Significant Difference In Functional Outcome Research Articles

Acute predictors for mortality after severe TBI in Spain: Gender differences and clinical data

Objective: The main objective of this study is to determine whether gender affects global mortality and functional outcome after severe traumatic brain injury (TBI).Methods: This retrospective cohort study included 629 patients with severe TBI (14.9% female) admitted to the ICU of a university hospital. Patients were split into gender groups to study potential differences in global mortality and functional outcome at ICU discharge and 6 months post-trauma using the GOS. The following variables were analysed: age, intracranial injury, injury mechanism, injury severity, factors contributing to secondary brain injury, monitoring level, treatment, complications, length of stay in the ICU and cause of death.Results: No differences were found between gender groups in neuromonitoring level or surgical procedures. Women had higher APACHE II scores, a higher incidence of pre-hospital hypotension, anaemia and transfusion and higher mortality rates in the ICU (OR = 1.74; 95% CI = 1.09–2.77) and 6 months post-trauma (OR = 1.65; 95% CI = 1.02–2.67). There were no significant differences in functional outcome at ICU discharge or 6 months post-injury. The multivariate analysis did not show gender as an independent predictive factor in mortality after severe TBI.Conclusion: In this study, gender was not found to be an independent predictor for poorer outcome after severe TBI.

Cartilage Restoration of the Knee

Background: Focal cartilage defects of the knee are a substantial cause of pain and disability in active patients. There has been an emergence of randomized controlled trials evaluating surgical techniques to manage such injuries, including marrow stimulation (MS), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OAT). Purpose: A meta-analysis was conducted to determine if any single technique provides superior clinical results at intermediate follow-up. Study Design: Systematic review and meta-analysis of randomized controlled trials. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched and supplemented with manual searches of PubMed and reference lists. Eligible studies consisted exclusively of randomized controlled trials comparing MS, ACI, or OAT techniques in patients with focal cartilage defects of the knee. The primary outcome of interest was function (Lysholm score, International Knee Documentation Committee score, Knee Osteoarthritis Outcome Score) and pain at 24 months postoperatively. A meta-analysis using standardized mean differences was performed to provide a pooled estimate of effect comparing treatments. Results: A total of 12 eligible randomized trials with a cumulative sample size of 765 patients (62% males) and a mean (±SD) lesion size of 3.9 ± 1.3 cm2 were included in this review. There were 5 trials comparing ACI with MS, 3 comparing ACI with OAT, and 3 evaluating different generations of ACI. In a pooled analysis comparing ACI with MS, there was no difference in outcomes at 24-month follow-up for function (standardized mean difference, 0.47 [95% CI, –0.19 to 1.13]; P = .16) or pain (standardized mean difference, –0.13 [95% CI, –0.39 to 0.13]; P = .33). The comparisons of ACI to OAT or between different generations of ACI were not amenable to pooled analysis. Overall, 5 of the 6 trials concluded that there was no significant difference in functional outcomes between ACI and OAT or between generations of ACI. Conclusion: There is no significant difference between MS, ACI, and OAT in improving function and pain at intermediate-term follow-up. Further randomized trials with long-term outcomes are warranted.

What's New in Spine Surgery.

