Functional Outcome Of Arthroscopic Repair Research Articles

A Study of Clinical and Functional Outcome of Arthroscopic Repair versus Open Latarjet Surgery for Bankart Lesion (Minimum Six (6) Months Follow Up

A Study of Clinical and Functional Outcome of Arthroscopic Repair versus Open Latarjet Surgery for Bankart Lesion (Minimum Six (6) Months Follow Up

Results of Arthroscopic Repair of Bankart Lesion in Chronic Anterior Instability of the Shoulder

Background: The shoulder is the most commonly dislocated major joint, affecting roughly 2% of the general population. Long-term studies have demonstrated a correlation between the number of instability episodes and the risk of degenerative arthritis. In an effort to treat the unstable shoulder, orthopedic surgeons have described several different operations that may help to prevent recurrent subluxation or dislocation in chronic instability cases. This study has been undertaken to assess the short-term functional outcome of Arthroscopic repair of Bankart’s Lesion in patients with Chronic Anterior Instability of the Shoulder using Constant Murley’s Score.

A prospective study of functional outcome of arthroscopic repair of recurrent anterior shoulder dislocation

Background: The causes of anterior dislocation of shoulder are usually trauma; a sports injury, road traffic accident, assault or fall. The arthroscopic Bankart repair offers minimally invasive procedure with less surgical trauma, less blood loss, with improvement in operative time, less perioperative morbidity, narcotic use, hospital stay, time loss from work, decrease in number of complications, cost of surgery and better cosmetic result.Aim: To assess the functional outcome of shoulder joint following arthroscopic repair of recurrent anterior shoulder dislocation.Materials and Methods: A hospital based prospective study was done with 30 patients to assess the functional outcome of arthroscopic repair of recurrent anterior shoulder dislocation from January 2019 to June 2020 done using the UCLA (University of California at Los Angeles), ASES (American Shoulder and Elbow Surgeons) shoulder score and the Rowe score.Results: Patients in the group operated with retro-grade femoral nailing showed similar functional outcome as compared to ante-grade femoral nailing. It was also noted that in patients with retro-grade femoral nailing early mobilization, smaller incision at entry point was possible and there was no need of a fracture table.Conclusion: Arthroscopic repair in cases of recurrent anterior shoulder instability is a reliable surgical procedure with respect to shoulder function and motion as it offers good clinical outcome, excellent post-operative shoulder range of motion with improved function. This surgical procedure has better patient compliance, and minimum surgical complications in properly selected patients.

FUNCTIONAL OUTCOME OF ARTHROSCOPIC REPAIR OF ISOLATED SUPRASPINATUS TEAR – A PROSPECTIVE OBSERVATIONAL STUDY

Background: Rotator cuff lesions are one of the more common conditions affecting the shoulder joint. The management of rotator cuff tears has changed dramatically from open procedures to less invasive procedures like arthroscopy. The results of arthroscopic rotator cuff repair have not been studied as extensively as open repair. The purpose of this study is to evaluate functional outcome of arthroscopic repair of isolated supraspinatus tear. Methods: A prospective observational study conducted on twenty patients with supraspinatus tendon tear who underwent arthroscopic supraspinatus repair between September 2017 and June 2018. Patients with tear of supraspinatus tendon, age between 45 and 70 years, repair performed solely with arthroscopic technique, consent to participate and follow up in post-operative rehabilitation were included. Patients with associated superior labrum anterior to posterior lesion, cuff tear arthropathy, acromioclavicular arthritis, tears involving other rotator cuff tendons and revision of rotator cuff repair were excluded. There were 15 female and 5 male with average mean age of 56.4 years. After assessing the tear pattern and subacromial decompression, the tear was repaired by either single row or double row techniques. All patients were assessed by University of California, Los Angles scoring system preoperatively, postoperatively 6 months and 1 year. Results: 10% patients had excellent results, 85% had good results and 5% had poor results. Mean University of California, Los Angles score increased from 6.55 preoperatively to 31.15 at the end of one year. Arthros Conclusion: copic repair for isolated Supraspinatus tendon tears gave good to excellent functional results in large percentage of patients.

Repair integrity and functional outcomes of arthroscopic repair in chronic anterior shoulder instability: single-loaded versus double-loaded single-row repair.

