Constant-Murley Research Articles

Latissimus dorsi tendon transfer versus open complete repair for symptomatic massive rotator cuff tear

BackgroundSymptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT. MethodsCases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset. ResultsThe functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05). ConclusionsLDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).

Additional Scapular Spine Bone Grafting Combined with Bankart and Remplissage for Off-Track Hill-Sachs Lesions with Subcritical Glenoid Bone Loss: Provides Better Stability.

Arthroscopic Bankart repair combined with remplissage and autologous scapular spine bone grafting have been described as a treatment for off-track Hill-Sachs lesions with subcritical glenoid bone defects in the anterior shoulder instability. However, whether these two techniques can achieve satisfactory postoperative outcomes is unclear, and there are few comparative studies between them. Therefore, this study compared the postoperative efficacy of the two techniques for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Between June 2017 and December 2020, 62 patients with shoulder instability due to Off-Track Hill-Sachs lesions with subcritical glenoid bone loss underwent surgical treatment and were included in this regression study. Thirty-two patients underwent arthroscopic Bankart repair combined with remplissage (B + R group), and 30 patients underwent additional autologous scapular glenoid bone grafting (additional bone grafting group). The general information of the patients was recorded. The patient's activity before and after surgery was recorded. The DASH score and Constant-Murley (CM) score were used to assess the patient's functional status; the Rowe score was used to evaluate the patient's shoulder stability. The shoulder function and stability before and after surgery were analyzed and compared between the two groups. The final DASH scores of the B + R group and the additional bone grafting group were significantly lower than those before surgery, with a statistically significant difference (9.76 ± 4.32 vs. 27.89 ± 6.63, 8.50 ± 3.32 vs. 28.0 ± 4.27, p = 0.000); the final CM scores of the two groups were significantly higher than those before surgery (88.71 ± 3.74 vs. 73.68 ± 3.74, 87.16 ± 2.29 vs. 71.37 ± 2.68, p = 0.000). There was no statistical difference in the final DASH score and final CM score between the two groups (p > 0.05). In terms of postoperative stability, the final Rowe scores of the two groups were significantly higher than those before surgery, with a statistically significant difference (89.06 ± 9.19 vs. 41.71 ± 4.13; 93.16 ± 4.99 vs. 42.33 ± 2.53, p = 0.000). Compared with the control group, the additional bone graft group achieved higher final Rowe scores (93.16 ± 4.99 vs. 89.06 ± 9.19, p = 0.032). For patients with anterior shoulder instability due to off-track Hill-Sachs lesions with subcritical glenoid bone loss, although Bankart and remplissage can achieve satisfactory clinical results, additional autogenous scapular spine bone grafting can provide better stability of the shoulder, especially for patients with high sports demands.

Clinical, sonographic and molecular changes in calcific tendinitis of the shoulder following extracorporeal shockwave therapy: a prospective case-control study.

Extracorporeal shockwave therapy (ESWT) is the primary treatment for calcific tendinitis of the shoulders, but what are the effects of clinical, sonographic, and molecular markers following ESWT in treating calcific tendinitis of the shoulder? Twenty-eight patients were categorized into radiodense and radiolucent subgroups. In addition, clinical assessments included the visual analogue scale (VAS), Constant-Murley (CM) score, American Shoulder and Elbow Surgeon (ASES) score, sonographic evaluation, and serum enzyme-linked immunosorbent assay (ELISA). The participants completed a one-year follow-up. All data were collected before and after treatment. After one year of follow-up, all patients showed notable improvement in VAS, CM, and ASES scores, with no significant clinical variations among the subgroups. However, the radiolucent group showed significant complete resorption and size reduction at the final follow-up. Sonographic evaluation revealed improved tissue perfusion and reduced calcification from 3 to 12 months in all patients, including those in the radiolucent group, but complete resorption of calcific deposits did not occur. The percentage of tissue perfusion was improved at 1 and 3 months after ESWT. There were no significant differences in the levels of the molecular markers interleukin-1 beta (IL-1 β) or IL-33, but the level of insulin-like growth factor 1 (IGF-1) was notably increased at 1 and 3 months post-ESWT. The BMP7 level was increased at 3 months and was then decreased significantly at 6 and 12 months. ESWT improved symptoms, reduced calcification, enhanced tissue perfusion, and promoted angiogenesis and BMP7 activity. In particular, it benefited radiolucent type patients with better calcification resorption. Partial resorption led to improvements in transparency, and a second ESWT session at 3 months was recommended for optimal results.