An increasing number of prospective studies have established the efficacy of many cervical spine procedures. At the same time, complications and morbidity have been critically analyzed. Several of these studies regarding anterior fusion and laminoplasty will be reviewed. ### Outcomes Long-term follow-up with use of validated instruments and strict radiographic criteria are effective for evaluating surgical results. The Cervical Spine Research Society prospectively followed 181 patients for two years to assess the influence of plates on outcomes. In patients with single-level fusions, the use of a plate was associated with a significantly higher rate of successful fusion (94% compared with 73%). Rigid and translational plates were associated with better results than plates that only allowed the toggle of screw heads. Other studies of intervertebral fusion devices have demonstrated conflicting results. Carbon fiber-reinforced spacers used as stand-alone devices had results similar to allografts, whereas tantalum mesh implants had poor results that necessitated the discontinuation of a randomized study. Pulsed electromagnetic field stimulation has been shown to induce fusion in the lumbar spine and the healing of extremity nonunions. In a prospective, randomized study, pulsed electromagnetic field stimulation was associated with higher rates of successful cervical fusion (84% compared with 69%), although no significant differences in functional outcomes were noted. Interestingly, successful fusion, either with or without pulsed electromagnetic field stimulation, was significantly correlated with good clinical outcomes. Controversies still remain with regard to the approach (i.e., anterior or posterior) for treatment of cervical spondylotic myelopathy. In a randomized study comparing corpectomy and autograft fusion with laminoplasty, no differences were noted with regard to the rate of neurologic recovery or the range of motion of the neck. However, both groups had significant improvement in neurologic function. Axial pain was greater in the laminoplasty group. Complications in the anterior treatment group included dysphagia and pseudarthrosis, …

Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

BackgroundWe aimed to define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscle strengthening following first-time patellar dislocation (FTPD). MethodsFifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or a specific-VM exercise and rehabilitation regime (n=25). The primary outcome was the Lysholm knee score, and secondary outcomes included the Tegner Level of Activity score, the Norwich Patellar Instability (NPI) score, and isometric knee extension strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12months. ResultsThere were statistically significant differences in functional outcome and activity levels with the Lysholm knee score and Tegner Level of Activity score at 12months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% confidence interval (CI): −14.0 to 0.0/p=0.04; 95% CI: −3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI score and isometric strength at any follow-up interval. The trial experienced substantial participant attrition (52% at 12months). ConclusionsWhilst there was a statistical difference in the Lysholm knee score and Tegner Level of Activity score between general quadriceps and VM exercise groups at 12months, this may not have necessarily been clinically important. This trial highlights that participant recruitment and retention are challenges which should be considered when designing future trials in this population. Level of evidenceTherapeutic study, Level I

Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors

We performed this study to investigate the natural course and factors affecting the incidence of drop sign immediately after stabilization of an unstable posterolateral (PL) dislocation of the elbow. Twenty-three patients who underwent a stabilization procedure for persistent instability after closed reduction of PL dislocation of the elbow were enrolled. The natural course was evaluated with simple radiographs taken at regular intervals after the operation. Primary repair of medial or lateral ligaments and overlying muscles, degree of adjacent muscle injury, and type of anesthesia were analyzed to determine their relationship to postoperative drop sign. Functional outcomes were evaluated by the Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score. A postoperative drop sign was observed in 4 cases (17%) and resolved within 1 week after the operation. There was no significant relationship between preoperative factors and drop sign except method of anesthesia. All drop signs were found in patients who had received a regional block (P=.006). There were no statistically significant differences in functional outcome between the drop sign group and the non-drop sign group. A postoperative drop sign was observed in 17% of patients who underwent a surgical stabilization procedure for an unstable PL elbow dislocation; this sign spontaneously disappeared in all 4 patients within 1 week of the operation. The drop sign was possibly caused by delayed return of muscle tone. A postoperative drop sign did not indicate the need to perform an additional stabilization procedure, nor did it affect postoperative functional outcome.

Dynamic condylar screw versus supacondylar nail in the management of supracondylar fracture distal femur

