Postoperative Range Of Motion Research Articles

Outcomes of Adolescent T-condylar Fractures: Kids Do Not Always Make You Look Good.

Optimal treatment for pediatric and adolescent T-condylar fractures remains poorly understood. We sought to assess how functional outcomes and range of motion (ROM) after surgical fixation of T-condylar fractures are affected by patient and surgical factors. This is a retrospective cohort study of 52 patients with operatively treated T-condylar fractures at a single tertiary pediatric referral center between 2003 and 2021. All patients younger than 18 at the time of injury with a radiographically confirmed diagnosis were included. Fifty-two T-condylar fractures were included, with a mean patient age of 12.9 years (SD, 2.8). The cohort was 65% male. Nine (19%) fractures were open, 46% (24/52) were AO type C2, and 33% (17/52) occurred in skeletally mature individuals. The surgical approach was through olecranon osteotomy in 29% (15/52) of patients, and fixation included anatomically specific plates and screws in 42% (22/52) of patients. In our cohort, 46% (24/52) achieved good outcomes based on Jarvis ROM criteria and 42% (22/52) achieved good to excellent results based on Roberts functional criteria. The median loss of ROM was 58 degrees at 6 weeks, 20 degrees at 3 and 6 months, and 8 degrees at 1 year postoperatively. We observed a complication rate of 54% (28/52). Patients undergoing adult-type plate fixation had better postoperative range of motion at 6 weeks (ROM loss 52 vs. 80 degrees, P =0.03) and 3 months (10 vs. 35 degrees P =0.004) compared with pediatric-type fixation and trended towards better functional outcomes. We did not identify significant differences in functional outcome scores or complication rates with respect to surgical approach or skeletal maturity. Surgical fixation of pediatric and adolescent T-condylar fractures achieved a good to excellent functional outcome in only a minority of patients (46% Jarvis / 42% Roberts) with a high rate of postoperative complications (54%). Future work is needed to elucidate optimal treatment to minimize complications and achieve the best functional outcomes in these challenging fractures. Level-IV.

Evaluation of muscle strength recovery following superior capsular reconstruction using a tensor fascia lata graft: A comparison with the unaffected side.

Superior capsular reconstruction (SCR) using a tensor fascia lata graft has been performed in patients with irreparable rotator cuff tears and shoulder pseudoparalysis (PPS), and good clinical results have been reported. This procedure can be indicated for younger patients who are highly active in sports and manual labor from the viewpoint of joint preservation. However, this procedure supplements the defect with a graft that has no muscle contractility; therefore, the extent to which shoulder muscle strength is recovered after SCR remains unclear. We hypothesized that the recovery of muscle strength after SCR would not be normalized and would be only approximately 50% of that of the healthy (unaffected) side. This study aimed to evaluate muscle strength after SCR in patients with PPS due to irreparable rotator cuff tears and the extent of recovery by comparing with that of the unaffected side. In total, 20 patients who underwent SCR for PPS using a tensor fascia lata graft with a minimum 2-year follow-up were included. Shoulder muscle strength in abduction, internal rotation, and external rotation was evaluated using a handheld dynamometer. Muscle strength was compared to that on the unaffected side, and the affected/unaffected ratio was measured. Shoulder range of motion (ROM) and acromiohumeral distance (AHD) were also evaluated. The postoperative ROMs and AHD (4.0 ± 1.4 mm vs. 8.4 ± 1.9 mm, P < .001) were significantly improved compared to those preoperatively. In external and internal rotation, the muscle strength of the affected side was recovered by approximately 80% compared to that of the unaffected side. However, in abduction, the muscle strength of the affected side (2.9 ± 1.5 kg) could not reach 50% (48.0 ± 15.9%, range: 25.0-76.5%) of that of the unaffected side (5.9 ± 1.8 kg). Abduction strength was not sufficiently restored after SCR when compared to that on the unaffected side.

Incidence of Repeat Elbow Capsular Release After Arthroscopic Elbow Capsular Release.

