Mean Single Assessment Numeric Evaluation Research Articles

Rate of graft retear is higher in over-the-top superior capsular reconstruction for massive posterosuperior rotator cuff tears with subscapularis tear.

To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates. Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores. SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly. For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate. Level III.

Intermediate Outcomes of Medial Ulnar Collateral Ligament Reconstruction Using Gracilis Allograft in Adolescent Patients.

Autograft palmaris has been the primary choice for the reconstruction of the medial ulnar collateral ligament (UCL) in the elbow. Agenesis of the palmaris tendon is not rare, and outcomes of allograft reconstruction in the breadth of athlete types found in the adolescent population are lacking. Allograft tendon reconstruction of the medial UCL in the young elbow would have low failure rates and satisfactory outcome scores. Case series; Level of evidence, 4. The records of patients who underwent allograft medial UCL reconstruction (UCLR) by a single surgeon between 2009 and 2019 were reviewed. Patient-reported outcome scores in adolescent patients obtained at a minimum 4-year follow-up (for intermediate assessment) were recorded, with no exclusion according to sex or sport type. Outcomes included the Timmerman-Andrews score, the Single Assessment Numeric Evaluation (SANE), and the Conway-Jobe score. Of 29 patients who underwent allograft UCLR, 10 adolescents (40% women; mean age at surgery, 15.8 years [age range, 15-17 years]) met the inclusion criteria and were included in the study. The mean follow-up was 8 years (range, 4.3-11.9 years). There were 4 overhead athletes (baseball, water polo) and 6 impact sports athletes (motocross, gymnastics, wrestling, and soccer). The mean SANE score was 86.3, and the mean subjective Timmerman-Andrews score was 92.5. The Conway-Jobe score was "excellent" in 7 of 10 participants; nonetheless, 3 elected not to return to sport (2 for reasons unrelated to the elbow). No patients experienced loss of range of motion, contracture, or ulnar nerve neuropathy. There was 1 patient with early failure (10%) who required revision reconstruction . Allograft reconstruction for medial UCL instability in adolescent patients from sport and trauma mechanisms demonstrated excellent patient-reported functional scores in this study. If the patient and surgeon desire to avoid autograft morbidity or agenesis of the palmaris longus, allograft tendon UCLR appears viable for both the throwing and the high-impact adolescent athlete, regardless of sex.

Revising Failed Reverse Total Shoulder Arthroplasty: Comprehensive Techniques for Precise Explantation of Well-Fixed Implants.

With the increased utilization of reverse total shoulder arthroplasty (RTSA), there has been a corresponding increase in the incidence of and demand for revision RTSA3. In cases in which the patient has undergone multiple previous surgeries and presents with well-fixed shoulder implants, even the most experienced shoulder surgeon can be overwhelmed and frustrated. Having a simple and reproducible treatment algorithm to plan and execute a successful revision surgery will ease the anxiety of a revision operation and avoid future additional revisions. The extraction techniques described here strive to preserve the humeral and glenoid anatomy, hopefully facilitating the reimplantation steps to follow. The main principles of implant removal include several consistent, simple steps. In order to revise a well-fixed humeral implant, (1) identify the old implants; (2) create a preoperative plan that systematically evaluates the glenoid and humeral deficiencies; (3) prepare consistent surgical tools, such as an oscillating saw, osteotomes, and/or a tamp; (4) follow the deltoid; (5) dissect the soft tissue with a sponge; (6) dissect the bone with use of an osteotome; and (7) remove the humeral stem in rotation. In cases in which there is also a well-fixed glenoid implant, the surgical procedure will require additional steps, including (8) exposure of the anteroinferior glenoid, (9) disengagement of the glenosphere, and (10) removal of the glenoid baseplate in rotation. Alternatives to revision RTSA include nonoperative treatment, implant retention with conversion of modular components, extensile revision surgical techniques, and/or mechanical implant removal. With the advent of modular humeral and glenoid components, surgeons may choose to change the implant components instead of removing the entire humeral and glenoid implants; however, repeat complications may occur if the previous implant or implant position was not completely revised. When confronted with a tough humeral explantation, an extensile surgical approach involves creating a cortical window or humeral osteotomy to expose the humeral implant. This approach can compromise the humeral shaft integrity, leading to alternative and less ideal reconstruction implant choices, the use of cerclage wires, and/or the use of a strut graft, all of which may complicate postoperative mobilization. If glenoid implant removal is necessary, the glenosphere is removed first, followed by the underlying baseplate component(s). If the glenosphere is stuck or if screws are cold-welded, the use of a conventional mechanical extraction technique with a burr or diamond saw may be required; however, this may lead to additional metal debris and intraoperative sparks. Revision RTSA can lead to high complication rates, ranging from 12% to 70%2, which will often require additional revision surgeries4. The first steps to all revision RTSA procedures include careful surgical exposure and component explantation. A simplified approach to expose the humerus and glenoid, coupled with a systematic and atraumatic approach to remove the implants without inadvertent injuries, will prevent surgical complications and the need for re-revision. The proposed comprehensive technique hopefully will allow precise removal of the humeral and glenoid implants while also preserving the remnant humerus or glenoid for future reconstruction. Few studies have evaluated postoperative patient outcomes in revision RTSA. Chalmers et al. performed a meta-analysis and found that patients were able to achieve a mean elevation of 106°, a mean American Shoulder and Elbow Surgeons score of 63, and a mean Single Assessment Numeric Evaluation score of 522. Boileau showed very similar outcomes, with a mean elevation of 107° and a mean adjusted Constant score of 621. These outcomes are slightly inferior to those of primary RTSA, but patients remain satisfied with their improvement from their preoperative function. Preoperative preparation will reduce intraoperative reparation. Know the existing implant and the unique features of its design, understand the patient anatomy including bone defects, and anticipate all of the potential tools that may be needed.Know your anatomy. The anteromedial deltoid edge will help you identify the scarred-in humeral shaft.Da Vinci said that simplicity is the ultimate sophistication. Some of the most common surgical tools and instruments can be more effective than custom-designed ones.The implant should be removed in rotation.There are some company-specific explantation instruments that can be very helpful. Give the appropriate ones a try, but be prepared to consider alternative solutions. RTSA = reverse total shoulder arthroplastyCT = computed tomographyFE = forward elevation.

