of motion, shoulder strength, and functional scores) were evaluated during scheduled outpatient visits. We calculated correlations between the preoperative sarcopenia indices, and the clinical results at the final follow-up. The mean preoperative grip strength and aRSMI were 21.6±4.0kg and 5.98±0.84kg/m2 in females and 30.6±7.5kg and 7.21±0.94kg/m2 in males, respectively; the grip strength and aRSMI were not associated with each other (P=.083). Ten females (25%) and 10 males (56%) met the criteria for sarcopenia. The postoperative abduction shoulder strength and Constant-Murley shoulder score increased significantly with higher preoperative grip strength (R=0.420 and P=.001; and R=0.497 and P<.001, respectively) and the American Shoulder and Elbow Surgeons score was related to the preoperative aRSMI (R=0.320, P=.039). The shoulder strength and functional score after RSA correlated positively with the preoperative grip strength. Measuring grip strength before RSA allows the surgeon to predict shoulder strength after RSA.

Early clinical efficacy analysis of enhanced recovery following surgery combined with interscalene brachial plexus block for arthroscopic rotator cuff repair.

To explore the early clinical value of enhanced recovery after surgery (ERAS) with interscalene brachial plexus block (ISB) for arthroscopic rotator cuff repair (ARCR). We enrolled 240 patients who underwent arthroscopic rotator cuff repair, randomly divided into 3 groups (n = 80 each). Groups A, B, and C underwent only surgery, surgery + ERAS, and ISB + surgery + ERAS, respectively. We analyzed the clinical data and postoperative indicators for the 3 patient groups. Group comparisons of clinical data and postoperative indicators revealed no significant differences in clinical characteristics (P > .05). Group C showed superior Visual Analog Scale scores at 0-6 and 6-24 hours postoperatively (P < .05), and the shortest length of hospital stay (LOS) (P < .05). At 6 weeks and 3 months postoperatively, Constant-Murley shoulder score and University of California-Los Angeles scores were better in Groups B and C than in Group A (P < .05). Joint swelling was more common in Group A than in Groups B and C (P < .05) but with no significant difference in the incidence of postoperative stiffness (P > .05). ERAS can relieve postoperative pain, shorten LOS, and help restore shoulder joint mobility, thereby reducing postoperative swelling. ISB + ERAS optimized pain control and allowed a shorter LOS, but had similar effects on early functional recovery and complications.

Functional Outcomes in Surgically Treated Clavicle Fractures: A Longitudinal Observational Study.

Introduction The clavicle is the most unique long bone and has a significant incidence in terms of fractures. Operative fixation for clavicle fractures has seen a steep rise in terms of technique as well as type of implant. Although extensive studies have been carried out in relation to clavicle fractures and their treatment modalities, no proper guidelines or approach has been identified as ideal, and hence, this study was carried out to evaluate operative fixation as a viable strategy. Objective The objective of this article was to assess functional outcomes of plate fixation in clavicle fractures. Materials and methods This longitudinal prospective observational study included 30 patients treated for clavicle fractures with plate fixation in the Orthopedics Department of Himalayan Institute Hospital Trust (HIHT), Jollygrant, Dehradun, over a period of one year. Functional outcomes were assessed as Constant-Murley shoulder scores, and complications were recorded. Radiological assessment was done on thebasis of time to union through follow-up skiagrams. Statistical analysis was performed using the SPSS statistical package version 17.0 (IBM Inc., Armonk, New York).Continuous variables are presented as mean±SD, and categorical variables are presented as absolute numbers and percentages.Continuous variablesand constant score values over time within the groups were analyzed using repeated measures analysis of variance (ANOVA) followed by Bonferroni's post hoc testing. A p-value of <0.05 was considered statistically significant. Results The mean age of patients undergoing surgical fixation of clavicle fractures was 36 ± 12.53 years, ranging from 18-65 years. Of the entire study group, 83.3% were males and 16.7% were females. Road traffic accident (RTA) was the most common cause of clavicle fracture, constituting 76.7% of the entire study population, followed by fall on the floor (20.0%), and one patient sustained trauma by being hit by a bull (3.3%). Our study demonstrated a mean Constant score of 73.87 ± 2.64, 82.80 ± 2.20, and92.40 ± 2.37 at one-month, two-month, and four-monthfollow-up times, respectively, which was found to be statistically significant in terms of progression (p value<0.001). The mean union time of clavicle fractures in our study population was 12.1 weeks. Two patients in our study developed implant impingement. Conclusion Our study revealed that patients with clavicle fractures treated with plate fixation had statistically significant good functional outcome (Constant) scores at sequential follow-ups, consistent with available literature. Mean union time was also comparable to existing literature. Non-union was not noted in our study, and only two cases developed implant impingement. Hence, we conclude that early primary plate fixation for displaced clavicle fractures is a promising technique with good overall functional outcomes and patient satisfaction, especially in young, active patients.