Elbow capsular release can be performed arthroscopically or through an open method to improve range of motion (ROM). However, it is unclear how frequently patients require an open capsular release after unsatisfactory results from an arthroscopic release. The purpose of this study was to determine the percentage of patients who underwent an arthroscopic elbow release for loss of motion who then required a repeat elbow capsular release or other subsequent surgery on the same elbow. It was hypothesized that patients who underwent arthroscopic elbow release would rarely (<5%) require a subsequent elbow release. Case series; Level of evidence, 4. Patients who underwent arthroscopic elbow capsular release from January 1, 2010, to December 31, 2019, were identified by chart review and procedure code. Demographic parameters, pre- and postoperative ROM, and surgical history were collected by chart review. Follow-up data included patient satisfaction and the Timmerman-Andrews (TA) elbow score. Data were compared between patients who did and those who did not require subsequent elbow surgery. Overall, of 140 study patients (116 male, 24 female; mean age, 49.6 years), 18 (12.9%) required subsequent surgery, including 6 capsular releases (4.3%; 1 open and 5 arthroscopic). The most common follow-up procedure was ulnar nerve releases/transpositions (n = 7). Total arc of elbow motion (flexion to extension) improved by a mean of 51.4°. The mean TA score was 76.5 ± 20.4 at a mean of 5.25 years postoperatively. Mean satisfaction score was 77.6 ± 26.3. In this study, 82.4% of patients stated that their symptoms either improved or resolved completely. Patients who required subsequent surgery had a significantly lower preoperative total arc of elbow motion versus those who did not require subsequent surgery (P = .046). There was no difference between the groups in symptom resolution, satisfaction, ROM, or TA score (P ≥ .279 for all). After arthroscopic elbow release, <5% of patients required a repeat elbow capsular release, 12.9% required some form of follow-up elbow surgery, and 4.3% had a new injury of the elbow. Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release.

Reverse Shoulder Arthroplasty in Upper Extremity Ambulators: A Matched-Cohort Analysis.

Upper extremity ambulators (UEA) who require prolonged use of assistive devices for mobility have a high incidence of shoulder pathology secondary to increased stress across the shoulder joint with upper extremity weight bearing. Reverse shoulder arthroplasty (RSA) for rotator cuff arthropathy (RCA) has historically been associated with increased complications in UEA, but more recent studies have shown more promising outcomes. The objective of this study is to evaluate clinical outcomes and complication rates between these two groups to define the relative risk of RSA in the UEA population and identify opportunities to improve treatment outcomes. An IRB-approved retrospective chart review was performed in patients that underwent RSA at our institution by the senior author from 2004-2019. UEA were defined as patients that used regular upper extremity assistive devices for community ambulation prior to initial consultation for the surgical extremity. Pre- and postoperative range of motion (ROM), Visual Analog Scale scores, American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley scores, and Simple Shoulder Test (SST) scores were measured at defined intervals. Complications including infection, instability and need for revision surgery were also compared. All patients were followed for a minimum of two years postoperatively. A total of 159 RSA procedures (70 UEA, 89 controls) were performed during the study period. On average, UEA patients had more preoperative pain and less shoulder function than controls, with statistically significant differences in Visual Analog scores (6.897 vs. 5.532, p=0.0010) and ASES scores (33.50 vs. 40.20, p=0.0290), respectively. Despite the lower baseline values, UEA patients experienced excellent postoperative improvement, leading to similar postoperative pain and shoulder function except for a lower average forward flexion in the UEA group (126.76° vs. 135.45°, p=0.0354). Notching and complication rates were also similar between the two groups, with notching rates of 59% and 50% and complication rates of 14.3% and 13.5% in the UEA and control groups, respectively. RSA in the UEA population can achieve similar pain and functional outcomes as compared to age-matched controls without a significant increase in complication rates; however, further studies are required to assess long-term comparative outcomes in this challenging patient population.

Outcomes of reverse total shoulder arthroplasty following subacromial balloon spacer implantation

BackgroundSubacromial balloon spacer implantation can be used in the treatment of irreparable rotator cuff tears; but in cases of treatment failure reverse total shoulder arthroplasty (RTSA) may be indicated. The effect of a previously performed subacromial balloon implantation on the outcomes of a subsequent RTSA is unknown. MethodsA single-center retrospective matched cohort study was performed on patients with a history of subacromial balloon spacer implantation who subsequently underwent RTSA in the same shoulder between 2010 and 2021 (Balloon group). A control group of patients who underwent RTSA for irreparable cuff tear/cuff tear arthropathy during the same time period without prior subacromial balloon implantation history was identified and matched by the number of previous rotator cuff repair surgeries and age (No Balloon group). The minimum follow-up was 1 year. Data collected included range of motion, subjective shoulder value, visual analog scale for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score, and the proportion of patients achieving patient acceptable symptomatic state (PASS). ResultsThirty cases were included, equally distributed between the two groups. The mean follow-up was 46 ± 23 months without significant differences between groups. The Balloon group included only male patients, whereas the No Balloon group comprised of 47% female patients. The Balloon group had a less advanced arthritic disease as evidenced by a lower Hamada grade compared to the No Balloon group (P = .03). There were no significant differences in preoperative or postoperative range of motion between groups, with an average forward flexion increase of 39° and no gain in rotations. Patient-reported outcomes were comparable between groups: visual analog scale, 4.7 vs. 3.3; subjective shoulder value, 50 vs. 64; and QDASH, 65 vs. 49 (all P > .05). There were four (27%) postoperative complications leading to reintervention in the Balloon group and one (7%) in the No Balloon group (P = .15). ConclusionIn this preliminary study, patients undergoing RTSA for irreparable cuff tear/cuff tear arthropathy had comparable outcomes irrespective of a history of previous subacromial balloon spacer implantation. Further studies in a larger population are indicated to examine the trend toward inferior patient-reported outcomes observed in this small series.