Does glenoid version affect the post-operative clinical outcome after repair of posterior labral tear: A retrospective study

IntroductionPosterior shoulder instability and consequent labral tear have been predominantly associated with retroversion of the bony glenoid and chondrolabral version. However, literature concerning the degree of glenoid and chondrolabral version and clinical outcomes following labral repair is scarce. MethodsA retrospective cohort study was undertaken among patients with posterior shoulder instability who had undergone arthroscopic isolated posterior labral repair. The MRI was used to assess the bony and labral variations of the glenoid using the Friedman method and further categorized as either anteverted or retroverted glenoid. American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE) scores were used to evaluate pre- and postoperative clinical outcomes at a minimum follow-up of one year. Results33 shoulder MRIs performed at our institution were available for radiographic analysis. Among the 33 shoulders that underwent posterior shoulder capsulolabral repair, 23 were available for clinical follow-up for at least one year (range, 12–108 months). The mean (±SD) labral version and bony version were −3.98 (±5.68) and −2.83 (±5.20), respectively. The mean (±SD) postoperative ASES, Oxford score, and SANE scores for all participants were 84.04 (±14.14), 43.38 (±3.81), and 78.57 (±17.40), respectively. However, the difference in clinical outcomes in patients with anteverted or retroverted glenoid versions was not statistically significant. ConclusionOur study concludes a strong correlation between posterior glenohumeral instability and higher degree of glenoid retroversion. Nevertheless, variations in the glenoid version appear to have no significant impact on clinical outcomes. Level of studyLevel IV, retrospective cohort.

Improved Patient-reported Outcomes in Patients Aged 16 and Younger at Two Years After Anterior Cruciate Ligament Reconstruction Despite Relatively High Rates of Reinjury and Repeat Surgery.

Anterior cruciate ligament reconstruction (ACLR) in adolescent patients, particularly those aged 16 and under, are increasingly common procedure that lacks robust clinical and patient-reported outcome (PRO) data. The purpose of this study was to report 2-year PROs of patients receiving ACLR aged 16 or younger using the single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome score (KOOS). Secondary aims included characterizing treatment characteristics, return to sport (RTS), and clinical outcomes. The institutional PRO database was queried for patients receiving ACLR from 2009 to 2020. Patients aged older than 16, revision procedures, concomitant ligament repairs/reconstructions, and patients without full outcome data at 2 years were excluded. Outcomes over 2 years after ACLR included SANE, KOOS, reinjuries, reoperations, and time to RTS. A total of 98 patients were included with an average age of 15.0 years. Most patients were females (77.6%). Bone-tendon-bone autograft (69.4%) was the most used. Average RTS was 8.7 months (range: 4.8 to 24.0mo), with 90% of patients eventually returning to sport. A total of 23 patients (23.5%) experienced a reinjury and 24.5% (n = 24) underwent reoperation. Timing to RTS was not associated with reinjury, but patients who returned between 9.5 and 13.7 months did not sustain reinjuries. Mean KOOS and SANE scores at 2 years were 87.1 and 89.1, respectively, with an average improvement of +18.4 and +22.9, respectively. Change in KOOS was negatively impacted by reinjury to the anterior cruciate ligament graft and reoperation (anterior cruciate ligament failure: +10.0 vs 19.3, P = 0.081, respectively; reoperation: +13.2 vs +20.1, P = 0.051, respectively), though these did not reach statistical significance. Patients experienced improved SANE and KOOS scores after ACLR. Rates of reinjury and reoperation were relatively high and negatively impacted PRO scores but were not associated with the timing of RTS. Adolescent patients should be counseled regarding the risk of subsequent ipsilateral and contralateral knee injury after ACLR. Level IV-case series.