This study compared the clinical outcome and repair integrity of single-loaded and double-loaded single-row arthroscopic repair of chronic anterior shoulder instability. Fifty consecutive chronic anterior shoulder instability cases treated by arthroscopic labral repair were included. A single-loaded single-row technique was used in the first 25 consecutive shoulders, and a double-loaded single-row technique was used in the next 25 consecutive shoulders. The number of suture anchors was 4 in the shoulders that underwent single-loaded repair and 3 in the shoulders that underwent double-loaded repair. 42 shoulders (84.0%) followed up clinical outcomes were evaluated a minimum 2years (mean 28.5months; range 24-46) postoperatively. The postoperative labral repair integrity was evaluated by MDCT-arthrogram at a minimum 6months postoperatively. At the final follow-up, the average UCLA, ASES, Constant, Rowe score, VAS pain score, and VAS for instability scores improved significantly, to 33.05, 92.33, 89.05, 94.86, 0.90 and 0.52, respectively, in the single-loaded group and to 32.19, 90.10, 89.05, 94.52, 0.90, and 0.86, respectively, in the double-loaded group. The clinical scores improved in both groups postoperatively (all P < 0.05); however, there was no significant difference between the two groups at final follow-up (P = 0.414, 0.508, 1.000, 0.917, 1.000, and 0.470, respectively). The re-tear rate was 2 (9.5%) in the shoulders that underwent single-loaded repair and 3 (14.3%) in the shoulders that underwent double-loaded repair; this difference was statistically not significant (P = 0.634). The double-loaded single-row technique resulted in comparable clinical outcomes, and re-tear rate compared with the single-loaded single-row technique in chronic anterior shoulder instability at short-term follow-up. Number of used suture anchor in double-loaded single-row technique was fewer than that of single-loaded single-row technique. Comparative retrospective study, level III.

Functional outcome of arthroscopic repair of bucket handle and longitudinal medial meniscal tears in a military population by inside out and outside in technique: A prospective observational study.

ObjectiveTo assess if young military personnel who had sustained medial meniscal bucket handle/longitudinal tears could return to full, unrestricted active duty after meniscal repair by outside in/inside out technique. Methods32 medial meniscal longitudinal/bucket handle tears were repaired by inside-out and outside in technique between Jul 01, 2017 and June 30, 2018 and followed up for at least 18 months. ResultsThere were 03 failures of repair. The first 05 patients developed para-meniscal cyst due to irritation of soft tissue by PROLENE® suture hence the suture material was changed to ULTRABRAID® in next 27 patients and there was no occurrence of this complication. The mean IKDC, Lysholm and Tegner scores showed significant improvement till 12 months post op and thereafter there was marginal improvement in these scores. Most patients who had successful outcome at one year were able to carry out preinjury level of activities and join unrestricted active duty. ConclusionWith more than 90% able to re-join active duty, we could demonstrate that inside out/outside in technique is an excellent method of reliably and economically repairing a torn meniscus even for very high demand military personnel.

Repair integrity and functional outcomes of arthroscopic repair for intratendinous partial-thickness rotator cuff tears.

We evaluated the clinical and radiological outcomes of arthroscopic repair of intratendinous partial-thickness rotator cuff tears. We retrospectively reviewed 30 patients who underwent arthroscopic repair of intratendinous partial-thickness rotator cuff tears from January 2010 to January 2015 in a single institute. Five outcome measures were used: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons score, the shoulder rating scale of the University of California at Los Angeles, the Constant-Murley score, and range of motion (ROM). Pain was recorded using the VAS. Active ROM was measured goniometrically. Rotator cuff repair integrity was determined via magnetic resonance imaging or ultrasonography at least 6 months after arthroscopic repair. Of the 30 patients, 29 (96.6%) returned for functional follow-up evaluation no earlier than 2 years after the operation. All functional scores exhibited significant improvements (all p = 0.000). The VAS improved from a mean of 5.8 ± 1.6 to 2.5 ± 2.6 ( p = 0.000). The mean active ROM of forward flexion changed from 149.8 ± 33.8° preoperatively to 172.4 ± 9.1° ( p = 0.001) at the last follow-up; abduction changed from 115.6 ± 50.3° to 171.3 ± 15.9° ( p = 0.000). Postoperative radiological evaluation revealed retearing in three patients (3/28, 10.7%), including two with articular-side partial-thickness retears and one with a bursal-side partial-thickness retear. Arthroscopic repair of intratendinous partial-thickness rotator cuff tears was associated with a retearing rate of 10.7% on radiological follow-up and afforded significant clinical and functional improvements.

