Simple Shoulder Test Research Articles

Utilizing Virtual Reality in the Treatment of Subacromial Impingement Syndrome: Enhancing Efficacy Through Integration with the Simple Shoulder Test and Pain Arch Test

<span lang="ES">Subacromial impingement syndrome (SIS) is a prevalent cause of shoulder pain and dysfunction. This study investigates the impact of virtual reality (VR) therapy on shoulder function, joint dysfunction, and pain in SIS patients, comparing its effectiveness to traditional rehabilitation methods. Materials and Methods: Over 50 weeks, 288 participants with SIS were recruited and divided into two groups: an experimental group (EG) receiving VR-augmented therapy and a control group (CG) undergoing conventional rehabilitation. Recovery was assessed using the Painful Arch Test and Simple Shoulder Test (SST) at key intervals (T0, T1, T2, and T3). Statistical analysis was conducted to evaluate recovery times and functional improvements. Results: The EG showed significantly faster recovery with a mean duration of 6.04 weeks compared to 7.01 weeks for the CG (p = 0.0041), as determined by the Welch Two Sample t-test. The 95% confidence interval (0.3137 to 1.6330) confirmed the reliability of these findings. The VR group demonstrated sustained functional improvements, as evidenced by narrower interquartile ranges and more stable SST scores over time, particularly by Session 18, indicating reduced variability and faster recovery compared to the CG. Conclusion: VR therapy significantly accelerates recovery in SIS patients, offering faster and more consistent outcomes compared to conventional rehabilitation. These findings highlight the potential of VR as a non-invasive and effective treatment for improving shoulder function in SIS. Further research is warranted to explore its long-term efficacy and potential for personalized rehabilitation programs.</span>

Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery.

The aim is to determine the effect on healing and functionality of patients after 1 year of biceps augmentation of a rotator cuff repair (RCR) compared to RCR plus long head of the biceps (LHB) tenotomy. In addition, to analyse the main factors involved in the recovery after the surgery. A prospective, comparative, non-randomized study (Level of Evidence III) was conducted. Patients with repairable rotator cuff tears were allocated to either the control group, with a double row transosseous equivalent RCR with LHB tenotomy, or the RCR+augmentation with LHB group. Patients were evaluated for radiological (MRI), clinical (cuff size, Patte and Goutallier scales) and functional variables (Constant and American Shoulder and Elbow Surgeons [ASES] scales) before the intervention. At 1-year follow-up cuff healing was confirmed through MRI and functional evaluation with Constant, ASES, simple shoulder test [SST] and Disabilities of the Arm, Shoulder and Hand scales. Seventy-seven patients underwent control or RCR+augmentation with LHB, there were no preoperative differences between the groups. After 1 year of the surgery, re-rupture occurred in 38.5% and 16% of the patients in control and RCR+augmentation with LHB groups, respectively (p = .026). Total functionality was higher (p < .05) in RCR+augmentation with LHB than in the control group: Constant, SST and ASES scales. Among the explored factors involved in healing, re-rupture occurred in 100% of the cases with high fatty degeneration. Besides, higher initial functionality (Constant scale) and RCR+augmentation with LHB increased the odds of healing (odds ratio [OR] = 1.12 [1.04-1.21]; OR = 5 [1, 61], respectively), while higher cuff length had a detrimental effect (OR = 0.92 [0.85-0.99]). RCR+augmentation with LHB achieves a higher healing percentage and a better functional evolution than RCR+LHB tenotomy, 1 year after cuff repair. Fatty degeneration, cuff length and initial functionality are the main factors involved in cuff healing. Level III randomized controlled trial.

Superior Suspensory Complex of the Shoulder Reconstruction for Acute and Chronic ACJ Dislocations: The QUASR 3-Tunnel Technique