The temporal effects of variable tourniquet use on pain after total knee arthroplasty

BackgroundTourniquet use in total knee arthroplasty (TKA) remains controversial. While widely studied, any temporal effects on pain and opioid utilization have not been investigated. We hypothesized that postoperative opioid utilization increases with increasing tourniquet times in TKA. MethodsWe retrospectively reviewed 1110 TKAs by three arthroplasty surgeons from October 2016 through September 2019. Exclusion criteria included ambulatory surgery, undocumented tourniquet times, simultaneous bilateral TKA, and diagnoses other than osteoarthritis, inflammatory arthritis, or osteonecrosis. Postoperative opioid medications were converted to daily morphine milligram equivalents (MME/day). Secondary outcomes included range of motion (ROM) at 1-month, 3-month, and 1-year visits as well as patient reported outcomes measures (PROMs) at 3 and 12 months. ResultsNine-hundred and eleven patients were included and stratified based on tourniquet use. Three-hundred and four patients were assigned to a “No Use” group (≤10’); 138 patients to “Low Use” (11–60’); 177 patients to “Medium Use” (61–90’); and 292 patients to “Prolonged Use” (91–120). Compared to No Use, MME/day was significantly increased with Medium Use (+7.676 MME/day, p = 0.001) and Prolonged Use (+12.44 MME/day, p =< 0.001). No significant differences were found between No Use and Low Use groups. Estimated blood loss (EBL) in Low Use and No Use groups was significantly increased compared to other groups (+120 mL, p < 0.001, +109 mL, p < 0.001 respectively). Post-operative ROM and complication rates were similar between groups at 1 year post-TKA. ConclusionsA threshold of 60 min of tourniquet time is associated with increased MME/day postoperatively compared to No Tourniquet. Functional and patient-reported outcomes are comparable between groups at 1 year follow-up.

Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair

To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P= .005 to P= .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P= .005) and external rotation (7.13° vs 1.65°; P= .031) ROM than the control group. Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level III retrospective comparative study.

Outcomes after arthroscopically assisted lower trapezius transfer with Achilles tendon allograft

Lower trapezius tendon transfer is 1 option to improve pain and function with massive irreparable rotator cuff tears. Magnetic resonance imaging (MRI) evaluation of tendon healing with the procedure has not yet been reported. The purpose of this study was to evaluate early tendon transfer healing using postoperative MRI scans and to assess early clinical outcomes in patients after arthroscopically assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears. This was a single institution retrospective review of consecutive patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2020 with a minimum 6-month follow-up. Patient information including age, sex, follow-up, prior surgical history, and type of work (sedentary or labor-intensive) was recorded. Preoperative and postoperative range of motion, external rotation strength, presence of a lag sign, and pain visual analog scale data were extracted from medical records. Patient-reported outcomes were extracted from patient charts. Six-month postoperative MRIs were reviewed for tendon transfer healing at both the greater tuberosity and the trapezius-allograft interface. A total of 19 patients met inclusion criteria with average age 56.7 (range, 29-72years). Of these patients, 17 (89.5%) were male. The average follow-up was 14.6 (range, 6-45) months. Fifteen (78.9%) patients had unsuccessful previous rotator cuff repair. Six-month MRI demonstrated complete healing of the transferred tendon in 17 of 19 patients (89.5%). There were significant improvements in postoperative pain visual analog scale (5.9±2 vs. 1.8±2), ASES score (44.6±18 vs. 71.2±24), and Patient Reported Outcomes Measurement Information System Physical (46.3±6 vs. 51.3±11) and in external rotation motion (10.5±17° vs. 40.5±13°) and strength (2.8/5±1 vs. 4.7/5±0.5) at final follow-up. All patients with a preoperative external rotation lag sign had reversal of their lag sign at final follow-up (15/15). Of 17 work-eligible patients, 13 (76.4%) were able to return to work. In this series, AALTT showed a high rate of healing of the transferred tendon on MRI by 6months postoperatively. The current findings of a high rate of early tendon transfer healing are consistent with the good early and mid-term outcomes that have been observed in AALTT and provide support for surgeon and patient expectations, postoperative rehabilitation, and return to work following AALTT for massive posterior superior rotator cuff tears.

Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid

Glenoid bone loss is a known challenge in primary and revision reverse total shoulder arthroplasty. In severe deficiency, even placing the baseplate in alternative centerline or using an augmented baseplate may be insufficient. This study reports on the use of a soft tissue resurfacing technique using Achilles tendon allograft, coined Yoke procedure, for salvage treatment of glenoid deficient shoulder requiring reconstruction. All patients who underwent the Yoke procedure between 2014 and 2020 by a single surgeon at a single academic center were identified and had their charts retrospectively reviewed. Demographics and surgical information were recorded. Preoperative X-rays and 3D-CT scans were reviewed to classify patient glenoid types, evaluate glenoid medialization, and measure shoulder angles. Preoperative and postoperative range of motion (ROM) and patient-reported outcome scores were evaluated, including anterior elevation (AE), external rotation (ER), internal rotation (IR), Visual Analog Scale (VAS), Subjective Shoulder Score (SSV), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores. Postoperative radiographs and follow-up notes were reviewed to evaluate postoperative complication profiles at 1 year. Seven patients with median age of 69 years (range 54-77) underwent Yoke procedure and had median 12-month follow-up (range 9 - 56). All patients were female and had median of 2 prior shoulder surgeries (range 0-13). Of all the patients, the most common comorbidity was osteoporosis (6) followed by rheumatoid arthritis (3). Of the 5 patients who had previous arthroplasty, the most common indications were baseplate failure (4), followed by instability (3) and infection (3). Median VAS score improved from 8 (range 3-9) to 2 (range 1-4). Median SST improved from 8% (range 0-42%) to 33% (range 17-83%). Median ASES score improved from 15 (range 5-38) to 52 (range 40-78). Median AE and ER improved from 20° (range 0°- 75°) to 100° (range 40°- 145°) and 10° (range 0°- 20°) to 20° (range 0°- 55°), respectively. There was no change in median IR. As of last follow-up, one patient reported postoperative complications of anterior superior implant escape, heterotopic ossification, and scapular notching. The Yoke procedure is a promising salvage treatment that can offer patients consistent pain reduction and moderate functional improvements at short-term follow-up. In the setting of poor bone quality and severe glenoid deficiency, glenoid baseplate implantation may not be absolutely necessary for a pain-relieving, functionally acceptable outcome.

Similar outcomes between transtendon repair and tear completion repair techniques for partial articular-sided supraspinatus tendon avulsion lesions: a systematic review and meta-analysis.

This study aimed to review studies comparing transtendon repair (TTR) with tear completion repair (TCR) techniques for partial articular-sided supraspinatus tendon avulsion (PASTA) lesions according to postoperative patient-reported outcomes and complications. Databases, including PubMed, Embase, Scopus, and Cochrane, were searched for studies published between 2008 and 2022 that directly compared the postoperative patient-reported outcomes and complications of the TTR and TCR techniques for PASTA lesions. Odds ratios (ORs) were calculated for dichotomous outcomes, while mean differences (MDs) were calculated for continuous outcomes. A total of seven studies (497 shoulders) were analysed. No statistically significant differences in the postoperative clinical outcomes at the final follow-up were observed between the TTR and TCR techniques for PASTA lesions. The overall retear rates of the TTR and TCR techniques were 7.7% and 11.6%, respectively (corresponding healing rates were 92.3% and 88.4%), whereas the overall occurrence rates of adhesive capsulitis were 4.7% and 3.3%, respectively. Furthermore, no significant difference was observed in postoperative range of motion (forward flexion, MD = - 1.22, 95% confidence interval (95%CI) - 5.28 to 3.34, n.s.; external rotation, MD = - 1.39, 95% CI - 3.19 to 0.42, n.s.), overall retear rate (OR 0.72, 95% CI 0.29-1.08, n.s.), and occurrence rate of adhesive capsulitis (OR 1.11, 95% CI 0.35-3.52, n.s.) between the two techniques. Both techniques improve clinical outcomes while having a low complication rate and a high rate of healing. No significant difference in clinical outcomes was observed between the two techniques. III.

Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery?

BackgroundDiabetes mellitus (DM) and osteoarthritis (OA) are common diseases that are predicted to increase in prevalence, and DM is a risk factor for OA progression and has a negative impact on the outcome. However, the evidence remains unclear on how it affects patients’ clinical results of total knee arthroplasty (TKA) under enhanced recovery after surgery (ERAS).MethodsA retrospective single-center study was conducted comparing diabetic and non-diabetic patients who underwent TKA in West China Hospital of Sichuan University between September 2016 to December 2017 under ERAS. Consecutive propensity score matching (PSM) was conducted by 1:1 (DM: non-DM) matching analysis with all baselines as covariates. The primary clinical results were the improvement of knee joint function, the incidence of postoperative complications, and the FJS-12 sensory results 5 years after the operation between DM and Non-DM groups. The secondary clinical results were the postoperative length of stay (LOS), postoperative blood test and total blood loss (TBL).ResultAfter PSM, the final analysis included 84 diabetic patients and 84 non-diabetic patients. Diabetic patients were more likely to experience early postoperative complications (21.4% vs. 4.8%, P = 0.003), of which wound complications are the most significant (10.7% vs. 1.2%, P = 0.022). Diabetic patients experienced longer postoperative LOS with a significant increase in patients with LOS exceeding 3 days (66.7% vs. 50%, P = 0.028) and showed less postoperative range of motion (ROM) (106.43 ± 7.88 vs. 109.50 ± 6.33 degrees, P = 0. 011). Diabetic patients also reported lower Forgotten joint score (FJS-12) than non-diabetic patients (68.16 + 12.16 vs. 71.57 + 10.75, P = 0.020) in the 5-year follow-up and were less likely to achieve a forgotten knee joint (10.7% vs. 1.2%, P = 0.022). In additional, Compared with non-diabetics, diabetic patients showed lower hemoglobin (Hb) (P < 0.001) and hematocrit (HCT) (P < 0.001) and were more likely to suffer from hypertension before TKA (P < 0.001).ConclusionDiabetic patients show increased risk for postoperative complications, and have lower lower postoperative ROM and lower FJS-12 compared with non-diabetic patients after TKA under ERAS. More perioperative protocols are still needed to be investigated and optimized for diabetic patients.

Early clinical and patient-reported outcomes for arthroscopic and mini-open superior capsular reconstruction are similar for irreparable rotator cuff tears

ObjectivesThe purpose of this study was to report and compare postoperative range of motion (ROM), patient-reported outcomes, and failure rates following superior capsular reconstruction (SCR) and to compare outcomes between arthroscopic and mini-open techniques. MethodsAll SCR procedures utilising dermal allograft with a minimum of 6 months of follow-up at multiple institutions between November 2015 and October 2019 were retrospectively reviewed. Preoperative patient demographics, imaging measurements, surgical technique (arthroscopic versus mini-open), and outcomes including pain scores, conversion to reverse shoulder arthroplasty, subsequent surgery, and postoperative ROM were recorded. Outcomes for arthroscopic versus mini-open approaches were compared via t-test, Fisher's exact test, or chi square test, as appropriate, with differences of p ​< ​0.05 considered significant. Results180 total patients were included, including 98 who underwent arthroscopic SCR and 82 who underwent mini-open SCR. Final follow-up was at a mean of 32 months (standard deviation = 11 months). SCR improved pain (visual analog scale ​= ​4.4 pre-operatively vs. 1.4 post-operatively, p ​< ​0.0001) and ROMin active forward flexion (136° pre-operatively vs. 150° post-operatively, p ​= ​0.0012). No difference in post-operative pain visual analog scores was found between mini-open and arthroscopic cohorts (1.3 vs. 1.6, p ​= ​0.3432) at a mean of 14 months post-operatively. At a mean of 32 months post-operatively, there were no differences in ASES, QuickDASH, SST, WORC, or SANE scores between open and arthroscopic cohorts. There was no difference in rates of failure between mini-open and arthroscopic cohorts (15.9% vs. 17.3%, p ​= ​0.789). ConclusionsThis study confirmed that SCR improves pain and ROM in the short term. Mini-open SCR appears to provide similar improvements in pain and ROM compared with arthroscopic SCR, as well as patient-reported outcomes at 3 years. No difference in failure rates was detected between the 2 procedures. Level of evidenceLevel 3 evidence.