Diagnostic Ultrasound in the Evaluation of Stiff Shoulder: Association of Axillary Recess Thickness with Standard Clinical Measures.

Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess (AR) thickness in shoulder stiffness. In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. AR thickness was measured using high-resolution ultrasound. Parameters like passive range of motion (PROM), Numerical Rating Scale (NRS), and Constant-Murley (CM) score were evaluated to find correlations with AR thickness. The average age was 50.7 years, and mean BMI was 22.7. AR thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, p < 0.001). A cutoff of 3.0 mm for AR thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between AR thickness and PROM, especially in shoulder external rotation and extension. AR thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.

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.

Functional Outcomes of Open Reduction and Internal Fixation in Proximal Humerus Fractures by Philos Plate

INTRODUCTION Proximal humerus fractures are one very common and usually occur in elderly people. These fractures are usually associated with some degree of comminution and deformity. Therefore, good anatomical reduction of fracture fragments and early mobilization are the main component for optimal outcomes of involved limb. This study was intended to evaluate the functional outcome of proximal humerus fracture in adults managed by open reduction and internal fixation (ORIF) by proximal humerus interlocking osteosynthesis (PHILOS) plate. MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from October 2021 to September 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent open reduction and internal fixation by PHILOS plate were enrolled in the study. Functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 55.38±11.40 years and male patients outnumbered female patients (39 males and 21 females). 36 cases (60%) were of right side and 24 (40%) were of left side. Majority of the fractures were due to fall injury (57%) followed by road traffic accident (35%). The mean Constant Murley Score was 78.15±5.620 and VAS (visual analogue score) was 1.88±0.865. CONCLUSION Open reduction and internal fixation by PHILOS plate is an effective procedure providing good anatomical restoration and early mobilization in proximal humerus fracture thus providing good functional outcome.

Assessment of Coracoclavicular Ligament Healing on MRI After Arthroscopic TightRope Fixation for Acute Acromioclavicular Joint Dislocation.

Arthroscopic-assisted fixation of acute high-grade acromioclavicular (AC) joint dislocation has gained popularity in the last decade. Coracoclavicular (CC) fixation using the TightRope device is a less invasive technique. To investigate CC ligament healing and functional outcomes after arthroscopic fixation using the TightRope device for acute AC joint disruption. Case series; Level of evidence, 4. The study retrospectively analyzed the data of patients admitted for arthroscopic surgical treatment of acute AC joint injury using a single TightRope device. The data collection commenced in October 2021. The Constant-Murley (CM) score and University of California, Los Angeles (UCLA) shoulder score were used for functional evaluation. The CC distance (CCD) was measured on plain radiographs, whereas healing of the CC ligament was evaluated on magnetic resonance imaging (MRI). Statistical analyses were conducted with the Mann-Whitney U test, independent t test, or paired t test, as appropriate. The analysis included 33 patients with a mean age of 37.7 years (range, 24-49 years) and a minimum follow-up of 24 months. Significant preoperative to postoperative increases were noted in both the CM and UCLA scores (from 34.1 ± 7.6 to 93.3 ± 3.6 and from 8.7 ± 2.1 to 32.9 ± 1.7, respectively; P < .0001 for both). The CCD decreased from 21.8 ± 3.02 mm preoperatively to 10.6 ± 1.2 mm postoperatively (P < .0001). All patients displayed CC ligament healing on MRI. Two patients with superficial infection and 1 case of partial reduction loss were confirmed at the end of this study. The arthroscopic TightRope technique was found to be a reliable and less invasive method of fixation for acute AC joint disruptions. The CC ligament healed adequately based on MRI evaluation, and the patients regained their preinjury activities, with favorable functional outcomes and minor comorbidities.