Unicortical versus bicortical plate fixation for midshaft clavicular fractures

BackgroundThe aim of this study was to compare the functional and radiological outcomes of unicortical vs bicortical fixation in patients with midshaft clavicular fractures who were treated using pre-contoured locking plates. MethodsWe performed a prospective multicenter study of 45 individuals who underwent open reduction and internal fixation of midshaft clavicular fractures with precontoured locking plates between March 2017 and December 2019. Twenty-five patients were treated with bicortical screws and 20 patients with unicortical screws. Functional outcomes were assessed at 6 months and 12 months after surgery using the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (Quick- DASH) score and the Single Assessment Numeric Evaluation (SANE) score. Pain was evaluated using a visual analog scale (VAS). The rate of return to work and sports was also recorded. Radiologic evaluation was obtained in the immediate postoperative day, monthly until fracture consolidation, at 6 months and 12 months. All intraoperative and postoperative complications were documented. ResultsAt both 6 and 12 months, the follow-up rates were 100%, and the mean age was 28.5 years (range, 20 to 45 years). The mean postoperative Constant score, Quick DASH, and SANE score at 12 months were 93.5 (±6), 2.3 (±3), and 92% (±7), respectively. There were no significant differences in the functional scores between the groups neither at 6 months nor at 12 months. Of the 30 active workers, 97% were able to return to their previous working routine and from the 25 patients who practiced sports before the injury,92% returned to sports all at the same level. All the fractures healed in both groups. There were 6 complications (13%). ConclusionIn young, active patients with displaced midshaft clavicular fractures, both unicortical and bicortical locked plates achieved 100% bone consolidation, with excellent functional outcomes and a low rate of complications without significant differences between the groups. Therefore, locked plates with unicortical fixation could be a very good alternative for the management of young patients with midshaft clavicular fractures, potentially avoiding severe neurovascular complications. Level of evidenceProspective comparative (Level II)

Paper 58: Against Surgeons’ Advice: The Return to Sport in High Demand Weightlifters Following Anatomic Total Shoulder Arthroplasty at Average 3.6 Years Follow-up

Objectives: Return to sport in high-demand weightlifters following total shoulder arthroplasty has rarely been investigated, as most surgeons recommend against returning to heavy lifting postoperatively. The purpose of this study is to determine the incidence of return to sport, patient reported outcomes, patient satisfaction, performance, and failures in a specific population of high demand weightlifters that continue lifting after undergoing total shoulder arthroplasty. Methods: Retrospective review of a specific population of high demand weightlifters that underwent anatomic total shoulder arthroplasty with minimum one-year clinical follow up was conducted. Prospective surveys determining pre- and postoperative participation in weightlifting included maximum weight, frequency, and duration of workouts, Single Assessment Numeric Evaluation (SANE), patient satisfaction, and post-operative range of motion were collected. Secondary outcomes included failure, revision surgery, risk factors for not returning to weightlifting, and performance measured as percentage of prior maximum bench press. Bivariate and multivariate analysis was performed to compare cohorts and identify risk factors, respectively. Results: Forty-two shoulders in 36 patients who met inclusion criteria (avg age 57.9 years, 97% male). No patient underwent revision surgery at average 3.6 year follow up (1 to 7 years, SD 1.9 years). The majority of patients (23/42 shoulders) report returning to heavy weightlifting postoperatively against senior surgeon’s recommendations. Mean SANE score for current weightlifters and retired weightlifters were 86.9 and 91.6, respectively (P = 0.148). In the weightlifting cohort, only 78.3% of patients achieved patient-acceptable symptom state (PASS) threshold for SANE compared to 89.5% of patients (p = .332) in the retired cohort. Patient satisfaction and return to sport satisfaction in current weightlifting shoulders were good-to-excellent in 91.3% (P= 0.922) and 82.6% (P = 0.972) respectively. Patients who continued lifting reported substantially decreased maximum weight in all lifts compared to pre symptomatic maximum. Conclusions: This data provides insight for surgeons on the expected activity level of prior high demand weightlifters. Against their surgeon’s recommendations, most patients who participated in preoperative weightlifting returned to high demand weightlifting after surgery, but patients demonstrated lower lifting performance postoperatively. There were no early clinical catastrophic failures with high patient reported outcomes. While caution is still advised with returning to heavy weightlifting, the current data highlights the advances of modern fixation techniques, fourth generations implants, and diminished lifting capacity after surgery, which likely play a role in the high implant survivorship in this cohort.

