Elbow Surgeons Shoulder Index Research Articles

Arthroscopic Coracoid Transfer in the Lateral Decubitus Position is Safe and Effective at Short-Term Follow-Up

To report on operative and clinical outcomes in a series of shoulders treated with arthroscopic Latarjet performed in the lateral decubitus position. Patients with shoulders that underwent arthroscopic Latarjet in the lateral decubitus position were identified. Data were retrospectively collected, including patient demographics, operative times, intra- and postoperative complications, and clinical and functional outcomes. Descriptive statistics were performed. Eighteen shoulders in 17 patients were included in the study with a mean follow-up of 14 ± 12.1 months (range, 4-39 months). The mean operative time for all procedures was 132.2 ± 18.0 minutes, and the mean operative time for the first half of the cohort was significantly longer than that of the second half (141.6 ± 14.2 minutes vs 122.8 ± 17.0 minutes, P= .02). There were no intraoperative complications, and no patients required a conversion to open surgery. One patient experienced a recurrent dislocation after a traumatic event but was able to be treated nonoperatively. Preoperative and postoperative patient-reported outcome measures (PROMs) were able to be collected on 8 of 18 patients (44.4%). Although all PROMs demonstrated improvements postoperatively, only the Single Assessment Numeric Evaluation score and American Shoulder and Elbow Surgeons Shoulder Index displayed a statistically significant increase (P<.05). Five of 8 (62.5%) shoulders demonstrated bony fusion on postoperative computed tomography scan. Of those eligible, 100% of patients returned to sport or felt that they could return if they wanted to. The arthroscopic Latarjet is an effective procedure for managing glenohumeral instability and can safely be performed in the lateral decubitus position. Level IV, therapeutic case series.

Triple-Row Technique Confers a Lower Retear Rate Than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs

To compare the structural and clinical results between the knotless suture bridge (SB) and triple-row (TR) techniques. This study is a retrospective study and included 212 shoulders with repairable rotator cuff tears treated with the SB technique and 206 shoulders treated with the TR technique. In the TR technique, medial and lateral anchors were placed as they would be for the SB technique, with a middle row anchor added on the edge of footprint to reduce the torn tendons. All patients underwent primary arthroscopic rotator cuff repair and had magnetic resonance imaging 6 months postoperatively to evaluate for retear. Sugaya's classification was used to classify the retear pattern. The function of all patients preoperatively and 2 years postoperatively were assessed by the American Shoulder and Elbow Surgeons shoulder index and the University of California at Los Angeles rating scale. According to Sugaya's classification, 24 (11.3%), 6 (2.8%), and 20 (9.4%) in SB-treated shoulders and 16 (7.8%), 12 (5.8%), and 8 (3.9%) in TR-treated shoulders, respectively had types 3, 4, and 5. There was a statistically significant greater type 5 retear in SB-treated shoulders (P= .038) than in TR-treated shoulders. The average clinical outcome scores at the final follow-up improved significantly relative to those before the surgeries in both groups. There were no statistical differences in the clinical outcome scores at the final follow-up between SB and TR groups. The use of the TR technique in arthroscopic rotator cuff repair resulted in a lower large-size retear rate when compared with the use of the SB technique. No clinical differences were noted in the outcomes between the 2 groups. Level III, therapeutic, retrospective cohort study.

Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

Background: The purpose of this study was to identify the clinical and radiological outcomes of hook plate fixation for lateral end fracture of the clavicle and acromioclavicular dislocation. Methods: There were a total of 20 cases with lateral end fracture of the clavicle and 16 cases with acromioclavicular dislocation. All patients were evaluated for range of motion, functional score by using Constant score, and American Shoulder and Elbow Surgeons shoulder index at just before implant removal and at final follow-up. Coracoclavicular distance was measured in acromioclavicular dislocation and bony union was evaluated in the lateral end fracture of the clavicle. Results: The clinical outcomes and range of motion were increased at the final follow-up compared with just before implant removal in both the lateral end fracture of the clavicle and acromioclavicular dislocation. In acromioclavicular dislocation, all cases—except one—showed maintenance of reduction after implant removal. Moreover, in the lateral end fracture of the clavicle, all cases—except one—showed bony union. Conclusions: Hook plate fixation in the lateral end fracture of the clavicle and acromioclavicular dislocation resulted in good clinical and radiological results.

Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors

To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P < .0001) and the American Shoulder and Elbow Surgeons index improved from 55.1 to 87.7 (P < .0001). No complications were observed. The retear rates after DR-ARCR with absorbable sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series.

Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up.

Aims:The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions.Materials and Methods:The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively.Statistical Analysis Used:Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher's exact test was used.Results:At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES) scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001) and the Simple Shoulder Test (SST) scores from 7.7 to 10.6 (P < 0.0002). Twenty-two out of the 25 patients (88%) stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs), 9 patients (43%) demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57%) had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs.Conclusions:Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.

Early clinical and structural results after autologous chondrocyte transplantation at the glenohumeral joint

The purpose of the study was to report early functional and radiographic results of a small series of patients who underwent autologous chondrocyte transplantation-collagen membrane seeding (ACT-Cs) for focal chondral defects of the shoulder. The outcome of 4 consecutive male patients (mean age, 29.3 ± 6.2 years; range, 21-36 years) who underwent ACT-Cs for treatment of large symptomatic glenohumeral cartilage defects was retrospectively evaluated with clinical and radiographic measures at a mean of 41.3 ± 24.9 months (range, 11-71 months) after surgery. The evaluation included a visual analog scale for pain, the Constant score, the American Shoulder and Elbow Surgeons shoulder index, the Rowe score, and a satisfaction scale. Magnetic resonance imaging evaluation was performed according to the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system. There were 3 humeral full-thickness cartilage defects (each 6.0 cm(2)) and 1 glenoid full-thickness cartilage defect (2.0 cm(2)). The mean postoperative visual analog scale score (0.3 of 10), the mean unweighted Constant score (83.3 ± 9.9), and the mean American Shoulder and Elbow Surgeons index (95.3 ± 8.1) were representative of satisfactory shoulder function. The Magnetic Resonance Observation of Cartilage Repair Tissue score was indicative of satisfactory defect coverage with signs of fibrocartilaginous repair tissue. Autologous chondrocyte transplantation at the glenohumeral joint is a remote option for young adults with symptomatic, isolated, large-diameter cartilage lesions. Potential complications as a result of the open approach and 2-step procedure have to be considered carefully. Long-term data, larger patient populations, and randomized studies are required to determine the potential for chondrocyte transplantation techniques to be standard procedure for treatment of symptomatic, large-diameter, full-thickness cartilage defects in the glenohumeral joint.

The success of closed reduction in acute locked posterior fracture-dislocations of the shoulder

We retrospectively reviewed the results of closed treatment in 7 patients with acute locked posterior fracture-dislocations of the shoulder. Shoulders were reduced with patients under general anesthesia and were splinted in neutral rotation for 6 weeks. Follow-up averaged 46 months (range, 24-88 months). All shoulders were reduced within 14 days. Humeral head defects ranged from 18% to 32% of the articular surface, and all patients had documented posterior instability under anesthesia after relocation. Of the 7 patients, 6 had a stable shoulder. The mean American Shoulder and Elbow Surgeons shoulder index was 93.5 (range, 83-100). The mean findings with regard to motion were active forward elevation to 169 degrees , external rotation to 73 degrees , and internal rotation to T11. All patients without preexisting shoulder pathology were treated successfully. Closed management of acute posterior fracture-dislocations can be highly successful, even in the face of instability under anesthesia and a 30% humeral head defect.

Intra-articular Repair of an Isolated Partial Articular-Surface Tear of the Subscapularis Tendon

Background Partial-thickness tear of the subscapularis tendon in the articular surface is common. Hypothesis Intra-articular repair of a partial articular-surface tear of the subscapularis tendon will provide a successful outcome. Study Design Case series; Level of evidence, 4. Methods A total of 29 shoulders with an isolated partial articular-surface tear of the subscapularis tendon without another rotator cuff lesion were treated with arthroscopic intra-articular repair using suture anchors. Biceps tenodesis was performed in 16 patients. Outcomes were prospectively evaluated at a mean of 27 months (range, 19-41 months) using 3 objective (University of California at Los Angeles, American Shoulder and Elbow Surgeons Shoulder Index, Simple Shoulder Test) and 2 subjective (pain and function visual analog scales) measurements. Results There were 21 men and 8 women, with a mean age of 54 years (range, 41-65 years). Tear widths were small (<1 cm) in 16 shoulders and large (>1 cm) in 13 shoulders. Twenty-six shoulders had articular cartilage erosion on the adjacent humeral head. Lesions of the biceps tendon were noted in 25 patients (partial tear in 15 shoulders; subluxation in 13 shoulders). Shoulder pain scores improved after surgery (5.0 ± 2.7 to 0.3 ± 0.7, P <. 05). According to American Shoulder and Elbow Surgeons Shoulder Index scores, 18 were excellent; 10, good; and 1, fair. Internal rotation strength deficit improved from 32% to 4%. Twenty-six patients returned to more than 90% of previous activity. There were no surgical complications; tear size and biceps tenodesis did not affect outcome (P >. 05). Conclusion Arthroscopic intra-articular repair of a partial articular-surface tear of the subscapularis tendon is an effective procedure that spares the intact tendon attachment in the bursal surface. Short-term outcomes were reliable by both objective and subjective measurements.