Reverse total shoulder arthroplasty with combined latissimus dorsi and teres major transfer in massive irreparable rotator cuff tear with loss of active external rotation: circumferential suturing technique

BackgroundElderly patients with a massive irreparable rotator cuff tear suitable for reverse total shoulder arthroplasty (rTSA), combined with additional loss of active external rotation (ER), experience distress after rTSA alone due to the inability to perform daily tasks that require spatial control of the arm’s position. We hypothesized that performing a combined transfer of Latissimus dorsi (LD) and Teres major (TM) along with rTSA in such patients could lead to improved outcomes after surgery, including those requiring active ER. MethodsThis is a retrospective review of 17 patients with a massive irreparable rotator cuff tear and loss of active ER, managed with rTSA and combined LD and TM transfer using a novel circumferential suturing technique. Eleven patients were female, and 6 were male, with a mean age of 73.2 years (ranging from 60 to 82 years). The mean follow-up was 60.5 months. Preoperative and final follow-up clinical and radiological findings were assessed and compared for all patients. ResultsThe mean forward flexion (FF) increased from 92° to 137° (P = .001). The mean abduction improved from 94° to 106° (P = .025). The mean ER improved from −14° to 8° (P < .001). The mean range of internal rotation decreased from 4.9 to 4.3 points (thoracolumbar junction to L2) (P = .065). The mean improvement of strength expressed as a percentage of the opposite side was significant for FF, abduction, and ER (P < .001). The mean visual analog scale score for pain improved from 5.5 to 1.7 point (P < .001). The mean University of California at Los Angeles shoulder score increased from 12.6 to 26.7 points (P < .001). The mean Constant Murley shoulder score improved from 40.6 to 75.7 (P < .001). The mean activities of daily living score, which requires active ER, increased from 4.5 to 22.3 points (P < .001). There was a reversal of loss of active ER in 15/17 (88.2%) patients. No perioperative complications related to the tendon transfer and fixation were observed. ConclusionThe combination of rTSA with LD and TM transfer leads to gains in FF and ER, improving clinical outcomes, including those requiring active ER. Circumferential suturing of LD and TM transfer avoids problems with suture anchors, interference screws, or bone tunnels. The posterodistal attachment site opposite to the original LD insertion is endorsed to mitigate the loss of internal rotation.

Clinical evaluation of treatment with hook plate in patients with acromioclavicular joint dislocation

Objectives: Treatment of acromioclavicular joint dislocations vary. In this study, we aim to examine the functional results of patients who underwent hook plate fixation due to dislocation of acromioclavicular joint. Methods: We retrospectively observed 21 patients who had been treated with hook plate due to dislocation of acromioclavicular joint. At follow up, Constant-Murley scoring system was performed for shoulder function evaluation, while radiological results were performed by X-ray. Results: Seventeen of these patients were male and four were female. Eleven of these patients had Rockwood type 5 joint dislocation and ten had Rockwood type 3 joint dislocation. The mean age was 36.7 ± 13.37 years (range: 19-61 years). The mean follow-up period was 27.3 ± 19.3 months (range: 10-59). Constant-Murley shoulder scoring was excellent in 18 patients (93.6) and good (82.5) in 3 patients. While one patient had wound site infection and one patient had plate broken, no one had any neurological damage. Except for the failed implants, plate removal was not performed because the patients did not have plate-related complaints. At follow-up, it was observed that the acromioclavicular joint was in the reduced position on direct radiographs. Conclusions: We observed good clinical and functional results for the treatment of acromioclavicular joint dislocation with hook plate treatment. The hook plate method is a safe and effective method in the acute treatment of type 3-5 injuries according to the Rockwood classification.