Poster 338: Analysis of Patient Reported Outcomes and Subsequent Surgery Rate following Quadriceps Tendon Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis in Skeletally Immature Patients: Two Year Follow-Up

Objectives: The incidence of anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients is increasing significantly and many patients possess risk factors that predispose to ACL re-tear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL re-tear. The purpose of this study is to evaluate the 2-year clinical outcomes of ACLR with soft tissue quadriceps tendon (QUAD) autograft and a lateral extra-articular tenodesis (LET) using a modified Lemaire technique in skeletally immature patients. Methods: A consecutive series of patients who underwent QUAD tendon autograft ACLR and LET with a minimum of 2-year follow-up data was analyzed retrospectively. ACLR techniques included all- epiphyseal (AE) and complete transphyseal (CT) and were indicated based on skeletal age. Outcome measures included participants’ return to sports (RTS), concomitant or subsequent surgical procedures and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Results: The final cohort included 50 consecutive adolescent patients aged 11 to 16 years (mean 14.2 ± 1 years) with a minimum follow-up of 2 years. Two patients were lost to follow-up. Of the patients included in the study (n=48), 98% participated in high-risk competitive sports (Table 1). Two patients (4%) were revision ACLR. Ten (21%) patients underwent AE and 38 (79%) underwent CT ACLR. Sixteen patients (33%) had subsequent surgical procedures, including 5 contralateral ACLR, 4 meniscus surgeries, 4 QUAD autograft scar revision, 4 irrigation and debridement (2 patients, 2 each) and 3 hardware removal procedures (2 for hemi-epiphysiodesis and 1 tibial socket button removal). The rate of graft failure was 0%. At two-year follow-up, mean SANE score was 93, mean Pedi-IKDC score was 90, and mean HSS-Pedi-FABS score was 23. RTS rate was 100%. Conclusions: A LET when performing an ACLR is safe and should be considered as a concomitant procedure for adolescent patients that are at high risk of re-tear. [Table: see text]

Clinical outcomes of a novel ‘all-suture’ fixation for valgus-impacted proximal humeral fractures

Background Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an ‘all-suture’ technique for this fracture subtype without the use of transosseous sutures. Methods All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent ‘all-suture’ repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures. Results We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up. Discussion Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.

Outcomes of reverse total shoulder arthroplasty were not adversely affected by the COVID-19 pandemic

BackgroundThe objective was to investigate outcomes in reverse total shoulder arthroplasty (RTSA) in patients affected by the COVID-19 pandemic shutdown. We hypothesized that patients undergoing RTSA in early 2020 would have decreased access to physical therapy (PT) and worse postoperative outcomes compared to historical controls. Materials and methodsPatients who received primary RTSA between 1/1/2020, and 3/17/2020, were included and patients who received primary RTSA between 1/1/2019, and 3/17/2019, were used as a control group. Retrospective chart review was performed, and patient-reported outcomes were recorded at an average of 2.69 ± 0.06 years and a minimum of 1 year postoperatively. Patient data were collected and statistically analyzed using the 2-sample t-test and chi-square test. The Mann-Whitney U test and Fisher’s exact test were used when appropriate. ResultsThirty eight patients in 2020 were included in this study and compared to 31 patients in 2019. RTSA performed in 2019 had improvements in forward elevation (FE) (95.7° ± 47.2° to 144.7° ± 17.2°, P < .001), but not in external rotation (ER) (32.5° ± 20.3° to 41.0° ± 13.3°, P = .15), or internal rotation (IR) (S1 to L5, P = .76). RTSA 2020 cases had improvements in FE (111.5° ± 40.3 to 132.8° ± 30.6, P = .016), but not ER (31.9° ± 18.2 to 35.7° ± 15.9, P = .36) or IR (S1 to L5, P = .13). Patients in 2019 (FE: 4 to 5-, P < .001; ER: 4+ to 5-, P = .003; IR: 5- to 5, P < .001) and 2020 (FE: 4 to 5-, P < .001; ER: 4+ to 5, P < .001; IR: 5- to 5, P = .02) both experienced improvements in strength. Patients in 2020 initiated PT later (2019: 39.3 ± 27.3 days, 2020: 57.1 ± 35.5 days, P = .028) and completed less PT sessions (2019: 20.7 ± 11.1, 2020: 12.9 ± 6.6, P < .001) than patients in 2019. In the 2020 cohort, 10.5% (4/38) did not complete any PT, 34.2% (13/38) reported a delay in initiating PT, and 47.4% (18/38) reported that their recovery was negatively affected by the COVID-19 pandemic. At final follow-up, patients in 2020 reported a mean single assessment numeric evaluation score of 73.6 ± 17.5 on their affected shoulder and a mean visual analog scale score of 1.68 ± 1.23. DiscussionDespite a delay in initiating PT and completing less PT overall, patients who received RTSA in 2020 experienced significant improvements in range of motion and strength at final follow-up and were comparable to the 2019 patients.