Background: Supracondylar femoral fracture poses a considerable therapeutic challenge. Operative treatment has become a standardized procedure. Stabilization has usually been achieved by an osteosynthesis with Dynamic condylar screws or retrograde supracondylar nailing. In this article we are going to compare the results of surgical management of supracondylar nail and dynamic condylar screw. Methods: Prospective study of forty two patients who underwent surgical management for supracondylar fracture of femur between Jan 2011 and Jan 2015. 22 patients underwent retrograde supracondylar nailing and 20 patients underwent DCS fixation. The inclusion criteria were AO type A, C1 and C2 and Gustilo & Anderson Grade I to III B distal femur supracondylar fracture. The exclusion criteria were Patients younger than 19 years, AO type B/C3 and Gustilo & Anderson Grade IIIC. The average age of our patients was 42years. Patients were assessed using Sanders et al scoring system Results: Patients with supracondylar fracture of femur have a good functional outcome following operative treatment. 15 patients (83.3%) treated with DCS had excellent to good functional outcome. 16 patients (80%) treated with retrograde nailing had excellent to good functional outcome. Conclusions: Dynamic condylar screw with plate fixation and retrograde supracondylar nailing provide good functional outcome in supracondylar fracture of femur. However in intra articular fractures of distal femur (Type C1 & C2), DCS with plate provides for better functional outcome compared to supracondylar nail. In extra articular fractures of distal femur (Type A), no significant difference in functional outcome was noticed between the patients treated with DCS & supracondylar nail. However, in view of minimal blood loss & soft tissue dissection required, supracondylar nailing may be a better option in the treatment of extra articular fractures of distal femur.

Traumatic anterior instability of the pediatric shoulder: a comparison of arthroscopic and open bankart repairs.

Arthroscopic and open Bankart repairs have proven efficacy in adults with recurrent anterior shoulder instability. Although studies have included children in their analysis, none have previously compared functional outcomes or redislocation rates between these 2 methodologies for anteroinferior glenoid labrum repair in this young population. We hypothesize that open and arthroscopic Bankart repair in children will have similar functional outcomes and redislocation rates, but differing results from adults treated in a similar manner. A retrospective chart review was performed on all Bankart repairs performed between 2006 and 2010 at a tertiary care children's hospital. A shift in treatment modalities occurred in 2008 creating 2 cohorts, open and arthroscopic. Brachial plexus injury, congenital soft-tissue disorder, or incomplete charts were excluded. Demographics, age at surgery, follow-up length, and sport were recorded. Telephone interviews were then performed obtaining the most current QuickDASH (Disability Arm, Shoulder, or Hand), WOSI (Western Ontario Shoulder Instability Index), SF-12 (Short Form 12), SANE (Single Assessment Numeric Evaluation), and verbal pain scores; as well as, inquiring about recurrent dislocation and further surgery. Ninety-nine children (16.9±1.5 y) were included (28 open, 71 arthroscopic). There were no differences in preoperative demographics. Fifty-one patients completed the questionnaires (11 open, 40 arthroscopic). No significant differences in the outcomes scores were seen between the 2 groups. Of the 99 patients, 21 (21%) had redislocation or secondary surgery; there was no significant difference in failure rate between groups (4 open, 17 arthroscopic). A plotted survival curve demonstrated that the adolescent shoulder undergoing Bankart repair for recurrent traumatic anterior instability has a 2-year survival of 86% and a 5-year survival of only 49%, regardless of technique. In adolescents, there is no significant difference in functional outcomes or redislocation rates between open and arthroscopic Bankart repair, yet both demonstrate a very high risk of failure in this young, athletic population which contrasts the results in the historic adult population. Level III-retrospective comparative study.

Outcomes of the Holmium Laser Enucleation of the Prostate for Patients With Prior Benign Prostatic Hyperplasia Surgery