Functional outcome following arthroscopic rotator cuff repair with single row technique using bio absorbable anchors: Prospective study

Background: Rotator cuff muscles play an important role in movements of the shoulder joint as well as in stabilizing the joint. The causes of rotator cuff tears are multifactorial. It can be due to degeneration or secondary to trauma. Rotator cuff repairs can be performed through either arthroscopic or open approaches. Complete arthroscopic Rotator Cuff repair have been promising and evolving.Methodology: Fifty patients between age of 25 to 80 who underwent arthroscopic repair of rotator cuff tears with single row technique using bioabsorbable anchors were analysed for functional outcome and the influence of age, gender and hand dominance as factors influencing functional outcome. The functional outcome of arthroscopic repair of rotator cuff tear with single row technique by using SPADI score and Constant shoulder score.Results: All the pre-op patients had poor score. After 3 months, 46 (92%) patients were having poor score and 4 (8%) were having fair score. After 6 months, 28 (56%) patients were having fair score, 11 (22%) patients with good and 11 (22%) patients with poor score. In 1 year follow up, 23 (46%) patients had good score, 22 (44%) patients were having excellent score, 4 (8%) patients with poor and 1 (2%) patients had fair score.Conclusion: Arthroscopic rotator cuff repair with single row technique demonstrates significant reduction in pain and improvement in shoulder function during medium term follow up. We found that age, gender and association of hand dominance are not significant predictors of outcome of surgery.

Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review.

The optimum treatment strategy for the surgical management of partial-thickness rotator cuff tears (PTRCT) is evolving. In this study, two research questions were sought to be answered: "Does the repair technique for PTRCTs involving >50% of the tendon thickness have an effect on structural and functional outcomes of arthroscopic repair?" and "Is there a difference in outcomes of arthroscopically treated articular- and bursal-sided PTRCTs?". A systematic review according to the PRISMA statement was conducted to identify all literature published reporting on outcomes of arthroscopic treatment of PTRCTs classified with the Ellman classification with minimum 2-year follow-up. Prospective randomized trials were eligible for quantitative synthesis. A total of 19 studies, published between 1999 and 2015, met the inclusion criteria of this systematic review. Two studies reporting outcomes of articular-sided PTRCTs with prospective randomized study design were included in quantitative synthesis calculations. Arthroscopic repair of PTRCTs >50% thickness results in significant pain relief and good to excellent functional outcomes. When in situ repair was compared with repair of the tendon after completion to full-thickness RCT, there were no significant differences in functional or structural outcomes or complication rates. The best treatment method for low-grade PTRCTs remains unclear. The repair technique (in situ repair versus repair of the tendon after completion to full-thickness RCT) did not significantly affect the outcomes for arthroscopic repair of PTRCTs >50% thickness. The current literature contains evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided compared to articular-sided PTRCTs, and some evidence suggests that repair of lower-grade bursal-sided tears may be beneficial over debridement. IV.

Medium and long-term follow-up outcome after arthroscopic repair of type II SLAP lesions with two Loops

Objective To determine the medium-long term functional outcome of arthroscopic repair of type II SLAP lesions with two loops. Methods According to retrospective study, 29 cases patients with arthroscopic repairs of isolated type II SLAP lesions were collected from March 2011 to June 2013, the mean patient age at the time of surgery was 31.8 years(range17 to 47 years). All patients with ground anchor suture, and through double loop knot technology to fix SLAP injury.Visual analogue scale(VAS), Kerlan-Jobe Orthopaedic Clinic(KJOC), Roche Shouder function Score(ROWE) were used to determine the function of shoulder joint.The shoulderjoint range of motion before treatment and post treatment were recorded, shoulder joint mobility was recorded, satisfaction survey was done, compared the preoperative and postoperative data to evaluate its clinical effect. Results All patients were available for follow-up of 2.7-5.2 years.Overall, functional outcome was improved from baseline compared with final follow-up for VAS scores((4.3±1.2) points vs.(1.5±0.8) points, t=5.435, P<0.05), KJOC scores((72.1±4.9) points vs.(92.8±5.4) points, t=5.921, P<0.01), and ROWE scores((54.1±12.4) points vs.(84.3±10.2) points, t=7.326, P<0.01). Only a minority of patients feel pain when they did srenuous exercise.According to satisfaction investigation of patients, patient satisfaction was reported in 89.7%, 3 cases had not good results, they could not return to previous level of play, including 2 cases were athletes, 1 case was not athlete. Conclusion There is no more persistent pain and dysfunction after surgery, a good or excellent medium-long term functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with two loops. Key words: SLAP lesions; Shoulder joint; Arthroscope; Repair

Functional outcome of arthroscopic repair of full-thickness degenerative rotator cuff tears