Factors associated with functional improvement after posteriorly augmented total shoulder arthroplasty.

Posteriorly augmented glenoid components in anatomic total shoulder arthroplasty (TSA) address posterior glenoid bone loss with inconsistent results. The purpose of this study was to identify preoperative and postoperative factors that impact range of motion (ROM) and function after augmented TSA in patients with type B2 or B3 glenoid morphology. This was a retrospective review of all patients who underwent TSA with a step-type augmentation performed by a single surgeon between 2009 and 2018. Patients with Walch type B2 or B3 glenoids were included. Outcomes included forward elevation (FE), external rotation (ER), internal rotation (IR), Single Assessment Numeric Evaluation (SANE) score, and visual analog scale pain score. Preoperative imaging was reviewed to assess glenoid retroversion and posterior humeral head subluxation relative to the scapular body and midglenoid face. Postoperative measurements included glenoid retroversion, subluxation relative to the scapular body, subluxation relative to the central glenoid peg, and center-peg osteolysis. Measurements were performed by investigators blinded to ROM and functional outcome scores. Fifty patients (mean age, 68.1±8.0 years) with a mean follow-up period of 42.0 months (range, 24-106 months) were included. Glenoid morphology included type B2 glenoids in 41 patients and type B3 glenoids in 9. One patient had center-peg osteolysis, and 1 patient had glenoid component loosening. Average preoperative FE, ER, and IR were 110°, 21°, and S1, respectively. Average postoperative FE, ER, and IR were 155°, 42°, and L1, respectively. The mean postoperative visual analog scale score was 0.5±0.8, and the mean SANE score was 94.5±5.6. Type B3 glenoids were associated with better postoperative IR compared with type B2 glenoids (T10 vs. L1, P=.024), with no other differences in ROM between the glenoid types. Preoperative glenoid retroversion did not significantly impact postoperative ROM. Postoperative glenoid component retroversion and residual posterior subluxation relative to the scapular body or glenoid face did not correlate with ROM in any plane. However, posterior subluxation relative to the glenoid face was moderately associated with lower SANE scores (r=-0.448, P=.006). Patients achieved excellent functional outcomes and pain improvement after TSA with an augmented glenoid component. Postoperative ROM and function showed no clinically important associations with preoperative or postoperative glenoid retroversion or humeral head subluxation in our cohort of posteriorly augmented TSAs, except for worse functional scores with increased humeral head subluxation in relation to the glenoid surface.

The Women's Soccer Health Study: From Head to Toe.

Women are under-represented in the sports literature despite increasing rates of sports participation. Our objective was to investigate the risks and benefits of an elite women's soccer career in five health domains: general, musculoskeletal, reproductive endocrinology, post-concussion, and mental. An online survey was distributed to retired US college, semi-professional, professional, and national team soccer players using personal networks, email, and social media. Short validated questionnaires were used to evaluate the health domains, including the Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numerical Evaluation (SANE), Post-Concussion Symptom Scale (PCSS), and Patient Health Questionnaire (PHQ). A total of 560 eligible players responded to the survey over a 1-year period. The highest competitive levels were 73% college, 16% semi-professional, 8% professional, and 4% national team. The mean number of years since retirement was 12 (SD = 9), and 17.0% retired for involuntary reasons. The mean SANE scores (0-100 scale as percentage of normal) were knee = 75% (SD = 23), hip = 83% (SD = 23), and shoulder = 87% (SD = 21). The majority (63%) reported that their current activity level included participation in impact sports. A substantial proportion of players reported menstrual irregularities during their careers: 40% had fewer periods with increasing exercise and 22% had no periods for ≥ 3months. The players (n = 44) who felt that post-concussion symptoms were due to soccer reported more time-loss concussions (F[2] = 6.80, p = 0.002) and symptom severity (F[2] = 30.26, p < 0.0001). Players who recently retired (0-5years) reported the highest anxiety/depression scores and lowest satisfaction rates compared with those who retired 19+years ago. Health concerns include musculoskeletal injuries, post-concussion symptoms, and lower mental health in the early years following retirement. This comprehensive survey provides initial results that will lay the foundation for further analyses and prioritize research studies that can help all female athletes.

A Single-Centre, Retrospective, Observational Study to Assess Safety and Functional Outcomes of Arthroscopic Meniscal Repair Using Surestitch All Inside Implant.