Background: To assess the functional outcomes and morbidity in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery. Methods: Patients were stratified into two groups, 558 patients who underwent primary HoLEP (group I) and 50 patients who underwent ‘secondary-HoLEP’ with prior transurethral prostate surgery (group II). Results: There were no significant differences in the preoperative parameters (median age, International Prostate Symptom Score [IPSS], prostate-specific antigen [PSA], prostate volume, maximum urinary flow rate [Qmax], and postvoid residual urine volume [PVR]). No significant intraoperative differences were noted in the use of total energy, resected volume, enucleation time, resection efficiency, and mean catheterization time. There were significant improvements in Qmax, PVR, and IPSS in both groups. Complications in groups I and II included 19 (3.1%) and 1 (2.0%) bladder injuries, 25 (4.4%) and 2 (4.0%) recatheterization for transient voiding difficulty, 20 (3.5%) and 2 (4%) cases of severe hematuria requiring additional treatment, and 5 (0.8%) and 0 cases for remorcellation due to remaining adenoma. Transient incontinence was the most common complication for both groups I and II, 30 cases (5.4%) and 3 cases (6.0%) respectively. Urinary tract infection showed improvement subsequent to antibiotic treatment. During the 6 month follow-up period, urethral stricture occurred in 7 cases (1.3%) for group I and in 1 case (2.0%) for group II. Conclusion: There were no significant differences in functional outcomes and morbidity between the two groups. ‘Secondary-HoLEP’ seems to be effective and safe for patients with prior BPH surgery.

Arthroscopic repair of a significant (>50%) partial-thickness subscapularis tear concomitant with a full-thickness supraspinatus tear: technical considerations for subscapularis repair (transtendon technique versus tear completion)

The purpose of this study was to compare clinical outcomes and structural integrity of arthroscopic repair by either transtendon repair or tear completion for a significant (>50%) partial-thickness articular-side subscapularis tear associated with a full-thickness supraspinatus tear. The study population comprised 109 patients who underwent arthroscopic repair for partial-thickness subscapularis tears associated with full-thickness supraspinatus tears with either a transtendon technique (81 patients, group T) or tear completion (28 patients, group C). Pain on a visual analog scale; the Subjective Shoulder Value; the American Shoulder and Elbow Surgeons score; and the University of California, Los Angeles shoulder score were used to compare clinical outcomes between the 2 groups. At 6 months after surgery, magnetic resonance arthrography or computed tomographic arthrography was performed to assess structural integrity. At the 2-year follow-up, there were no significant differences in functional outcomes between groups. In group T, external rotation was reduced significantly from 55° to 51° (P < .001). The subscapularis and overall retear rates were 8% and 19%, respectively, in group T and 12% and 23%, respectively, in group C. There were no significant differences in retear rates between groups. Arthroscopic repair of partial-thickness subscapularis tears associated with full-thickness supraspinatus tears using either the transtendon technique or tear completion resulted in significant functional improvements in both groups except for postoperative external rotation in group T, and there were no significant differences between groups. The retear rates were also not significantly different between groups. However, after subscapularis repair using the transtendon technique, some patients may have decreased external rotation.

Prior antiplatelet agent use and outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke: a meta-analysis of cohort studies and randomized controlled trials.

There is uncertainty surrounding the influence of prior antiplatelet agent use on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke. We performed a systematic review with a final meta-analysis to evaluate the efficacy and safety of prior antiplatelet use before intravenous recombinant tissue plasminogen activator for acute ischemic stroke. We searched PubMed and Embase databases from 1997 to 2014. Primary outcome was functional outcome at the end of follow-up; secondary outcomes were symptomatic intracranial hemorrhage and recanalization rate. The meta-analysis was performed with Review Manager 5.2 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012). Eleven studies with a total of 19,453 patients were included. A total of 6517 (33.5%) patients who had received intravenous recombinant tissue plasminogen activator were taking antiplatelet agent before stroke onset. Pooled analysis demonstrated a clear trend that previous antiplatelet users had a reduced probability of good outcome, although it was not conventionally statistically significant (OR 0.86; 95% CI 0.73-1.01; P = 0.06). There was no difference in recanalization rate between two groups (OR 1.23; 95% CI 0.30-4.99; P = 0.77). The risk of symptomatic intracranial hemorrhage was significantly increased in the antiplatelet group (OR 1.65; 95% CI 1.44-1.90; P < 0.01). In acute ischemic stroke patients receiving intravenous recombinant tissue plasminogen activator therapy, prior antiplatelet agent use did not lead to a significant difference in functional outcome, although it significantly increased the risk of symptomatic intracranial hemorrhage. Recanalization rate was not different between two groups. In the subgroup analysis, prior clopidogrel mono therapy may not increase the risk of symptomatic intracranial hemorrhage, which will need further studies to confirm.

Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity.

Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity.

Comparative Effectiveness of Traumatic Brain Injury Rehabilitation

To measure patient functional outcomes across rehabilitation centers. Traumatic Brain Injury Model System (TBIMS) centers. Patients with traumatic brain injury (TBI) admitted to 21 TBIMS rehabilitation centers (N = 6975, during 1999-2008). Retrospective analysis of prospectively collected data. Center-specific functional outcomes of TBI patients using Functional Independence Measure, Disability Rating Scale, and Glasgow Outcome Scale-Extended. There were large differences in patient characteristics across centers (demographics, TBI severity, and functional deficits at admission to rehabilitation). However, even after taking those factors into account, there were significant differences in functional outcomes of patients treated at different TBIMS centers. There are significant differences in functional outcomes of TBI patients across rehabilitation centers.

Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis

We conducted a meta-analysis of randomized trials to compare delayed vs early motion therapy on function after arthroscopic rotator cuff repair. We searched 4 electronic databases (Medline, Embase, Cochrane, and Physiotherapy Evidence Database [PEDro]). The methodologic quality of the included studies was assessed, and the relevant data were extracted. Data were pooled for functional outcomes, rotator cuff tear recurrence, and shoulder range of motion. Complications were reported descriptively. Three level I and 1 level II randomized trials were eligible and included. Pooled analysis revealed no statistically significant differences in American Shoulder and Elbow Surgeons scores between delayed vs early motion rehabilitation (mean difference [MD], 1.4; 95% confidence interval [CI], -1.8 to 4.7; P = .38, I(2) = 34%). The risk of retears after surgery did not differ statistically between treatment groups (risk ratio, 1.01; 95% CI, 0.63-1.64; P = .95). Early passive motion led to a statistically significant, although clinically unimportant, improvement in forward elevation between groups (MD, -1°; 95% CI, -2° to 0°; P = 0.04, I(2) = 0%). There was no difference in external rotation between treatment groups (MD, 1°; 95% CI, -2° to 4°; P = 0.63, I(2) = 0%). None of the included studies identified any cases of postoperative shoulder stiffness. The current meta-analysis did not identify any significant differences in functional outcomes and relative risks of recurrent tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A statistically significant difference in forward elevation range of motion was identified; however, this difference is likely clinically unimportant.

A Comparison of Intramedullary and Extramedullary Fixation Devices in Unstable Trochanteric Fractures

Objectives: The main objective of the study was to compare functional outcome and complications associated with a proximal femoral nail, an intramedullary device with those of a traditional extramedullary device, the dynamic hip screw, in patients with unstable trochanteric fracture. Method: In this prospective, randomized study, total of 86 patients were randomized to the intramedullary group [Group A ( n = 40)] or the extrmedullary group [Group B ( n = 46)]. All relevant perioperative information and complications were recorded, and assessments of functional outcome were made. Results: The extramedullary group required a longer operative time (p value 0.001) and was associated with greater blood loss (p value 0.002) than the intramedullary group. The re-operation rate as well, was lower in the group A compared with the group B, although there were no statistically significant difference in the overall complication rate between the two groups (p value 0.221). There were no significant differences in functional outcome between both groups. Conclusions: The intramedullary device is useful in the treatment of unstable trochanteric fractures.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis. A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans. Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 (P = .007) and the pain (VAS) score improved from 11 to 4 (P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit. With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up. Level II, prospective comparative study.