Functional Outcomes of Close Reduction and Percutaneous Pinning in Proximal Humerus Fractures

INTRODUCTION Proximal humerus fractures are usually sustained from trivial fall in elderly. These fractures are usually associated with severe degree of comminution and deformity. Therefore, anatomical reduction of fracture fragments, and early mobilization are key factors for optimal outcomes of involved limb. This study was intended to evaluate the functional outcomes of proximal humer- us fractures in adults managed by closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2021 to June 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent closed reduction and percutaneous pinning were enrolled in the study and functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 53.08±13.10 years and male patients outnumbered female patients (37 males and 23 females). Forty one cases (68.3%) were of right side and 19 (31.7%) were of the left side. Majority of the fractures were due to fall injury (53.3%), followed by road traffic accident (40%). The mean Constant Murley Score was 76.95 ± 5.53 and VAS (visual analogue score) was 1.97 ± 0.97. CONCLUSION Closed reduction and percutaneous pinning is simple, less invasive and effective procedure for proximal humerus fracture providing good functional outcome.

No difference in clinical outcome after rotator cuff repair performed within or later than 3 months after trauma: a retrospective cohort study

PurposeRotator cuff (RC) tear is one of the most common injuries of the shoulder. Patients with RC tears often report a trauma initiating shoulder pain and impaired function. The aim of this retrospective analysis of a prospectively registered cohort was to elucidate whether the time interval between the trauma and RC repair, using a cut off of 3 months, affects the functional outcome after 2 years.MethodsIn a single orthopedic unit, 819 consecutive patients were treated with rotator cuff repair during the period from 2010 to 2014 and 733 of the patients completed the Western Ontario Rotator Cuff (WORC) index preoperatively and at 2-year follow-up. The Constant–Murley (CM) score was completed by trained physiotherapists after a clinical examination both preoperatively and at 2-year follow-up. Preoperative magnetic resonance imaging (MRI) was performed in all patients and postoperatively in 65% of the included patients. Re-tears and partial repairs were excluded, as were patients with pseudoparalysis who were given high priority and underwent surgery during the first 3 weeks after trauma.ResultsOf the 733 treated patients, 437 (60%) reported having had a shoulder trauma in their medical history initiating their shoulder symptoms, and of these, 358 met the inclusion criteria. 296 patients with non-traumatic tears, 9 repairs done within 3 weeks after trauma, 25 partial repairs, 33 re-tears and 12 others were excluded. At 2-year follow-up there was no significant difference in WORC index (n.s.) or CM score (n.s.) between patients who had their RC repaired within or more than 3 months after trauma. In patients where RC repair was performed within 3 months, the WORC index improved by 42.9%, and in the group of patients operated later than 3 months, the increase was 38.7%. This difference between the groups was neither statistically significant (n.s.) nor clinically relevant. On postoperative MRI, 80% of the repairs were healed in both groups.ConclusionIn this retrospective cohort study, no differences in clinical outcome were found when RC repair was performed between 3 weeks and 3 months or later than 3 months after injury in patients describing their onset of symptoms as traumatic.Level of evidenceIII.

Comparison of Open Versus Arthroscopic Repair for Subscapularis Tendon Tears With or Without Concomitant Supraspinatus Tendon Tears.