BackgroundManagement of acromioclavicular joint (ACJ) injuries have wide variety of classification systems, surgical indications and operative techniques. Our study describes the QUASR (Queensland Unit for Advanced Shoulder Research) 3-Tunnel Technique with LARS (Ligament Augmentation and Reconstruction System; Surgical Implants and Devices, Arc sur Tille, France) artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in acute, chronic and revision ACJ dislocations and lateral clavicle fractures. MethodsOur prospective cohort series of patients undergoing the QUASR 3-Tunnel Technique using LARS artificial ligament. This technique reconstructs the SSSC using two 4mm clavicle tunnels, one acromion tunnel, and is arthroscopically assisted to pass the artificial ligament under the coracoid. The ligament is secured with braided composite sutures and no interference screw is used. Pre and postoperative functional outcome scores were compared in patients with minimum 12-months follow-up. ResultsOf 26 patients in this series, 7 (27%) were operated within 4 weeks of injury, two (8%) were revision cases, and six (23%) were lateral clavicle fractures. Mean time to surgery was 14 weeks (2-650). Mean postoperative scores with associated 95% CI were Specific Acromioclavicular Score 87.38 (CI 75.38, 99.37), American Shoulder and Elbow Surgeons score 94.60 (87.85, 101.35), Constant 79.47 (71.87, 87.07), Simple Shoulder Test 85.44 (72.34, 98.54) and Visual Analogue Score 0.50 (-0.15, 1.15). There were two infections and one atraumatic loss of reduction, however there were no tunnel fractures. ConclusionThe QUASR 3-Tunnel Technique with LARS artificial ligament is a safe and efficient technique for both acute and chronic acromioclavicular joint reconstruction, lateral clavicle fractures with coracoclavicular ligament disruption and complex revision cases with favorable outcomes at mid-term follow-up.

Arthroscopic management of isolated partial-thickness rotator cuff tears.

The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons(ASES)score following in situ transtendon repair and tear completion, followed by repair. Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASESscore,the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair. Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I2 = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants. Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs. Level IV.

Demographic-, Radiographic-, and Surgery-Related Factors Do Not Affect Functional Internal Rotation Following Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Study.

This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups ("IROgood" or "IRObad"). Patients were classified as having good fIR (≥8 points in the Constant-Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro-Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann-Whitney-U Test. Radiographic changes were compared using chi-square or Fisher's exact tests. The significance level was set at p < 0.05. Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5-57.5]) were included in the "IRObad" group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5-65.5]) were included in the "IROgood" group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort.

Critical shoulder angle and acromial index do not influence functional outcomes after repair of massive rotator cuff tears

ObjectivesCritical shoulder angle (CSA) and acromial index (AI) are two radiographic signs that can influence the risk of rotator cuff tears and the outcomes of repair. The purpose of this study was to determine the influence of CSA and AI on massive cuff tears and on the functional outcomes after repair. The hypothesis was that CSA and AI would be higher in posterosuperior compared to anterosuperior tears. MethodsCSA and AI were retrospectively measured on radiographs of patients who underwent repair of two rotator cuff tendons. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) at least six months postoperatively. Patients were divided according to the tendons repaired into anterosuperior group and posterosuperior group. Radiographic measurements and functional outcomes were compared. Patients in the posterosuperior group were subdivided into low or high CSA (cut-off value ​= ​39), and into low or high AI (cut-off value ​= ​0.75). All available preoperative magnetic resonance images were reviewed and graded according to Goutallier classification. Multivariate analysis was used to determine the influence of CSA, AI and Goutallier grade on functional outcomes. ResultsEighty six patients were included. Both CSA and AI were statistically significantly higher in the posterosuperior group (p ​= ​0.0143 and 0.0052, respectively). After a mean follow-up of 33 months, ASES and SST were significantly better in patients with Goutallier grades 0–1 than grades>1 (multivariate p ​= ​0.03 and 0.009, respectively). No statistically significant differences were found between low and high CSA and AI groups in terms of functional outcomes of the posterosuperior group after repair (multivariate p ​= ​0.9). ConclusionHigher CSA and AI seem to increase the risk of posterosuperior more than anterosuperior rotator cuff tears. Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair. Level of evidenceLevel III.