Functional outcome of fifth metatarsal fractures

IntroductionFifth metatarsal fractures are common and the outcome has been reported; however, prospective studies reporting the functional outcome using validated questionnaires are lacking in the literature. The aims of this study were to determine whether fifth metatarsal fractures remain symptomatic in the medium term and whether the fracture type influences outcome. MethodsOver the course of a year, 117 patients (62 avulsion fractures, 26 Jones fractures, 29 shaft fractures) were followed up (1 month, 4 months, 12 months), with functional outcome assessed using the Foot Function Index (FFI)- and Short Form 36 (SF36)-validated questionnaires. ResultsThe FFI reduced (function improved) over the course of the year from 22.0 (8.4–38.5) at 1 month to 0.0 (0.0–4.2) at 4 months, to 0.0 (0.0–1.3) at 1 year. There was no significant difference in the FFI scores with regard to gender or fracture type.Pain scores were also observed to decline over the year, with no significant differences between fracture types. However, while the severity of pain was low, the numbers of people reporting pain were relatively high. At 1 month, >80% of patients reported ongoing pain (83% avulsion, 88% Jones and 83% shaft), reducing to 38% at 4 months and 28% at 1 year. At final follow-up, 25% with an avulsion fracture, 28% with a Jones fracture and 33% with a shaft fracture reported pain. ConclusionsWhile 25–33% of patients continue to experience pain at 1 year, <10% experience any limitation of their activities. At the final follow-up at 1 year, there were no significant differences in functional outcome by fracture type, gender or patient age. Patients should be advised about the likelihood of ongoing low-level symptoms, even after a year from injury in this previously presumed innocuous injury.

Arthroscopic Stabilization for Recurrent Shoulder Instability With Moderate Glenoid Bone Defect in Patients With Moderate to Low Functional Demand

The purpose of this study was to investigate the functional outcomes of arthroscopic Bankart repair for recurrent shoulder instability in the setting of moderate glenoid bone defect ranging from 20% to 30% in patients with moderate to low functional demand. This study included 36 patients with unilateral recurrent instability and glenoid bone defects of 20% to 30% treated with arthroscopic stabilization. Glenoid bone loss was estimated on the en-face view of preoperative 3-dimensional computed tomography. Joint laxity was assessed clinically by use of the Beighton and Horan criteria, and patients were divided into 2 groups based on the presence of excessive joint laxity, group L (n=13), or absence of excessive joint laxity, group N (n= 23). Functional assessments were performed with the patient-reported activity level; subjective shoulder value; Rowe score; and University of California, Los Angeles shoulder score. The mean glenoid defect size was 25.1% (range, 20% to 29%), and the overall functional outcomes improved significantly after surgery. A return to greater than 90% of the premorbid activity level was reported by 72% of patients (26 of 36 patients), and patient satisfaction was 83% (30 of 36 patients). There was no significant difference in functional outcomes between groups L and N (subjective shoulder value, 85.0% for group L v 88.9% for group N, P= .397; Rowe score, 83.5 for group L v 92.8 for group N, P= .537; and University of California, Los Angeles shoulder score, 32.2 for group L v 31.9 for group N, P= .697). Recurrent instability occurred in 4 patients (11%), 3 patients in group L (3 of 13, 23%) and 1 patient in group N (1 of 23, 4%), but this difference was not statistically significant (P= .125). Arthroscopic stabilization for recurrent shoulder instability in patients with moderate to low functional demand produced satisfactory outcomes despite the presence of moderate glenoid bone defects of 20% to 30%. For patients with excessive joint laxity, however, arthroscopic stabilization may not be reliable, with a recurrence rate of 23%. Level IV, therapeutic case series.

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty

Background: Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated. Purpose: To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California–Los Angeles (UCLA) score, and Short Form–12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperative imaging was reviewed to classify the acromial morphologic type, acromial angle, and lateral acromial angulation. Results: A total of 114 patients were initially enrolled in the study, and 95 (83%; 43 nonacromioplasty, 52 acromioplasty) were available for a minimum 2-year follow-up. There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Within groups, there was a significant (P < .001) improvement in all functional outcome scores from preoperatively to all follow-up time points, including 2 years, for the nonacromioplasty and acromioplasty groups (ASES score: 55.1-91.5, 48.8-89.0; Constant score: 48.3-75.0, 51.9-78.7, respectively). There were no significant differences in functional outcomes between nonacromioplasty and acromioplasty groups or between subjects with different acromial features at any time point. Conclusion: The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair with or without acromioplasty at 2 years postoperatively.