Background:The literature comparing open and arthroscopic repair of subscapularis tendon (ST) tears is insufficient.Purpose:To compare the clinical results of open versus arthroscopic repair of ST tears with or without concomitant supraspinatus tears.Study Design:Retrospective cohort study.Methods:We retrospectively evaluated 70 patients treated for isolated ST tears and ST tears with concomitant supraspinatus tendon tears at a single center between 2011 and 2019. Patients were divided into 2 groups: those who underwent open ST repairs (group O) and those with an arthroscopic ST repair (group A). Range of motion (ROM), liftoff and belly-press tests, and Constant-Murley (CM) scores were included in the pre- and postoperative functional evaluations. The minimal clinically important difference was calculated using the anchor-based method for changes in CM score. Tear size was evaluated according to the Lafosse classification. The categorical data were assessed using the Pearson chi-square, Fisher exact, and Fisher-Freeman-Halton tests. The parametric and nonparametric data were evaluated using the Student t test and Mann-Whitney U test, respectively. The dependent groups (for nonnormally distributed data) were evaluated using the Wilcoxon signed rank test.Results:Group O included 34 patients, and group A included 36 patients. The mean age was 62.9 years, and the mean follow-up period was 66.7 months. Even though group O exhibited a significantly better preoperative CM score (53.7 ± 4.6 vs 48.9 ± 6.8 [mean ± SD]; P = .001), group A had a significantly better postoperative CM score (88.7 ± 4.7 vs 84.6 ± 2.9; P < .001). Our measurements revealed a minimal clinically important difference of 11.5 points for the CM score. Group A had significantly greater postoperative ROM in abduction (153° vs 143.9°; P = .005) and forward elevation (159.1° vs 149.7°; P = .005), as well as significantly greater postoperative improvement in positive belly-press test results (P = .028). Complications occurred in 4 patients in group O and in 1 patient in group A.Conclusion:The study findings indicated that arthroscopic ST repair was more advantageous than open repair in terms of ROM and functional outcomes.

The Efficacy of Manipulation with Distension Arthrography to Treat Adhesive Capsulitis: A Multicenter, Randomized, Single-Blind, Controlled Trial.

Objective To determine whether arthrographic distention combined with manipulation for frozen shoulder provides additional benefits. Methods A total of 180 participants from five clinical centers with pain and stiffness in predominantly 1 shoulder for >3 months entered the study, and 165 completed the study. The control group was treated with arthrographic distention alone, and the treatment group underwent manipulation after resting for 5 minutes following arthrographic distention. Patients were followed up at the one and two weeks and at three and six months. For the clinical evaluation, shoulder-specific disability measure (SPADI) score, the visual analog scales (VASs) for pain, and range of active motion were used. Results 83 patients out of 90 in the treatment group and 82 out of 90 in the control finished the entire study period. SPADI, VAS, Constant-Murley (CM), and range of motion (ROM) were improved after treatments in both groups. The statistical differences were not observed in the CM, adduction, internal rotation, and posterior extension function between groups (P > .05) after the first treatment. And the statistical differences were not observed in the internal rotation, the extorsion, and posterior extension function (P > .05) after the second treatment. Conclusion Distention arthrography plus manual therapy provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in AROM of the shoulder than distention arthrography alone in patients with frozen shoulder.

Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary NailA Prospective Interventional Study

Introduction: Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. Aim: To evaluate rotator cuff integrity with Ultrasound (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using constant murley and QuickDASH scores. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using constant Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). Results: At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by constant murley score were 76.50±12.61 for the entire series, 77.82±12.75 for patients without rotator cuff rupture, and 69±10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90±7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41±7.92 versus 12.70±6.84) but without statistically significant difference (p=0.510). Conclusion: The functional outcome of the shoulder joint is satisfactory and is not influenced by the presence or absence of a rotator cuff tear following the procedure.

Comparative study of surgical management with plating versus non-operative management of displaced fracture of middle one-third of the clavicle