Evaluation of the Outcome of Osteoarthritis among Patients Undergoing Total Knee Replacement.

To assess the outcome of osteoarthritis among patients undergoing total knee replacement (TKR). One hundred and four subjects with one hundred and fifty-two cemented total knee arthroplasties have been analyzed in the current research. Functional assessment was carried out using the preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) score and its five subscales: pain, other symptoms, function in activity of daily living (ADL), function in sport and recreation (Sport/Rec), and knee-related quality of life (QOL). A significant improvement in the KOOS symptom score was seen with score grade changing to excellent from poor. The average postoperative KOOS symptom score occurred to be 89.9198, whereas the mean preoperative KOOS score was 30.7960 with a mean difference of 59.02385. The mean postoperative KOOS pain score was 94.6304 and the mean preoperative KOOS score was 18.4831 with a mean difference of 76.14731. A significant improvement in the KOOS pain score was seen with score grade changing to excellent from poor. Sixty patients of 104 (57.7%) had an excellent satisfaction level with a postoperative range of motion, twenty-eight patients (26.9%) had a good, eleven patients (10.6%) had a fair, and five patients (4.8%) had a poor satisfaction level with a postoperative range of motion. Surgery for a TKR is successful in reducing individuals' pain and restoring their functional ability. Preoperative expectations and KOOS subscale scores are factors in patients' satisfaction, which is determined a year following surgery.

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 247: Predictors of Poor Outcomes Following Quadriceps Tendon Repair

Objectives: Ruptures of the quadriceps tendon can lead to significant morbidity and are nearly always treated with surgical repair. Although relatively uncommon, they present most frequently in older adults and individuals with underlying medical conditions. Specifically, spontaneous bilateral ruptures have been shown to be associated with gout, diabetes, or steroid use. In other areas of orthopedics, factors such as an obese BMI have been shown to be predictive of poor outcomes after surgical treatment. To date, there has been little published literature to demonstrate how factors such as age, BMI, and smoking status are associated with quadriceps tendon tear or outcomes. The purpose of this study was to examine the relationship between patient factors such as age, sex, BMI, and smoking status, as well as intraoperative factors and the outcome of quadriceps tendon repair. We hypothesize that older age, higher BMI, and poor smoking habits will be associated with worse range of motion and complication rates following quadriceps tendon repair. Methods: All patients undergoing Quadriceps tendon repair from 1/1/2016-9/1/2021 were retrospectively identified at our institution using CPT codes, and patients who had definitive documentation of a quadriceps tendon tear within the operative report were included in the study. Patients under the age of 18 years were excluded. Physician clinical notes were reviewed, recording detailed information regarding the presenting symptoms and physical exam findings. Pre-operative demographic information and intraoperative findings were evaluated. Poor outcomes were defined as a need for revision, complications, post-operative range of motion (ROM) of less than 110 degrees of knee flexion, and extensor lag greater than 5 degrees. Parametric continuous data was presented as mean(SD) and p values were calculated by performing T tests. Nonparametric continuous data was also presented as mean(SD) for easier interpretation and p values were calculated by performing Mann- Whitney tests. P values less than 0.05 were deemed significant. All statistical analyses were done using R Studio (Version 4.1.2, Vienna, Austria). Results: There were 235 patients who met the inclusion criteria. Patients had an average age of 59 (13.3) years at time of surgery consistent of predominantly males (90.2%). The mean BMI for this cohort was 32.1(6.34). The most common surgical procedure was Transosseous fixation (81.5%) followed by suture anchors (16%) and simple sutures (2.6%). The most common mechanism of injury was trauma (57.6%) followed by spontaneous injury (39.8%). On post-operative physical exam, 18.4% of patients experienced loss of range of motion, 15.4% experienced extension lag, 9.52% had post-operative complications, and 4.7% underwent revision. Three sets of logistic regressions were run for subgroups of poor outcomes showing BMI (OR, 1.07, 95% CI, 1.01 – 1.14) and Age (OR, 1.05, 95% CI, 1.02 – 1.08) were significantly associated with loss of range of motion. Post-operative extension lag was also associated with greater BMI (OR, 1.63, 95% CI, 1.17 – 2.91). Complications were found to be significantly associated with patients found to have pre-operative tendon degeneration via MRI (OR, 4.74, 95% CI, 1.65 – 14.67) and those who were current smokers (OR, 7.84, 95% CI, 2.32 – 27.12). Amount of retraction, degree of pre-operative osteoarthritis, retinacular involvement, tear thickness and location were not significantly associated with poor outcomes. Conclusions: This study demonstrates that patient specific characteristics can play a significant role in outcomes following quadriceps tendon repair. Advanced age, BMI, tendon degeneration and current smokers are all at risk for poor outcomes following quadriceps tendon repair.