Longitudinal Analysis of the ASES and Constant-Murley Scores, and the Internal Rotation/Shift and Jobe Tests Following Arthroscopic Repair of Supraspinatus Lesions.

It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley shoulder (CMS) scores, as well as clinical tests, such as the Internal Rotation and Shift (IRO/Shift) and Jobe tests. In this study, 51 out of an initial 87 patients underwent an arthroscopic supraspinatus repair (22 single-row, 16 double-row, 13 debridement). Testing occurred pre-surgery, and 3 and 6 months post-surgery. Both surveys showed significant improvements over time among all 87 patients, but there were no differences between groups (lesion/no lesion) (p > 0.815) or time × group (p > 0.895). The IRO/Shift test showed a stronger ability to distinguish between both groups (positive vs. negative) with respect to the ASES and CMS scores over time, but the Jobe test did not (p > 0.100). Improvements in the CMS scores and the Jobe test were lower following repair compared to the ASES and IRO/Shift test. Most patients returned to adequate levels of functional abilities at 6 months post-surgery. The time required to return to activities of daily living and negative clinical tests was longer for the double-row repair patients compared to the single-row and debridement groups. In conclusion, both the functional surveys and the clinical tests demonstrated improvements following surgery.

Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating.

Background Proximal humerus fractures comprise nearly 4%-5% of all fracture types and nearly 25% of fracture humerus. These fractures are commonly seen in the elderly population (people aged 60 years or more). The best way to treat elderly people who have three- or four-part fractures of the proximal humerus is debatable, with many in favour of prosthetic humeral head replacements. This study aimed to assess the functional outcome of proximal humerus fractures managed with a proximal humerus locking plate and to investigate the incidence of complications in these patients. Methodology This retrospective study included 32 cases of proximal humerus fractures managed surgically at a tertiary care teaching hospital in Rajasthan between July 2016 to July 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER scoring system was used to categorise the fractures. Functional assessment was done using Constant Murley's shoulder score. Constant Murley shoulder score was graded as failure (0-69 points), unsatisfactory (70-79), satisfactory (80-89), and excellent (90-100). Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results The mean age was 54.5±6.4 years. Of the total 32 cases of proximal humerus fractures, 12 cases of two-part fractures received an excellent grade, compared to seven cases of three-part fractures. Three two-part fracture cases and two three-part fracture cases all received satisfactory grades. Excellent results (score > 89) were noticed in 62.5% (n = 20) of the instances, satisfactory results (scoring 80-89) in 21.87% (n=7), poor results (score 70-79) in 9.38% (n=3), and failure results (score 70) in 6.25% (n=2). In 65.6% of cases, follow-up showed no complications. Shoulder stiffness and malunion (9.38%) were the most frequent consequences, followed by avascular necrosis (6.25%). Conclusions Based on the findings of this retrospective study, it can be opined that PHILOS plaiting appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilisation, and excellent functional outcomes as observed in this study. Additionally, very few post-operative complication rates again support our conclusion.

The Spanish version of the Constant-Murley Shoulder Score: translation, cultural adaptation, and validity.