Clavicle is subcutaneously located and is relatively anterior in location, these peculiarities makes clavicle fracture as one of the commonest injury. Among clavicle fracture mid shaft fracures are the most common type. Both non operative and surgical management are the standard method of choice for midshaft clavicle fractures, however there are lots of debate in literature regarding which gives better results, hence the present study is undertaken to compare surgical management with plating and conservative management interms of functional outcome, the rates of malunion, delayed union and nonunion and related complications.Aims and Objectives:1.To analyse the functional and radiological outcome of fracture of middle third of the clavicle treated surgically with plating versus non operative management.2.To evaluate the complications associated with the operative and the non-operative management of the fracture of middle-third of clavicle.Method: 40 cases of mid shaft clavicular fracture were recruited for the study. They were divided into 2 groups each having 20 patients. Patients in group 1 were managed conservatively and patients in group 2 were managed surgically. Follow up was done at 6 weeks, 3 month and 6 months to assess functional and radiological outcomes.Result: Radiographic and clinical union was faster in the operative group, Constant and murley scores showed more improvement in the operative group when compared to non operative group. The average Constant murley score at the end of 6 months in group 1 was 73.8 and group 2 was 80 with significant mean difference of 6.20. Out of 20 cases operated 3 had surgical site infection (15%) and out of 20 conservatively managed cases three had non union (15%) and two had delayed union (10%).Conclusion: The current study showa that union rate was faster, incidence of malunion and non union were lesser and fuctional outcome assessed using Constant murley scores were significantly higher in the surgical group, this asserts that for displaced and communited mid shaft clavicle fractures operative intervention provides better results and early recovery of function.

Pseudoparalysis and Acromiohumeral Interval Reversibility Are the Most Important Factors Affecting the Achievement of Patient-Acceptable Symptom State After Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer

To determine the patient-acceptable symptom state (PASS) values for American Shoulder and Elbow Surgeons (ASES) score and the Constant-Murley (CM) score after arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) and to identify potential factors affecting the achievement of PASS. Fifty consecutive patients who underwent arthroscopic-assisted LDTT between 2015 and 2020 were retrospectively analyzed. In total, 42 patients met the inclusion criteria with minimum follow-up of 1 year postoperative. Patients were evaluated preoperatively and 1-year postoperatively with multiple clinical measurements including ASES, CM, score and PASS. The primary outcome was identified as patient satisfaction which assessed with achievement of a PASS. Potential factors affecting the patient satisfaction including age, sex, body mass index, previous surgery, presence of pseudoparalysis, critical shoulder angle, shoulder abduction moment index, acromiohumeral interval (AHI) reversibility, Hamada grade and fatty infiltration were evaluated for their association with PASS value by stepwise logistic regression analysis. A total of 42 patients were evaluated with mean follow-up 27.8 ± 8.21 months. The ASES and CM scores improved from preoperative means of 21.6± 6.5 and 25.2 ± 8.5 to 65.6 ± 20.7 points and 56.8 ± 16.5 points, respectively (P < .001). The PASS values for theASES and CM scores were 62.4 and 52.5, respectively. The univariate analysis showed that older age (P= .021), presence of pseudoparalysis (P < .001), previous surgery (P= .016), lower preoperative AHI (P= .028), and lower AHI reversibility (P < .001) were all significantly associated with worse patient satisfaction. The multivariable logistic regression analysis showed that pseudoparalysis (P= .038) and AHI reversibility (P= .021) were independent prognostic factors affecting theachievement of a PASS after arthroscopic-assisted LDTT. The cutoff value for AHI reversibility topredict an achievement of PASS was found to be 4.0 mm. Arthroscopic-assisted LDTT led to satisfactoryresults in patients withmassive rotator cuff tears. However, pseudoparalysis and AHI reversibility were the most important independent prognostic factors that consistently reduced and increased, respectively, the odds of achieving a PASS. Level IV, retrospective case series.

Arthroscopic rotator cuff repair with biologically enhanced patch augmentation.