Poster 177: Does Prior Ipsilateral Steroid Injection Affect Outcomes After Rotator Cuff Repair?

Objectives: Rotator cuff pathology is a common problem, affecting approximately 17 million individuals in the US. Among professional and competitive athletes, only 49.9% have returned to play at the same level as before their injury. Initial treatment often includes corticosteroid injections, but some patients continue to have pain resulting in surgical treatment. Although steroids are the mainstay of conservative treatment, recent studies have shown concerns for increased rates of postoperative infections and revision surgeries after RCR. This study aimed to determine the effect of prior ipsilateral steroid injection on outcomes following arthroscopic rotator cuff repair. Methods: A retrospective chart review was performed on 295 patients who underwent rotator cuff repair by a single fellowship-trained orthopedic surgeon from 2017-2019. Of the 225 patients that met inclusion criteria and underwent analysis, 42 patients were in the injection group (IG) and 183 in the control group (CG). Demographics, range of motion (ROM), patient-reported pain and satisfaction (0- 10), subjective shoulder value (SSV), complications and reoperations were compared between groups. Delta ROM and strength were defined as postoperative ROM minus preoperative ROM. Complications were defined as reoperations, retears, or subsequent infection. Statistical analysis included chi-square and student t-tests. Results: The cohort consisted of 57.4% males with an average age of 58.3, BMI of 29.5, and mean follow-up of 7.3 months. The mean time from injection to surgery was 5.6 months. There were no significant differences in demographics between the injection and control group. Preoperatively, the injection group had a significantly greater median supraspinatus strength (p=0.002), summed strength (p=0.003), forward elevation (p=0.003), abduction (p=0.005), and active external rotation (p&lt;0.001). This was specific to injections received within the 12 months before surgery. Postoperatively, there were no significant differences between the groups on measures of pain, shoulder function, shoulder strength, range of motion, or SSV. The frequency of complications was also comparable between the no injection and injection group, having similar rates of persistent pain, limited ROM or stiffness, numbness or tingling, weakness, cervicalgia, adhesions, retear, and upper extremity DVT, and postoperative infections. Conclusions: The results of our study indicate that ipsilateral shoulder injection within one year of arthroscopic rotator cuff repair improves preoperative functional outcomes, namely improvements in forward flexion, abduction, external rotation, and relative strength. Despite enhancements preoperatively, postoperative measures of strength, range of motion, and complications are comparable between groups, which persists when analyzing the timing and number of injections. These results support the use of subacromial corticosteroid injections as an effective conservative treatment prior to rotator cuff repair. However, there is still a lack of consensus on how close in proximity to surgery it is safe to receive an injection and what preoperative patient characteristics may be more likely to benefit from injection prior to surgery. Future studies are needed to assess the short-term impact of corticosteroid injections on outcomes of rotator cuff repair, particularly in athletes.

Clinical outcomes of anatomic vs. reverse total shoulder arthroplasty in primary osteoarthritis with preoperative rotational stiffness and an intact rotator cuff: a case control study.