Introduction The meniscus plays a vital role in maintaining knee stability. It acts as a shock absorber and knee filler. The incidence of meniscal tears is estimated to be 60 per 100,000 people. Due to lack of awareness among patients, only 10% of the meniscus tears were treated through partial or total meniscectomy. Recently, the concept of meniscus preservation surgery has emerged to preserve early degeneration of the knee joint. In the current retrospective study, safety and functional outcomes of arthroscopic meniscal repair surgery using SurestitchAll inside implants (Sironix Arthroscopy Solutions, Healthium Medtech Limited, Bengalaru, India) were assessed. Methods Fifty-two patients who underwent arthroscopic meniscal repair surgery between January 2019 to July 2022 at Epic Hospital in Gujarat, India, were enrolled in the study. Retrospective data including demographics, injury details, surgery details, and post-surgery complications were collected from the medical records of the patients. Then, the patients were followed up telephonically to document safety and functional outcomes using patient-reported instruments such as International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, and Lysholm knee score. Results The recruited patients had the mean age, height, and weight of 37.56 ± 12.52 years, 167.61 ± 7.28 cm, and 75.87 ± 10.7 kgs, respectively. Seventy-one percent of patients were male and 29% were female. Majority of the patients had the routine of doing mild exercise. During pre-surgery representations, medial meniscal tear was observed in majority of patients. The mean length of the tear was 1.32 ± 0.84 cm. In addition, patients were also diagnosed with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) tears, and osteochondral defects. Surgeries for meniscal repair were performed using Surestitch All inside implant. In patient-reported outcomes, the mean IKDC, SANE, and Lysholm scores were 81.72 ± 14.23, 94.02 ± 13.79, and 93.32 ± 14.63, respectively. When the mean Tegner scores of pre-injury and post-surgery periods were compared, this resulted in no significant difference (p>0.05) in the activity levels of the patients. Conclusion Based on our findings, arthroscopic meniscal repair with Surestitch All inside meniscal repair implant provides satisfactory and favorable functional outcomes with no remarkable adverse events.

Assessment of Safety, Efficacy, and Functional Outcomes After Rotator Cuff Repair Using Ceptre® Titanium Screw Anchor: A Retrospective Study.

Background Rotator cuff tears (RCTs) are the most common cause of shoulder disability. RCT is characterized by progressive wear and tear of the tendon tissue over time. The incidence of cuff tears ranges from 5% to 39%. With increasing advancements in the surgical sector, an upward trend has been observed in repair surgeries where torn tendons are repaired arthroscopically by inserting surgical implants. With this background, this study aimed to assess the safety, efficacy, and functional outcomes after RCT repair using Ceptre® titanium screw anchor implants. Methodology This retrospective, observational, single-center, clinical study was conducted at Epic Hospital in Gujarat, India. Patients who underwent rotator cuff repair surgery between January 2019 and July 2022 were recruited and followed up in December 2022. Baseline characteristics and surgical and post-surgical details were collected from patient medical reports and post-surgery progress data were documented through telephonic follow-up. The functional outcomes and efficacy of the implant were assessed using the American Shoulder and Elbow Surgeons (ASES) form, Shoulder Pain and Disability Index (SPADI) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) score. Results The mean age of the recruited patients was 59.74 ± 8.91 years. Among the recruited patients, 64% were females and 36% were males. About 85% of patients had a right shoulder injury and 15% of patients (n = 6/39) had a left shoulder injury. Further, 64% (n = 25/39) of patients had supraspinatus tears, whereas 36%(n = 14) of patients had both supraspinatus and infraspinatus tears. The mean ASES, SPADI, SST, and SANE scores were observed to be 81.43 ± 14.20, 29.41 ± 12.6, 75.41 ± 12.96, and 94.67 ± 7.50, respectively. No adverse events, re-injuries, or re-surgeries were reported by any of the patients during the study period. Conclusions Our findings suggest that arthroscopic rotator cuff repair using Ceptre Knotted Ultra-High-Molecular-Weight Polyethylene Suture Titanium Screw Anchor resulted in favorable functional outcomes. Thus, it could be a considerable implant for a successful surgery.

Outcomes of young active patients with displaced clavicle fractures treated with Rockwood pin.

Various fixation techniques have been described for midshaft clavicle fractures in the literature. We hypothesized that use of the Rockwood pin for fixation of displaced midshaft clavicle fractures would result in favorable outcomes in a young active cohort. Patients aged 10-35years who underwent Rockwood clavicle pin fixation at a single institution were identified. Preoperative and postoperative radiographs were reviewed and assessed for fracture characteristics, postoperative alignment, and radiographic union. Postoperative outcome scores were obtained. A total of 39 patients (age 17.3 ± 3.9years) with clavicle fracture treated with Rockwood pin were identified. Radiographic review demonstrated that 88% of fractures were 100%, or more, displaced, and surgery achieved near-anatomic reduction in 92% of cases. Average time to radiographic union was 2.3 ± 0.8months, and average time to clinical union was 2.5 ± 0.3months. One patient required revision for nonunion (3%). Complete outcome responses were obtained for 24 patients, with an average 40 ± 27.7months of follow-up. Mean Total Clavicle Functional score was 2.75 ± 3.6 for minor patients. For adult patients, Nottingham Clavicle score was 90.7 ± 10.7, mean American Shoulder and Elbow Society score was 92.4 ± 11.2, and mean Single Assessment Numerical Evaluation score was 88.8 ± 21.5. 77% of adults reported no long-term functional limitation; 54% reported a bump at the prior fracture site, but 100% reported satisfaction with shoulder appearance. In our cohort of young active patients, treatment with Rockwood pin allowed for anatomic reduction, healing with a low nonunion rate, and favorable patient reported outcomes.