The purpose of this guide is to illustrate an arthroscopic rotator cuff repair (RCR) with two techniques for biologically enhanced patch augmentation. Massive rotator cuff tears (> 5 cm) and revision RCR. Active joint or systemic infection; severe fatty muscle atrophy; severe glenohumeral arthropathy; American Society of Anesthesiologists Physical Status (ASA PS)IV. Dermal allograft patch augmented with concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP) and platelet-poor plasma (PPP); or Regeneten patch augmented with bursa, PRP, PPP, and autologous thrombin. A30° abduction sling for 6weeks; unrestricted active-assisted external rotation and forward elevation after 12weeks; focus on restoration of scapular stability and strength. A total of 22 patients received revision massive RCR using adermal allograft patch enhanced with cBMA and PRP with amean follow-up of 2.5years (1.0-5.8years). There was asignificant improvement in the preoperative Simple Shoulder Test (SST). There was also atrend towards improved pain and American Shoulder and Elbow Surgeons (ASES) Shoulder Score. In this cohort, 45% reached the minimal clinically important difference (MCID), 41% achieved substantial clinical benefit (SCB), and 32% had apatient-acceptable symptomatic state (PASS) for the ASES score. Preliminary data using the Regeneten patch technique with bursa, PRP, PPP, and autologous thrombin was prospectively collected in five patients between 05/2020 and 03/2021 at the author's institution. Mean follow-up was 6.5 ± 1.3 (6-8months). There was an improvement from preop to postop in pain, ASES, SANE, Constant-Murley (CM) score and active range of motion.

Short-term and long-term outcome of manipulation under anesthesia in primary frozen shoulder

Background: Painful restriction of active and passive shoulder range of motion which cannot be attributed to any internal shoulder pathology is termed as primary frozen shoulder. It has three stages – freezing stage, frozen stage, and thawing stage. Nonsteroidal anti-inflammatory drugs, physiotherapy, intra-articular corticosteroid injection, hydrodilatation, arthroscopic capsular release, and manipulation under anesthesia (MUA) are different modalities of treatment. Aims and Objectives: The main objective of our study was to assess the short-term and long-term outcome of MUA in frozen shoulder once it did not respond to 3 months course of physiotherapy. Materials and Methods: Fifty patients of primary frozen shoulder fulfilling inclusion criteria were manipulated under general anesthesia, and intra-articular Depo-Medrol and bupivacaine were administered. Functional status of the shoulder was assessed using the adjusted Constant-Murley (CM) score preoperatively and in subsequent follow-ups. Results: There was a significant improvement of mean adjusted CM score in short- and long-term follow-ups compared to pre-manipulation value. A significant negative correlation was found between the age of the patient and the final outcome. Conclusion: MUA is an effective modality of treatment in primary frozen shoulder with good short- and long-term outcomes.

Comparison of trans-articular Kirschner wire fixation and TightRope System for the treatment of acromioclavicular joint injuries

Aim: Acromioclavicular joint (ACJ) injuries are common among the young and middle-aged population. The management of Grade III ACJ injuries is still controversial. The purpose of the present study was to compare the clinical results and complication rates of trans-articular Kirschner (K) wire fixation and the TightRope System for surgically treated ACJ injuries.&#x0D; Material and Method: Patients with Grade III or more ACJ injuries surgically treated for acute ACJ injuries were included in the study. The patients were grouped according to the fixation method; the patients treated with the TightRope System were called Group 1 (n=17). The patients treated with trans-articular K-wire fixation were called Group 2 (n=21). The American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CS), Visual Analog Scale (VAS) scores, and shoulder range of motion (ROM) values were evaluated, and the complications were recorded and compared between the two groups.&#x0D; Results: Thirty-eight patients (7 females, 31 males) were included in the study with a mean age of 33±9.04. There was no significant difference between the two groups in terms of demographic and preoperative variables. ASES (P=0.400), CS (P=0.172), VAS (P=0.234), and ROM values were similar between the two groups. The rate of complications was significantly higher in Group 2 (P=0.025). &#x0D; Conclusion: Trans-articular K-wire fixation and the TightRope System have similar clinical scores and ROM values; on the other hand, trans-articular K-wire fixation has significantly higher complication rates.

Difference in the results of repair made with single or double rows according to the shape and size of the tear in arthroscopic rotator cuff surgery.