Accelerated rehabilitation after arthroscopic bankart repair for selected cases: a prospective randomized clinical study

Purpose: Increased stress within a certain limit enhances ligament healing and improves joint function. In this prospective randomized clinical trial, we compared the clinical results of early motion versus conventional immobilization after arthroscopic Bankart repair in a selected patient population. Type of Study: Prospective randomized clinical trial. Methods: We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic recurrent anterior instability of the shoulder. Patients were randomized into 2 groups; group 1 (28 patients; mean age, 28 years) was managed with 3 weeks of immobilization using an abduction sling and conventional rehabilitation program, and group 2 (34 patients; mean age, 29 years) was managed with an accelerated rehabilitation program that consisted of staged range of motion and strengthening exercises from the immediate postoperative day. Selection criteria were nonathletes with recurrent anterior shoulder dislocation and a classic Bankart lesion with a robust labrum limited to 1 cm from the midglenoid notch. The patients were followed up for a mean of 31 months (range, 27 to 45 months; standard deviation, 9 months). Analysis of outcome included pain scores at 6 weeks and at final follow-up evaluation, range of motion, return to activity, recurrence rate, patient satisfaction with each rehabilitation program, and shoulder scores assessed by the American Shoulder and Elbow Surgeons Shoulder Index, the rating system of the University of California at Los Angeles, and another scoring system. Results: The recurrence rate was not different between the 2 groups ( P = .842). None of the groups developed recurrent dislocation. Two patients from each group were positive for anterior apprehension signs. Patients who underwent accelerated rehabilitation resumed functional range of motion faster ( P < .001) and returned earlier to the functional level of activity ( P < .001). Accelerated rehabilitation decreased postoperative pain ( P = .013), and more patients were satisfied with this program ( P <.001). Shoulder scores, return to activity, pain score, and range of motion were not different between the 2 groups at the final follow-up evaluation ( P > .05). Conclusions: Early mobilization of the operated shoulder after arthroscopic Bankart repair does not increase the recurrence rate in a selected group of patients. Although the final outcomes are approximately the same for both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which allows patients an early return to desired activities.

Accelerated Rehabilitation After Arthroscopic Bankart Repair: A Prospective Randomized Clinical Study (SS-16)

Background: An increased stress within a certain limit enhances healing of a ligament and improves function of the joint. In this prospective randomized clinical trial, we compared the clinical results of early motion versus the conventional immobilization after the arthroscopic Bankart repair in the selected patient population. Methods: We performed an arthroscopic Bankart repair using suture anchors in sixty-two patients with traumatic recurrent anterior instability of the shoulder and randomized them into two groups; Group 1 (twenty-eight patients; mean age, 28 years) was managed with three weeks of immobilization using an abduction sling and conventional rehabilitation program, and Group 2 (thirty-four patients; mean age, 29 years) was managed with an accelerated rehabilitation program, which consisted of staged range of motion and strengthening exercises, from the immediate postoperative day. Selection criteria of patients were non-athletes with recurrent anterior shoulder instability who have a classic Bankart lesion with a robust labrum. The patients were followed for a mean of thirty-one months (range, twenty-seven to forty-five months; Standard deviation, nine months). Analysis of outcome included pain scores at the first six weeks and at the final follow-up, range of motion, return to activity, recurrence rate, patients’ satisfaction with each rehabilitation program, and shoulder scores assessed by the American Shoulder and Elbow Surgeons Shoulder Index, the rating system of the University of California at Los Angeles and Rowe et al. Results: The recurrent rate was not different between the two groups (p = 0.842). None of the groups developed recurrent dislocation. Two patients from each group had positive anterior apprehension. Patients who underwent accelerated rehabilitation resumed functional range-of-motion faster (p 0.05). Conclusion: Early mobilization of the operated shoulder after arthroscopic Bankart repair does not increase the recurrence rate in selected group of patients. Although the final outcomes are approximately the same in both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which enables patients an early institution of their desired activities.