A Modified Lemaire Lateral Extra-articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: 2-Year Clinical Outcomes

Background: The incidence of anterior cruciate ligament (ACL) reconstruction (ACLR) in children and adolescents has increased significantly, and many such patients are at increased risk for ACL retear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL retear. Purpose: To evaluate the 2-year clinical outcomes of ACLR with soft tissue quadriceps tendon (QUAD) autograft performed with a concomitant LET using a modified Lemaire technique in skeletally immature patients. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of adolescent patients who underwent QUAD autograft ACLR and LET with a minimum of 2 years of follow-up data were analyzed retrospectively. ACLR techniques, including all-epiphyseal and complete transphyseal, were indicated based on skeletal age. Outcome measures included return to sports, concomitant or subsequent surgical procedures, and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores. Results: The final cohort included 49 consecutive adolescent patients aged 11 to 16 years (mean, 14.2 ± 1 years) with a minimum follow-up of 2 years. One patient was lost to follow-up. Of the patients included in the study (N = 48; 27 male, 21 female), 98% participated in high-risk competitive sports. Two (4%) patients were undergoing revision ACLR. Thirty-eight (79%) patients underwent complete transphyseal, and 10 (21%) patients underwent all-epiphyseal ACLR. Sixteen (33%) patients had subsequent surgical procedures, including 5 contralateral ACLR, 4 meniscal surgery, 4 QUAD autograft scar revision, 4 irrigation and debridement (2 patients, 2 each), and 3 hardware removal (2 for hemi-epiphysiodesis and 1 tibial socket button removal) procedures. The rate of graft rupture was 0%. At a mean follow-up of 3.4 ± 1.2 years (range, 2-7 range), the mean SANE score was 93, the mean Pedi-IKDC score was 89, and the mean HSS Pedi-FABS score was 23. The return-to-sports rate was 100%. Conclusion: An LET performed concomitantly with an ACLR is safe and should be considered as a concomitant procedure for adolescent patients with nonmodifiable risk factors who are at high risk of retear.

Paper 02: Is There a Benefit of Sling Immobilization After Open Latarjet Surgery for Anterior Shoulder Instability™ A Randomized Control Trial

Objectives: Recurrent traumatic anterior shoulder instability occurs most commonly in young to middle-aged male athletes. The Latarjet procedure was reported to enable early return to sport compared to capsulolabral repair. Recent research has highlighted the negative effect of immobilization on shoulder rehabilitation. However, only few studies evaluated different rehabilitation programs after open Latarjet and their potential impact on complication rates, stiffness and time to return to sport. The reported immobilization periods ranged from zero to three weeks, and different types of mobilization protocols were used. The aim of this study was to evaluate the benefit of sling immobilization after open Latarjet procedure for anterior shoulder instability. The hypothesis was that immediate self-rehabilitation without sling immobilization would result in improved functional scores at 6 months compared to patient wearing a sling for 3 weeks postoperatively. Methods: We randomized 72 patients with anterior shoulder instability scheduled for open Latarjet procedure into sling and no-sling groups. Two partially 1 cm apart threaded 4.0-mm cancellous screws were used to secure the graft. Both groups started the same immediate self-rehabilitation protocol. Patients were evaluated clinically using Rowe score, the Single Assessment Numeric Evaluation (SANE) instability score as well as visual analogue pain scale (VAS) preoperatively and at 1.5, 3, and 6 months. A computed tomography was performed at 6 months to evaluate graft healing. Results: Both groups had similar preoperative patient characteristics. Both groups had a significant improvement in Rowe score (from 38.8 ± 20.4 to 81.6 ± 17.8, p &lt; 0.001), SANE instability score (from 42.5 ± 20.5 to 84.7 ± 13.2, p &lt; 0.001) and VAS (from 27.7 ± 21.8 to 13.9 ± 16.1, p &lt; 0.001) at 6 months postoperative. There was no difference in functional outcomes between the two groups at 6 months. Mean Rowe score was respectively 80.7 ± 15.9 and 82.6 ± 19.6 in the sling and no-sling group (p = 0.64). Mean SANE instability score was 83.7 ± 13.0 and 85.7 ± 13.6 (p = 0.53) and mean VAS 15.6 ± 14.8 versus 12.2 ± 17.5 (p = 0.38), for sling and no-sling group respectively. Finally, computed tomography evaluation revealed no significant differences regarding bone graft healing between both groups (p = 0.35). Conclusions: Both treatment groups resulted in excellent early functional outcomes. Absence of sling immobilization did not increase complication rates after open Latarjet. Sling immobilization seems therefore optional after open Latarjet procedure.