The aim of this study was to evaluate the effect on the results of patients applied with arthroscopic full layer total layer rotator cuff repair made according to the shape and size of the tear.The study included a total of 120 patients applied with arthroscopic full layer rotator cuff repair as single or double row repair. The patients were separated into 3 groups of 40 according to the shape of the tear, as Group A (crescent type), Group B (U type), and Group C (L type).The mean age of the whole sample was 66.68 ± 6.86 years (range, 50–81 years). A statistically significant difference was determined between the groups in respect of constant murley (CM), American shoulder and elbow surgeons score (ASES), and University of California Los Angeles score (UCLA) scores (P < .05). The scores of Group A of all the scales were found to be higher than those of Group C (P < .05). In single row and double row repair of small and medium-sized tears of all shapes, no significant difference was determined in respect of the CM and UCLA scores (P > .05).No significant difference was determined between single and double row repair of crescent type tears of all sizes. In large U-shaped tears, the CM, ASES, and UCLA scores were determined to be high in double row repair.

Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: Mid-to Long-Term Results

Background: Over the past decade, conversion to Reverse Total Shoulder Arthroplasty (RTSA) has become the preferred treatment for revision of an Anatomic Hemi (HA) or Total Shoulder Arthroplasty (TSA). However, conversion of failed stemmed shoulder arthroplasty to RTSA is still a highly demanding procedure and carries unique technical challenges and risks. Questions/Purposes: This study aimed to analyze the mid- to long-term results after conversion of failed anatomical shoulder arthroplasty to RTSA and investigate whether preserving the humeral stem offers advantages over revising the humeral stem. Materials and Methods: Between 2005 and 2018, 99 hemiarthroplasties and 62 total shoulder arthroplasties (total =161 shoulders; 157 patients) were revised to RTSA without (n=47) or with (n=114) stem exchange. Complications and revisions were documented from medical and surgical records. Longitudinal pre- and post-operative clinical (Constant-Murley (CS) score, Subjective Shoulder Value (SSV)), and radiographic outcomes were assessed. Complete clinical and radiographic follow-up was available on 80% of shoulders (127 patients; 128 of 161 procedures, 46 without and 82 with stem exchange) at a minimum of 24 months and a mean of 70 months (range, 24 to 184 months). Results: Humeral stem retention was associated with a significantly reduced surgical time (193 min vs. 227 min, p=0.001, less blood loss (591 mL vs. 753 mL, p=0.037), less intraoperative complications (13% vs. 19%; Odds Ratio (OR), 1.4, p=0.32) and fewer subsequent reinterventions (19% vs. 28%; OR, 2.3, p=0.06). The complication/revision rate leading to drop out from the study was considerable in the stem revision group (ten patients; ten of 114 shoulders (9%)), but there were no complication-related dropouts in the stem-retaining group. Conclusion: Our findings suggest that humeral stem revision is associated with decreased surgical time, less blood loss, less intra- and postoperative complications, and a lower revision rate compared to humeral stem retention. Based on these findings, a shoulder arthroplasty system modularity offers substantial benefit if conversion to reverse total shoulder arthroplasty becomes necessary. Level of Evidence: Level III, therapeutic study.

Comparison of sleep quality, shoulder function, and quality of life in patients with different-sized rotator cuff tears

Background: Many patients with rotator cuff tears suffer from nocturnal shoulder pain resulting in sleep disturbance, inability on shoulder function, and reduced quality of life.&#x0D; Aims and Objective: This study aimed to compare patients with different sizes of rotator cuff tears (RCTs) concerning sleep quality, shoulder function, quality of life, and emotional state.&#x0D; Materials and Methods: Forty-four patients (mean age 49.43±10.71) with different size of RCT were included in this prospective cross-sectional study. Patients were divided into two groups according to RCT size diagnosed with magnetic resonance imaging. Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Constant Murley (CM) score, Western Ontario Rotator Cuff Index (WORC), and Beck Depression Inventory (BDI).&#x0D; Results: There was no significant difference between patients with small and large size RCT in terms of sleep quality, shoulder functionality, quality of life and emotional state (p=0.841, p=0.258, p=0.916, p=0.936, respectively).&#x0D; Conclusion: We demonstrated that patients with RCT had poor sleep quality, decreased shoulder function, poor quality of life, and normal emotional status, regardless of the tear size.