BackgroundIn the past decade, in spite of the advancement in the clinical knowledge, imaging modalities for precise diagnosis and minimally invasive surgeries, the ideal management for degenerative rotator cuff tears is still a matter of debate. MethodsThis prospective study was conducted from January 2013 to August 2016, involved 16 patients (09 males, 07 females) with the mean age of 62.81±7.24 years (range 54–80 years), who had the full-thickness degenerative tear of the rotator cuff. Arthroscopic repair using single row technique was performed in all the patients. The outcome was assessed using ASES questionnaire; pain score by visual analogue scale (VAS) and range of motion of the shoulder joint at presentation, 24 weeks and at final follow-up. ResultsAt the mean follow-up of 24.68±3.17 months (range 20–29 months), the mean ASES score and pain score (VAS) improved significantly from 31.16±5.57 to 71.79±3.92 (p-value <0.001) and 5.63±0.72 to 1.9±0.92 (p-value <0.001) respectively. There was significant improvement in all the movements of the shoulder joint. 14 patients were satisfied with the final functional outcome. ConclusionArthroscopic repair of a full thickness degenerative tear of the rotator cuff using single row repair technique leads to satisfactory functional outcome in terms of activities of daily living, pain scores and range of motion.

Should massive rotator cuff tears be reconstructed even when only partially repairable?

(1) To evaluate midterm functional outcomes of arthroscopic repair of massive rotator cuff tears and (2) to determine the prognostic factors that could influence outcome. The hypothesis was that both partial and complete repairs would result in equivalent improvement of clinical score. From a prospective series of 525 rotator cuff repairs, we analysed records of the 73 patients who were treated for massive tears. The median follow-up was 41months (range 29-55), and functional outcome was evaluated using the Constant score, shoulder strength, and subjective shoulder value. The median CS improved from 34 points to 81 points (p<0.001). The scores were better for both types of two-tendon tears, posterosuperior (83, n=33) and anterosuperior (85, n=13) (n.s.), than for three-tendon tears (74, n=27) (p<0.001). The scores were also better when fatty infiltration was of stage I (84, n=28) than of stage II (78, n=34) (p<0.001) or stage III (74, n=11) (p=0.04). The scores were only slightly higher for completely reparable tears (81.5, n=50) than for partially reparable tears (79, n=23) (n.s.). Ultrasonic examination revealed incomplete healing, in 10 of the 50 completely repaired tears, and in 11 of the 23 partially repaired tears. The results of the present study compare favourably with those in recent literature and confirm the hypothesis that both partial and complete repairs of massive rotator cuff tears produce equivalent improvements of Constant scores. The clinical relevance of these observations is that even if repairs of two-tendon tears result in superior functional outcomes, repairs of three-tendon tears produce equivalent 'relative' improvement that grants sufficient patient satisfaction and autonomy. Comparative case series, Level IV.

Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series.

The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing.

Medialization of the Subscapularis Footprint Does Not Affect Functional Outcome of Arthroscopic Repair

The purpose of this study was to compare the functional outcome of arthroscopic subscapularis repair of complete subscapularis tendon tears performed with anatomic tendon-to-bone repair versus repair with medialization of the footprint. A retrospective review was performed of subscapularis tendon tears repaired with an arthroscopic technique from 1998 to 2009. Complete tears of 100% of the length of the subscapularis tendon repaired arthroscopically were included in the study. The exclusion criteria included subscapularis tendon tears of less than 100% of the tendon length, revision repairs, or open repairs. The minimum follow-up was 2 years. Postoperative functional outcome was determined by University of California, Los Angeles and American Shoulder and Elbow Surgeons scores. Group I comprised 14 tears that were anatomically repaired to the normal lesser tuberosity footprint. Group II comprised 9 tears that were repaired to the lesser tuberosity after medialization of the footprint. There was no difference in improvement in University of California, Los Angeles or American Shoulder and Elbow Surgeons scores between the 2 groups (P > .05). Furthermore, there was no difference in how patients rated their shoulder, patient satisfaction, or return to activity between the 2 groups (P > .05). On the basis of this study, functional outcome does not appear to be compromised by medialization of the subscapularis footprint. Medialization by 4 to 7 mm is acceptable when tendon mobility is otherwise insufficient to perform an anatomic tendon-to-bone repair of a complete subscapularis tendon tear. Level III, retrospective comparative study.