The Constant-Murley Score (CMS) is one of the most employed tools for assessing shoulder function. It was first devised in 1987 for the English population and is now widely used internationally. However, it had yet to be cross-culturally adapted and validated to Spanish, which is the world's second-most native language. Formal adaptation and validation of clinical scores is paramount for them to be used with rigorous scientific methodology. Following international recommendations for the cross-cultural adaptation of self-report measures, the CMS was first adapted into Spanish in six stages: translation, synthesis, back-translation, a review by expert committee, pretesting, and final appraisal by expert committee. After conducting a pretest with 30 individuals, the Spanish version of the CMS was tested on 104 patients with various shoulder pathologies to assess content, construct, criterion validity, and reliability. No major conflicts were encountered in the process of cross-cultural adaptation, with 96.7% of pretested patients having a full understanding of every item in the test. The validation showed excellent content validity (content validity index=.90), construct validity (strong correlation between items within the same subsection of the test), and criterion validity (CMS - Simple Shoulder Test, Pearson r=.587, P=.01; CMS - American Shoulder and Elbow Surgeons, Pearson r=.690, P=.01). Reliability of the test was also excellent, with high internal consistency (Cronbach's α=.819), interrater reliability (intraclass correlation coefficient =.982), and intrarater reliability (intraclass correlation coefficient =.937), without showing ceiling or floor effects. Spanish version of the CMS has been proved to accurately reproduce the original score and to be easily comprehensible by native Spanish speakers with acceptable intrarater-interrater reliability and construct validity. INTRODUCCIóN: La escala de Constant-Murley (CMS) es una de las más empleadas para evaluar la función del hombro. Se ideó por primera vez para la población inglesa en 1987 y actualmente es ampliamente empleada a nivel internacional. Sin embargo, su validación y adaptación transcultural no se han realizado al español, la segunda lengua nativa más hablada en el mundo. Actualmente no puede resultar admisible el empleo de escalas en las que no tengamos la seguridad de que existe una equivalencia conceptual, cultural y lingüística entre la versión original y la empleada. MATERIAL Y MéTODO: La versión traducida al español de la CMS se realizó siguiendo las recomendaciones internacionales: traducción, síntesis de la traducción, retrotraducción, revisión por comité de expertos, pretest y validación. Tras la realización del pretest en 30 individuos, la versión española de la escala de CMS se probó en 104 pacientes con diferentes patologías de hombro para evaluar las propiedades psicométricas de la escala: contenido, constructo, validez de criterio y fiabilidad. No se encontraron problemas importantes durante el proceso de adaptación transultural con un entendimiento completo de todos los ítems del pretest por el 96.7% de los pacientes. La escala adaptada demostró una excelente validez de contenido (índice de validezde contenido=.90), de constructo (fuerte correlación entre ítems de la misma subsección del test), y de criterio (CMS-SST Pearson's r=.587, p=.01; CMS-ASES Pearson's r=.690, p=.01). La Fiabilidad del test resultó excelente, con una elevada consistencia interna (Cronbach's α=.819), fiabilidad interobservador (ICC=.982) e intraobservador (ICC=.937), sin efectos techo y suelo. CONCLUSIóN: La versión Española de la CMS garantiza la equivalencia con respecto al cuestionario original. Los presentes resultados, sugieren que esta versión es válida, fiable y reproducible para la evaluación de la patología de hombro en nuestro entorno.

Poster 179: Unsupervised Machine Learning to Identify Clinically Meaningful Subgroups in Patients Undergoing Arthroscopic Rotator Cuff Repair

Objectives: Rotator cuff tears are estimated to affect 20.7% of the population, with the prevalence increasing with age. Surgery is indicated after non-response to nonoperative treatment, with arthroscopic rotator cuff repair (ARCR) as the current standard for full thickness tears. Clinically significant outcomes (CSOs) of ARCR can be measured in part with patient reported outcomes. Notably, Single Assessment Numerical Evaluation (SANE) scores and American Shoulder and Elbow Surgeon (ASES) scores are used to assess postoperative shoulder function. This study aims to determine predictors of achieving CSO thresholds following elective ARCR by utilizing machine learning (UML). Methods: A retrospective case-cohort analysis of a prospectively collected database was performed to identify patients who underwent elective ARCR from 2017-2018. Tear dimensions were measured on MRI utilizing a validated technique. CSO achievements on the American Shoulder and Elbow Surgeon (ASES), the Single Assessment Numerical Evaluation (SANE), and the Constant Murley Subjective Score (CMS) at 2-years follow-up were calculated. An unsupervised random forest algorithm was utilized to partition patients into optimal and suboptimal CSO achievement subgroups and subsequently internally validate partitioning based on stability, connectivity, Dunn’s partition coefficient, and silhouette coefficients. This data, along with a total of 30 demographic, clinical, and preoperative PROs were assessed for prognostic value through a stepwise multivariable logistic regression. Results: A total of 346 patients (male: 192, 55.5%; Age: 57.2±9.1, BMI: 30.1±5.4) were eligible for inclusion and followed for an average of 3.8 (range: 2.0 – 6.2 years). The random forest algorithm arrived at an optimal partition of 2 subgroups (Stability: 0.16; connectivity: 180.8; Dunn: 0.16; Silhouette: 0.05), with 176 patients in the optimal achievement subgroup and 157 patients in the suboptimal achievement subgroup. The two subgroups differed significantly (P≤0.004) in the likelihood of achievement of all CSOs. Stepwise multivariable logistic regression identified an increase of 1 mm in tear size in the sagittal dimension to predict a 10% increase in the probability of suboptimal achievement. Additional, additive risk factors for suboptimal CSO achievement included increased preoperative Constant-Murley shoulder score (OR: 1.11, 95% CI: 1.04-1.18, P&lt;0.001), increasing number of tendons involved (OR: 14.07, 95% CI: 4.5-44.02, P&lt;0.001) and subscapularis involvement (OR: 8.67, 95% CI: 2.45-30.71, P=0.01). Protective factors included performance of a subpectoral biceps tenodesis compared to biceps tenotomy (OR: 0.26, 95% CI: 0.05-0.92, P=0.03). Conclusions: Clinically meaningful subgroups were uncovered using a machine learning clustering approach in patients undergoing ARCR. Tear size, number of tendons involved, and subscapularis involvement were highly significant and additive predictors of suboptimal CSO achievement at 2-year minimum follow-up. Treatment of concurrent biceps pathology with tenodesis confers 74% increased likelihood of CSO achievement vs. tenotomy. [Table: see text] [Table: see text]