Reverse total shoulder arthroplasty (rTSA) has begun to challenge the place of anatomic total shoulder arthroplasty (aTSA) as a primary procedure for certain indications. One purported benefit of aTSA is improved postoperative range of motion (ROM) compared to rTSA especially in internal rotation; however, it is unclear whether aTSA can provide patients with significant preoperative stiffness superior ROM compared to rTSA. Our purpose was to compare clinical outcomes of aTSA and rTSA performed in stiff vs. non-stiff shoulders for rotator cuff intact (RCI) glenohumeral osteoarthritis (GHOA). A retrospective review of an international shoulder arthroplasty database identified 1608 aTSAs and 600 rTSAs performed for RCI GHOA with minimum 2-year follow-up. Defining preoperative stiffness as ≤ 0° of passive external rotation (ER), we matched: (1) stiff aTSAs (n=257) 1:3 to non-stiff aTSAs, (2) stiff rTSAs (n=87) 1:3 to non-stiff rTSAs, and (3) stiff rTSAs (n=87) 1:1 to stiff aTSAs. We compared ROM, outcome scores, and the rate of complications and revision surgery at latest follow-up. Despite stiff aTSAs having poorer preoperative ROM and functional outcome scores for all measures assessed (P<.001 for all), only poorer postoperative active abduction (113±27° vs. 128±35°; P<.001), active ER (39±18° vs. 50±20°; P<.001), and passive ER (45±17° vs. 56±18°; P<.001) persisted postoperatively compared to the non-stiff cohort. Similarly, stiff rTSAs had poorer preoperative ROM and functional outcome scores for all measures assessed compared to non-stiff rTSAs (P≤.044), but only poorer active abduction (108±24° vs. 128±29°, P<.001), active ER (28±17° vs. 42±17°, P<.001), and passive ER (36±15° vs. 48±17°, P<.001) persisted. When comparing stiff rTSAs to matched stiff aTSAs, no significant differences in preoperative ROM or functional outcome scores were found. However, stiff aTSAs had greater postoperative active internal rotation score (4.8±1.5 vs. 4.2±1.7, P=.022), active ER (40±19° vs. 28±17°, P<.001), and passive ER (46±18° vs. 36±15°, P=.001). Postoperative outcome scores were similar across all matched cohort comparisons despite motion differences. The rate of complications and need for revision surgery did not differ between any group comparisons. Patients with RCI GHOA who have preoperative rotational stiffness have poorer postoperative ROM compared with non-stiff patients following both aTSA and rTSA, but similar functional outcome scores. Notably, preoperative limitations in passive ER do not appear to be a limitation to utilizing aTSA. Indeed, patients with limited preoperative ER treated with aTSA had greater postoperative internal rotation and ER compared to those treated with rTSA.

Lateral joint tightness in flexion following cementless mobile-bearing total knee arthroplasty decreases patient-reported outcome measures and postoperative range of motion

PurposeThe purpose of this study was to clarify the association between clinical outcomes and the flexion joint gap following rotating concave–convex (Vanguard ROCC) total knee arthroplasty (TKA). MethodsThis consecutive retrospective series included 55 knees that underwent ROCC TKA. All the surgical procedures were performed using a spacer-based gap-balancing technique. To evaluate the medial and lateral flexion gaps, axial radiographs of the distal femur were obtained using the epicondylar view with a distraction force to the lower leg at 6 months postoperatively. Lateral joint tightness was defined as the lateral gap being greater than the medial gap. To evaluate clinical outcomes, patients were asked to complete patient-reported outcome measures (PROMs) questionnaires preoperatively and during at least 1 year of follow-up postoperatively. ResultsThe median follow-up duration was 24.0 months. Overall, 16.0% of patients had postoperative lateral joint tightness in flexion. The postoperative range of motion and PROMs were lower in patients with lateral joint tightness than in those with a balanced flexion gap or lateral joint laxity. No serious complications, including bearing dislocations, occurred during the observation period. ConclusionLateral joint tightness in flexion following ROCC TKA decreases PROMs and postoperative range of motion. Level of evidence4.

Which comorbid conditions and risk factors affect the outcome of and progression to total temporomandibular joint replacement?

Surgery is an effective modality to reduce pain and increase range of motion (ROM) in TMJ disorders. The aim of this study was to determine which comorbidities and risk factors affect outcomes and progression to total joint replacement (TJR). A retrospective cohort study of patients who underwent TJR between 2000- 2018 at MGH was conducted. Primary outcome was successful vs unsuccessful surgery. Success was defined as pain score ≤ 4 and ROM ≥ 30 mm; failure was defined as lack of either or both. Secondary outcome was differences between patients undergoing TJR only (group A) and those undergoing multiple surgeries progressing to TJR (group B). 99 patients (82 females, 17 males) were included. Mean follow-up was 4.1 years; mean age at first surgery was 34.2 (range 14–71) years. Unsuccessful outcomes were associated with high preoperative pain, low preoperative ROM, and higher number of surgeries. Male sex favored successful outcome. 75.0% group A and 47.6% group B had successful outcome. Group B had more females, higher postoperative pain, lower postoperative ROM, and used more opioids compared to group A. High preoperative pain, low preoperative ROM, and more surgeries were associated with poorer outcomes and frequent opioid use.

Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score–Matched Study

Background: Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. Purpose: To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings—including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM—were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. Results: Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). Conclusion: aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.