Impact of insurance payer type (medicare vs. private) on the patient reported outcomes after shoulder arthroplasty

BackgroundThis study’s purpose is to determine if there is a difference in patient reported outcome measures (PROMs) following shoulder arthroplasty (SA) based upon payer insurance type with a secondary outcome of determining if any appreciable difference surpasses the minimal clinically important difference (MCID). MethodsSubjects undergoing anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) were prospectively enrolled between March 2019 – March 2021. Subjects completed PROMIS Upper Extremity (P-UE), the American Shoulder and Elbow Score (ASES), and the Simple Shoulder Test (SST) preoperatively and at 2-weeks, 6-weeks, 3-months, 6-months, and 12-months postoperatively. Descriptive statistics of baseline patient characteristics and preoperative PROMs (ASES, SST, P-UE) were compared between insurance types. Results143 patients were identified who met the inclusion criteria for this study. There were 98 patients within the Medicare cohort and 45 patients with private insurance. Patients in the Medicare cohort were older (mean age 70.5 vs 61.3 years), with high proportion of smokers, diabetics, and rTSA compared to the private payor cohort. There were no significant differences between the two cohorts with respect to outcomes scores except for significantly better SST in the private insurance cohort (69.3 versus 79.4, p=0.02). No significant differences were noted for the achievement of MCID between cohorts [P-UE (p=1.0), ASES (p=0.25), SST (0.52)] and pre- to postoperative improvements for P-UE (p=0.62), ASES (p=0.4), or SST (0.66). ConclusionOur study demonstrates that, at a tertiary level academic institution in a metropolitan city, payor type does not have significant impact on achieving MCID or pre-to-postoperative improvements in PROMs after SA.

Short-term clinical and radiographic outcomes with modular long stem for revision reverse total shoulder arthroplasty

BackgroundWhen performing reverse total shoulder arthroplasty with compromised proximal bone fixation, surgeons must consider using specialized stems with a distal press-fit design. In this study, the authors report on the clinical and radiographic outcomes of patients who underwent surgical management with modular diaphyseal press-fit stems. MethodsIn 2017-2021, patients who underwent revision reverse total shoulder arthroplasty reconstruction with diaphyseal press-fit stems (Aequalis Adjustable Stem [AS] or Aequalis Flex Revive Stem [RS]; Stryker, Kalamazoo, MI, USA) with minimum 1-year follow-up were identified. Patients with complex proximal humerus and scapula fractures, neurological injuries, and custom humeral replacements were excluded. Demographics and clinical follow-up data including range of motion, Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder Elbow Surgeons (ASES) Score, and Single Assessment Numeric Evaluation were retrospectively reviewed. Postoperative radiographs were reviewed for aseptic humeral loosening, periprosthetic instability, stress shielding, periprosthetic fractures, and humeral stem failure. ResultsSixty-five patients (29 AS and 36 RS) had mean follow-up of 25 months (standard deviation ± 16). Mean anterior elevation improved from 57° ± 39 preoperative to 121° ± 31 postoperatively. Mean external rotation improved from 3° ± 17 to 34° ± 16. Mean internal rotation improved from 4° ± 13 to 35° ± 26. Mean VAS improved from 6.7 ± 2.2 to 2.9 ± 1.5. Mean SST improved from 13% ± 13% to 65% ± 22%. Mean ASES score improved from 19 ± 13 to 60 ± 18. Mean Single Assessment Numeric Evaluation improved from 25% ± 18% to 71% ± 17%. There were statistically significant differences in mean postoperative VAS (P = .0017), SST (P = .025), and ASES score (P = .0228) in favor of the RS group. There were no other notable differences between groups. The most common complications were aseptic humeral stem loosening (24% vs. 3%, P = .018) and periprosthetic instability (10% vs. 6%, P = .649) for the AS and RS cohorts, respectively. There was no statistically significant difference between surgical revision rates between the AS and RS cohorts (24% vs. 8%, respectively. P = .096). DiscussionDiaphyseal press-fit modular humeral stem can provide a viable surgical alternative in compromised proximal humeral bone. At short-term follow-up, the clinical and radiographic outcomes are comparable to other stem designs. Further studies are necessary to identify risks and causes of failure associated with modular diaphyseal press-fit stems.

Comparison of short- and midterm outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties

Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients because of potential activity restriction and concerns about glenoid loosening. The ream-and-run procedure (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising, although more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple time points between matched aTSA and RnR cohorts. Second, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort Last, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering. We performed a retrospective matched-cohort study comparing patients who underwent an RnR vs. patients who underwent the aTSA procedure between 2017 and 2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and daily and worst pain outcomes were compared between groups at 3 and 6 months, and 1 and 2 years postarthroplasty. Pre- and postoperative glenoid anatomy and humeral decentering were measured radiographically, and correlation analyses were conducted to explore relationships between these factors and 2-year pain and function scores. Forty-six shoulders (23 RnR and 23aTSA) belonging to 43 male patients with an average age of 56.2±8.3 years were included. Eighteen matched pairs were available at 3 and 6 months, 21 matched pairs at 1 year, and all 23 matched pairs at the 2-year time point. RnR patients reported significantly higher daily pain ratings (P=.047) and lower ASES scores (P=.031) compared with the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoanatomy outcomes were not directly related to final reported pain or function in the RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort. Young male patients undergoing RnR can likely expect similar short-term results as young male patients who undergo aTSA. Additionally, the RnR outcomes were not affected by preoperative glenoid wear or humeral head decentering. Our findings support the RnR as a viable surgical alternative for young, active patients with shoulder arthritis.

Outcomes of Total Shoulder Arthroplasty With and Without Prior Rotator Cuff Repair: A Systematic Review.

The effect of prior rotator cuff repair (RCR) on clinical outcomes after total shoulder arthroplasty (TSA) is unclear. To systematically review the literature to compare the outcomes of TSA in patients with and without prior RCR. Systematic review; Level of evidence, 4. A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching the PubMed, Cochrane Library, and Embase databases to identify studies comparing outcomes of TSA with and without prior RCR. The inclusion criteria were full-text studies that directly compared outcomes between patients undergoing anatomic or reverse TSA with and without prior RCR. A quality assessment was performed using the Modified Coleman Methodology Score (MCMS), and risk of bias assessment was performed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. A total of 1542 articles were identified for review based on initial database queries. Weighted means of quantifiable demographics and patient-reported outcomes were calculated for all included studies and compiled, in addition to the MCMS and ROBINS-I tool. Twelve studies (10 level 3, 2 level 4) met inclusion criteria, including a total of 885 patients who underwent RCR before TSA (mean age, 68.2 years) and 2275 patients with no prior RCR (mean age, 70.0 years). Of all outcomes evaluated, patients with reverse TSA showed superior results in the no prior RCR group. Three reverse TSA studies found the no prior RCR group to have significantly higher postoperative American Shoulder and Elbow Surgeons scores when compared with the prior RCR group (P < .05). Multiple reverse TSA studies found the no prior RCR group to have significantly higher postoperative Simple Shoulder Test scores (P < .05) and significantly improved forward elevation (P < .05) when compared with the prior RCR group. Of all outcomes in anatomic TSA studies, only complication rate was different between groups, with 1 study finding a significantly lower complication rate in the no prior RCR group (P = .01). Patients undergoing reverse TSA without prior RCR can be expected to experience statistically better outcomes when compared with patients with prior RCR, while patients undergoing anatomic TSA can be expected to have similar outcomes regardless of prior RCR status.

The impact of mental health on shoulder arthroplasty and rotator cuff repair: a meta-analysis.

The aim of this study was to evaluate the impact of mental health attributes, such as the presence of psychiatric comorbidities or psychological comorbidities (low resilience), on outcomes after rotator cuff repair (RCR) and total shoulder arthroplasty (TSA). PubMed, Cochrane, and Google Scholar (results pages 1-20) were searched up to November 2023. Mental health problems of interest included the presence of psychiatric comorbidities (depression, anxiety) or indicators of poor psychological functioning, such as low resilience or the presence of distress. Patients were assigned to poor or good mental health groups in this study based on their grouping in the original study. Fourteen studies were included in the meta-analysis. Patients with good mental health had greater improvements in postoperative American Shoulder and Elbow Surgeons and Simple Shoulder Test scores in the TSA cohort (P=0.003 and P=0.01), RCR cohort (P<0.001), and the combined TSA and RCR cohort (P<0.001). No difference was found in visual analog scale score, satisfaction, external rotation, or flexion between the two mental health groups. Patients with poor mental health undergoing RCR experienced higher rates of adverse events and transfusions (P<0.001). Patients with poor mental health also had greater rates of revision and emergency department visits in the TSA cohort (P<0.001), RCR cohort (P=0.05 and P=0.03), and combined cohort (P<0.001). Patients with poor mental health undergoing TSA had a higher rate of re-admission (P<0.001). Patients with poor preoperative mental health showed inferior patient-reported outcome scores and increased rates of adverse events, revisions, and re-admissions. Level of evidence: III.