Patient-Reported and Radiographic Outcomes After Revision Sacroiliac Joint Fusion.

Sacroiliac joint fusion (SIJF) has been established as an effective treatment for sacroiliac joint dysfunction. However, failure necessitating revision has been reported in up to 30% of cases. Little is known regarding outcomes of revision SIJF. We retrospectively reviewed all revision SIJF at a single academic center between 2017 and 2020. Revision surgery was performed using the principles of joint decortication, bone grafting, compression, and rigid internal fixation. Outcomes were assessed at 6 months and 1 year after surgery using the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), and Single Assessment Numeric Evaluation (SANE) scale. Fusion was assessed using computed tomography at 12 months postoperatively. Eighteen revision SIJFs in 13 patients were included. The mean age was 55.8 years (range 35-75). Mean body mass index was 27.9 (range 21.7-36.7). Sixty-two percent of the patients were women. The indications for revision were pseudarthrosis without fixation failure in 14 cases (77.8%), hardware failure (loosening) in 3 cases (16.7%), and continued pain after partial fusion in 1 case (5.6%). ODI and NPRS scores demonstrated significant statistical and clinical improvements at all timepoints. Mean (SD) ODI scores improved from 53.8 (19.9) preoperative to 37.5 (19.8) at 6 months and 32.9 (21.7) at 12 months. Improvement in ODI was found in 15 joints (83.3%), and the minimal clinically important difference (MCID) was achieved in 12 joints (66.7%). Mean (SD) NPRS scores improved from 6.5 (1.4) preoperative to 3.2 (2.8) at 6 months and 3.4 (2.6) at 12 months. Improvement in NPRS was also identified in 17 joints (94.4%), and 10 joints (55.6%) achieved MCID for NPRS. Mean (SD) SANE score was 72.0% (30.8) at 6 months and 70.0% (33.8) at 12 months. There were no radiographic lucencies, implant subsidence, or implant fractures at final follow-up. We identified an 88.9% fusion rate with definitive bridging bone across the sacroiliac joint. Utilizing a principles-based technique of joint decortication, compression, and rigid internal fixation, revision SIJF showed an improvement in patient-reported outcomes as well as high rate of fusion at 12 months. The most common indications for revision SIJF are symptomatic pseudarthrosis and implant loosening. This is the largest series of revision SIJF to date.

Return to Sport After Arthroscopic Capsular Repair in Elite Baseball Players.

Chronic attritional midsubstance capsular tears arising from repetitive throwing stress are a rare but important source of pain and dysfunction in elite baseball players; however, little is known regarding outcomes after arthroscopic capsular repair. To evaluate the patient-reported outcomes and return-to-sport (RTS) rates after arthroscopic capsular repair in elite baseball players. Case series; Level of evidence, 4. We identified 11 elite-level baseball players who were treated with arthroscopic repair for a midsubstance glenohumeral capsular tear by a single surgeon with a uniform approach and a standardized postoperative protocol between 2012 and 2019. All players had at least 2 years of follow-up data. Demographic data and concomitant surgical procedures were recorded. Preoperative and postoperative Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and Single Assessment Numeric Evaluation (SANE) scores were collected in a subset of the cohort, and statistical comparisons were made. A telephone survey was conducted to determine the patients' RTS level and outcome scores. Statistical comparisons between preoperative and postoperative outcomes scores were made using t tests. Eight major league players, 1 minor league player, and 2 collegiate players were included. There were 9 pitchers, 1 catcher, and 1 outfielder. All patients had debridement of the posterosuperior labrum and rotator cuff. Two pitchers underwent a rotator cuff repair, and 1 outfielder underwent a posterior labral repair. The mean age at the time of surgery was 26.9 years (range, 20-34 years), with a mean follow-up of 3.5 years (range, 2.6-5.9 years). There were significant preoperative versus postoperative improvements in the mean KJOC (20.6 vs 89.8; P = .0002) and SANE (28.3 vs 86.7; P = .001) scores. All patients reported a high degree of satisfaction. At a mean of 16.3 months (range, 6.5-25.4 months), 10 of 11 (90.1%) players met the Conway-Jobe good or excellent criteria for RTS. Arthroscopic capsular repair provided significant improvements in functional outcomes in elite baseball players, high levels of patient satisfaction, and high levels of RTS.

3D planning and patient specific instrumentation for intraarticular corrective osteotomy of trapeziometacarpal-, metacarpal and finger joints

BackgroundIntra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints.MethodsComputer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)).ResultsTen patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98).ConclusionThe use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.