Results of Plate Osteosynthesis with Deltopectoral Approach for Proximal Humerus Fractures

ABSTRACT&#x0D; Aim: The aim of this study was to evaluate the functional and radiological results of patients who underwent plate osteosynthesis with the deltopectoral approach in proximal humerus fractures, according to the intact shoulder.&#x0D; Materials and Methods: Our study included 33 patients who underwent proximal humeral anatomic locking plate with deltopectoral approach due to proximal humeral fracture (PHF) between 2015 and 2017. Patients over 18 years of age, with closed humeral fractures, and with intact contralateral humerus and shoulder were included in our retrospective study. The functional results between the operated and healthy sides of the patients were evaluated by comparing the Constant-Murley score and radiological results with the full anteroposterior radiography and the collodiaphyseal angles.&#x0D; Results: According to the Constant Murley scoring categorical data structure of the patients, the operated side was 6.1% (n=2) poor, 6.1% (n=2) moderate, 39.4% (n=13) good, 48.5% (n=16) excellent, while the healthy side was %. Results were 0 (n=0) poor, 3% (n=1) moderate, 30.3% (n=10) good, and 66.7% (n:22) excellent. According to the Constant Murley scoring categorical data structure, a statistical difference was found between the operated side and the healthy side (p&gt;0.05). While the mean Constant Murley score of the operated side was 85.82 ± 7.07, the mean Constant Murley score of the healthy side was 90.67 ± 5.76. While the average of the collodiaphyseal angles of the operated side was 130.03± 4.64; the mean of the angles of the intact side is 135.64 ± 5.04. In terms of Constant Murley shoulder scores and collodiaphyseal angle values of the patients; a statistical difference was observed between the operated side and the healthy side (p

Outcomes of Shoulder Instability Repair - Latarjet vs Arthroscopic Bankart Repair: A Retrospective Study

This retrospective study aimed to compare the outcomes of two surgical procedures, Latarjet repair and arthroscopic Bankart repair, for the treatment of anterior shoulder instability. The study included 31 patients between the ages of 16 and 40 years who underwent either Latarjet repair or arthroscopic Bankart repair. The patients were evaluated using the Constant Murley Shoulder Score (CMS) and the American Shoulder and Elbow Surgeons Score (ASES) at 3, 6, and 12 months postoperatively. The results showed a gradual improvement in functional outcomes for both groups during the follow-up period. At one year postoperative, the Bankart repair group exhibited a CMS score of 89.3 and an ASES score of 94.1, while the Latarjet repair group showed a CMS score of 87.8 and an ASES score of 91.3. Statistical analysis revealed no significant differences in the CMS scores at any follow-up time point. However, the ASES score at 12 months postoperative was significantly higher in the Bankart repair group compared to the Latarjet repair group. The findings of this study suggest that both Latarjet repair and arthroscopic Bankart repair yield favorable clinical outcomes in terms of functional improvement for patients with anterior shoulder instability. Although arthroscopic techniques are minimally invasive and preferred by surgeons, the Latarjet procedure offers comparable results with less expenditure. The choice of surgical approach should be based on factors such as the patient's age, level of activity, and the presence of significant bone defects or soft tissue deficiencies. Further comparative studies with long-term follow-ups are recommended to validate these findings and provide more comprehensive insights into the outcomes of these procedures.