Arthroscopic Repair of Anterosuperior Rotator Cuff Tears Combined With Open Biceps Tenodesis

The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears with open biceps tenodesis when indicated. We retrospectively reviewed the cases of 17 patients (17 shoulders) who underwent arthroscopic repair of anterosuperior tears with concurrent open biceps tenodesis. At final follow-up, an independent examiner collected shoulder functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog pain scale. Objective information including range of motion and strength was also collected. Of the 17 patients, 13 (77%) were available for evaluation with a mean age of 52.7 ± 7.0 years at the time of surgery (range, 32 to 65 years) and a mean follow-up of 34.6 ± 10.5 months (range, 14 to 52 months). The mean American Shoulder and Elbow Surgeons score improved from 50.6 ± 18.9 (range, 13 to 75) preoperatively to 89.6 ± 7.5 (range, 50 to 100) postoperatively (P < .001). There was a significant increase in the mean Simple Shoulder Test score from 6.1 ± 3.2 preoperatively (range, 0 to 10) to 10.7 ± 1.2 (range, 9 to 12) postoperatively (P < .001). Of the 13 patients, 11 (85%) patients were "delighted" with the surgical outcome and the other 2 patients (15%) were "pleased." Arthroscopic repair of anterosuperior rotator cuff tears with open biceps tenodesis provides a significant improvement in pain relief and shoulder function. Level IV, therapeutic case series.

Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion

The effectiveness of arthroscopic repair of type II superior labrum anterior-posterior lesion (SLAP) was unclear as previous studies examined this treatment with patients of combined types of SLAP lesions. To address this research gap, we evaluated the clinical and functional outcomes of arthroscopic repair for 16 patients (mean=24.2, SD=6.5) with clinical evidence of isolated type II SLAP lesion. After having arthroscopic stabilizations with Bioknotless suture anchors (Mitek), the patients were offered post-operative rehabilitation programs (e.g., physiotherapy) for 6 months. The symptoms of SLAP lesion and the functions of the shoulder were assessed pre-operatively and 28-month post-operatively by O'Brien test, Speed test, Yergason test, and University of California at Los Angeles rating for pain and function of the shoulder. Wilcoxon Signed Ranks test and McNemar test were employed to analyze the difference between assessment in pre-operation and post-operation phases. The result showed that patients' shoulder functions improved (UCLA Shoulder Score), and symptoms of SLAP lesion reduced (O'Brien test, Speed test, and Yergason test) significantly (P<0.05). Time for returning to play with pre-injury level was in average 9.4 months (range 4-24), and no complication or recurrence was detected. We concluded that arthroscopic repair is an effective operation of type II SLAP lesion with good clinical and functional outcomes; however, athletes with high demand of overhead throwing activities are likely to take longer duration of rehabilitation to attain full recovery.

Functional Outcome of Arthroscopic Repair with Concomitant Manipulation in Rotator Cuff Tears with Stiff Shoulder

Background Little has been reported on treatment of rotator cuff tears with shoulder stiffness. Hypothesis Rotator cuff tears with shoulder stiffness will show worse clinical results than will tears without stiffness. Those with stiffness are expected to take longer time in pain reduction and recovery of range of motion. Study Design Case control study; Level of evidence, 3. Methods Among patients who underwent arthroscopic rotator cuff repairs, 15 cases with preoperative shoulder stiffness (group A) and 30 without shoulder stiffness (group B) were enrolled in this study. Preoperative mean forward flexion was 118.3° in group A and 163.4° in group B, whereas external rotation at the side was 34.6° and 55.0°, respectively. The mean follow-up period of group A was 29.8 months (range, 19.5-73.9 months) and 32.4 months (range, 16–0.6 months) in group B. Results The mean visual analog scale during motion at the last follow-up was 0.75 in group A and 0.76 in group B (P = .942). The mean University of California at Los Angeles score was, respectively, 33.1 and 33.2 points (P = .561). Forward flexion was 166.7° in group A and 170.2° in group B, whereas external rotation at the side was 48.8° and 53.4°, respectively (P = .157 and .384, respectively). However, the 2 groups showed a significant difference in forward flexion until 1 year postoperatively as group A recovered more slowly (P = .021). Both groups showed significant differences in external rotation at the side, internal rotation to the back, and cross-body adduction until 6 weeks postoperatively (P = .009, P < .001, and P = .026, respectively). Conclusion Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of the presence of shoulder stiffness. Patients with full-thickness rotator cuff tears and stiffness of the shoulder can be treated with a single surgery and concomitant manipulation with overall good results. Although final outcomes were as good as those in patients without stiffness, the return of range of motion took longer in those patients undergoing manipulation for stiffness of the shoulder.