Cuff tear arthropathy is best treated with a reverse total shoulder arthroplasty

Cuff tear arthropathy is the arthritic eroded collapse of the glenohumeral joint with progressive superior humeral migration in the setting of long-standing rotator cuff insufficiency. The ideal management of cuff tear arthropathy remains elusive. Current arthroplasty options include hemiarthroplasty or reverse shoulder arthroplasty. Proper clinical and radiographic evaluation is essential in decision making in order to optimize outcomes. Acromio-humeral distance (AHD), as measured on plain radiographs, as well as fatty degeneration of the rotator cuff muscles on MRI are reliable tools for decision making. AHD < 7mm correlates well with complete tear of the supraspinatus while AHD < 5mm indicates infraspinatus involvement with significant muscular atrophy. Hemiarthroplasty remains an option for providing pain relief; however, continued development of superior migration and glenoid erosion remains a concern. The conversion to reverse total shoulder arthroplasty after hemiarthroplasty can be difficult due to glenoid bone loss. Recent literature supports the use of reverse total shoulder arthroplasty over hemiarthroplasty for cuff tear arthropathy with significant differences in functional outcome. Here, we discuss the radiographic evaluation of cuff tear arthropathy and review the treatment options and why we advocate the use of the reverse prosthesis.

Abstract W P112: Natural History and Outcomes of Ischemic Stroke Patients with Mild Presenting Symptoms and Large Vessel Occlusion

Introduction: Large vessel occlusion (LVO) is thought to be an independent predictor of clinical outcome in acute ischemic stroke (AIS). Despite various available treatment modalities, optimal therapy for LVO patients presenting with mild symptoms is not known. These patients remain a significant challenge in clinical practice. Methods: Retrospective chart review of AIS patients admitted between January 2010 and August 2012 at a large tertiary care center. Inclusion criteria: symptom onset within 8 hours, LVO as cause of symptoms, initial NIH stroke scale (NIHSS) &lt; 8. Patients with bilateral lesions, distal small vessel involvement or single vertebral artery disease were excluded. Tandem lesions were included. Patient demographics, administered therapies and short term clinical outcomes were analyzed. Results: A total of 51 patients (56.9% male; mean age 66.4±14.5) fulfilled our strict criteria for inclusion. MCA involvement was seen in 31 (60.8%), ICA 13 (25.5%), basilar 3 (5.9%) and tandem ICA-MCA in 4 (7.8%). A total of 15 (29.4%) received acute therapy with IV t-PA and/or endovascular intervention (TX); both were used only in 6 (11.8%). Follow-up at 30 days was available in 64.7% of patients: 58.3% with TX and 80% without. Mean NIHSS remained relatively stable showing 4.3±2.1 on admission, and 2.6±3.4 on discharge (NS), with 75.8% of patients having same or better NIHSS on follow-up. There was a significant difference in functional outcome: mRS≤2 was present in 98% of patients on admission, but only in 63.6% at follow-up. If extended the mRS range, 90.9% of patients had mRS≤3 on follow-up. Only 33.3% at follow-up had same or better mRS than on admission. Results were consistent, irrespective of receiving acute therapy. Conclusion: Acute LVO with mild presenting symptoms remains a difficult therapeutic challenge. Our data shows that despite stable gross clinical examination (by NIHSS) on follow-up, a large proportion of patients experience mild to moderately worse functional outcome, irrespective of receiving acute therapy. Our study limitations include retrospective analysis and suboptimal patient follow-up, especially in untreated patient population. We believe that a prospective, larger cohort is warranted to find optimal treatment approach.