Results of a differential approach to surgical treatment of proximal humerus fractures in patients with osteoporosis

Objective. To conduct a comparative retrospective analysis of the anatomical and functional results of surgical treatment of proximal humerus fractures AO/OTA 11-B, 11-C using different methods in patients over 50 years old with osteoporosis to justify a differential approach. Methods. The study included 102 patients aged 50 years and older with osteoporosis and proximal humerus fractures AO/OTA 11-B, 11-C. The patients were divided into three groups: I — 50 (16 men, 34 women) whom were performed open reduction and internal fixation (ORIF) with the PHILOS plate; II — 44 (8 men, 36 women) — ORIF with the PHILOS plate and using 3D polylactide (PLA) porous implants were applied; III — 8 (2 men, 6 women) whom were performed primary reversed total shoulder arthroplasty (RTSA) with developed total reversible endoprosthesis. The results of treatment were evaluated according to the Constant-Murley Shoulder Score system after 3, 6, 12 months. The results. Positive results in the first group were obtained in 72.0 % of patients (the average Constant-Murley Shoulder Score after 12 months was 78.4 points); in the second — in 81.8 % (88.0 points); in the third — 75.0 % (82.0 points). A differentiated approach to the choice of surgical treatment of patients aged 50 years and older with fractures AO/OTA 11-B, 11-C is proposed. The clinical trial of the reverse total modular shoulder endoprosthesis developed by us using porous 3D titanium parts, manufactured by additive technologies, showed positive short-term results. The design features of the device increase the reliability and durability of proposed endoprosthesis. Conclusions. RTSA in the case of unstable proximal humerus fracture or in the case of metal structure migration after primary ORIF in patients with low bone mineral density is the effective surgical intervention that allows to achieve satisfactory functional results in up to 3 years.

SLAP lesion type IX: case series and a review of literature.

A type IX SLAP (superior labrum anterior to posterior) lesion involves 360° of the glenohumeral labrum. Only rare reports have been published analyzing the risk factors of this lesion and the success of its arthroscopic management. The aim of our study is to evaluate predisposing factors that lead to SLAP IX and to assess the clinical outcome after arthroscopic treatment. Our treatment algorithm is also presented. We report on a series of six patients treated in our institution between January 2014 and January 2019 who underwent shoulder arthroscopy and were intraoperatively found to have a SLAP lesion type IX. Arthroscopic labral repair and biceps tenodesis were indicated in all patients. American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Rowe Score and Constant Murley Shoulder Score (CS) were used for clinical evaluation. Patients were evaluated preoperatively and at 12weeks, 1year and 2years postoperatively. We analyzed six patients of which 83% were males (5/6 patients). The average age at the time of surgery was 37.16 (range 30-42years). The dominant arm was affected in 50% of patients (3/6 patients). A significant postoperative improvement was seen in all six patients. 83% (5/6) of patients returned to their pre-injury activity level. Average values of all three measured scores show a significant increase comparing preoperative to postoperative period (P-value < 0.05). All patients were able to return to work. The final diagnosis was established intraoperatively as 83% (5/6) of radiology reports differed from subsequent arthroscopic findings. The mechanism of injury in all our cases was high energy trauma with traction, arm in abduction or anteflexion. We observed great success with arthroscopic treatment as high percentage of our patients returned back to work and sports.

Functional outcome of Latarjet for recurrent anterior shoulder dislocation

Background and Aim: Recurrent shoulder dislocations can be treated with a variety of surgical procedures. However, soft-tissue repair appears to be ineffective in all cases of recurrent shoulder dislocation. The present study aimed to determine the Latar jet technique functional outcome for recurrent anterior shoulder dislocation. Patients and Methods: This descriptive cross-sectional study was conducted on 42 recurrent shoulder dislocation patients at the MTI Lady Reading Hospital Peshawar from January 2019 to December 2022. All the eligible patients were operated with open Latar jet procedure. Constant-Murley shoulder score was used for the assessment of functional outcome at 6th months. SPSS version 27 was used for data analysis. Results: Of the total 42 patients, there were 40 (95.2%) male and 2 (4.8%) female. The overall mean age was 46.8±8.4 years. The right and left-side involvement was found in 32 (76.2%) and 12 (23.8%) respectively. The incidence of poor, fair, good, and very good outcomes was 3 (7.1%), 4 (9.5%), 12 (28.6%), and 23 (54.8%) respectively. There was significant improvement in shoulder motion and reduction in pain after 6th month's follow-up.

Mid-term outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification type Ⅰ A delaminiated rotator cuff tear

Objective: To investigate the mid-term clinical outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification type ⅠA delaminated rotator cuff tear. Methods: A follow-up study. The clinical data of 42 consecutive patients with Kim classification type ⅠA delaminated rotator cuff tear admitted to the First Affiliated Hospital of Jinan University from January 2018 to June 2019 were retrospectively included. All patients underwent shoulder arthroscopic surgery. During the operation, the autogenous long head of the biceps tendon was transferred to repair the deep layer of delaminated rotator cuff tear. The preoperative and postoperative (last follow-up) visual analogue scale (VAS) for pain, University of California Los Angeles (UCLA) score, Constant-Murley shoulder score, range of motion (ROM) of the shoulder and radiographic results were statistically analyzed. Results: A total of 42 patients were included in this study. There were 18 males and 24 females, with an average age of (64.5±15.2) years and a mean follow-up of (43.9±7.1) months. At the last follow-up, ROM of abduction increased from 80.8°±26.5° to 154.2°±14.3°, and ROM of external rotation increased from 18.2°±13.6° to 31.8°±7.8°; the VAS score of pain decreased from (5.5±1.3) points to (0.7±0.7) points, the UCLA score increased from (21.3±3.7) points to (29.9±2.1) points, and the Constant-Murley score increased from (45.4±10.0) points to (87.2±4.8) points; the differences were all statistically significant (all P<0.001). The X-ray films showed that there were no upward of the humeral head in all the patients. MRI results indicated that rotator cuff re-teared in one case (Sugaya classification type Ⅲ), and healed in other cases (Sugaya classification type Ⅰ-Ⅱ). No complications such as upper limb nerve injury was found in all cases. Conclusion: Deep layer repair with the long head of the biceps autograft bridging can significantly alleviate the pain and improve the function of patients with Kim classification type ⅠA delaminated rotator cuff tear, and the incidence of retear is low.

Decreased muscle strength and scapular muscle endurance associated with shoulder function after neck dissection.

Shoulder disability is a common problem following neck dissection. Even if nerve structures are preserved, this may occur after the surgery. The primary aim was to research changes in rotator cuff and scapular muscles strength, and scapular muscle endurance after neck dissection in patients with head and neck cancer. The secondary aim was to investigate the relationship between these changes and postoperative shoulder function. This cross-sectional and prospective follow-up study included 14patients who underwent neck dissection (9unilateral and 5bilateral). Evaluations were performed preoperatively and at 3months postoperatively. Muscle strength measurements, including trapezius, serratus anterior, and rotator cuff muscles, were obtained using a handheld dynamometer. The scapular muscle endurance test was used for muscle endurance assessment. Postoperative shoulder function was evaluated using Constant-Murley shoulder score. A decrease in muscle strength and the scapular muscle endurance test was found at 3months postoperatively, except for the subscapularis muscle strength (p< 0.05). There were moderate to strong correlations between Constant-Murley shoulder score and percentage changes in muscle strength and the scapular muscle endurance test, except for the upper trapezius muscle strength (p< 0.05). Muscle strength and scapular muscle endurance may reduce following neck dissection. These reductions are associated with postoperative shoulder function. Thus, muscle strength and endurance training may be beneficial for early postoperative rehabilitation in patients with head and neck cancer.