Defining the tipping point for revision reverse shoulder arthroplasty

Background This study sought to characterize the tipping point values (the functional scores that patients deem dysfunctional enough to warrant surgery) for patients undergoing first revision reverse total shoulder arthroplasty (rTSA). Methods This study was a retrospective review of a prospectively collected single-institution database of patients undergoing first revision rTSA between August 2015 and December 2019. Tipping point evaluation utilized preoperative scores including the American Shoulder and Elbow Surgeons (ASES), raw and normalized Constant, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) scores, and active range of motion including abduction, forward elevation (FE), external rotation (ER), and internal rotation score (IR) prior to elective revision rTSA. Results We included 125 revision rTSAs. Tipping points were 37.6 ASES score, 30.5 raw Constant score, 35.5 normalized Constant score, 68.1 SPADI, 3.7 SST, 13.2 UCLA score, 64° abduction, 69° FE, 23° ER, and 3.1 IR. Higher SST was found for older patients and patients with a lower body mass index. Lower abduction and FE tipping points were reported in patients undergoing revision rTSA for rotator cuff failure, unexplained pain, and implant wear. Discussion These tipping points can help surgeons counsel patients regarding when to undergo revision rTSA. Level of evidence Level III; retrospective cohort study; treatment study.

Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes.

The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2years postoperatively. No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. This clinical trial was registered on Clinicaltrials.gov.

Reverse Total Shoulder Arthroplasty Using Lateralized Glenoid Baseplates Has Superior Patient-determined Outcome Scores at Short-term Follow-up.

There are a variety of baseplate options when performing reverse total shoulder arthroplasty (RTSA). Currently, there is no consensus on the optimal glenoid baseplate. The hypothesis of this study was that the use of lateralized baseplates would improve patient-determined outcomes and postoperative range of motion after RTSA compared with standard baseplates without increasing the risk of complications. Patients undergoing RTSA were stratified into a standard baseplate group (SBG) and a lateralized baseplate group (LBG). The LBG included 3 mm lateralization, 6 mm lateralization, and full-wedge augmentation (8 mm lateralization). The Western Ontario Osteoarthritis Score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) were recorded at baseline, 1 year, and 2 years. Range of motion was recorded at baseline and 1 year. Differences in complications between groups were recorded. The LBG included 187 patients, and the SBG included 51 patients. No difference was observed in any patient-determined outcome score at 1-year follow-up. At 2 years, there were greater Western Ontario Osteoarthritis Score (84 ± 16 versus 74 ± 19; P = 0.01), American Shoulder and Elbow Surgeons score (81 ± 15 versus 70 ± 20; P = 0.001), SST (8.0 ± 2.4 versus 6.6 ± 2.6; P = 0.007), and SANE (82 ± 17 versus 68 ± 25; P = 0.0005). The improvement in SST (5.0 ± 2.7 versus 3.3 ± 3.6; P = 0.02) and SANE (54 ± 26 versus 37 ± 30; P = 0.004) at 2 years compared with baseline was greater in the LBG compared with the SBG. No difference was observed in any range-of-motion metric between groups. Total complications were similar between groups (P = 0.91). Scapular notching was more prevalent in the SBG (7.8% versus 1.6%; P = 0.01). The LBG had better patient-determined outcome scores compared with the SBG at 2-year follow-up with a similar rate of overall complications but a lower rate of scapular notching. Range of motion was not improved by the use of a lateralized baseplate compared with a standard baseplate.

Functional assessment and quality of life of patients after reverse total shoulder arthroplasty in the late follow-up period.

Due to the systematically increasing number of shoulder replacement procedures among older people, the need to assess their quality of life is becoming more and more important. The aim of the study was to functionally assess the shoulder joint and the quality of life of patients before and after reverse total shoulder arthroplasty (rTSA). The observational study included 15 patients after the rTSA procedure (randomly selected). The quality of life and shoulder joint function before and after rTSA were assessed using the following scales: SF-36, Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand Scale (DASH) and the University of California-Los Angeles Shoulder Rating Scale (UCLA scale) and Simple Shoulder Test (SST). There were statistically significant differences (p< 0.001) between measurements in the overall scores of the SF-36 questionnaire. Statistically significant differences (p< 0.001) were found between measurements in terms of the Constant-Murley, DASH, UCLA and SST scales results. Reverse total shoulder arthroplasty significantly improved the patients' quality of life and the functional condition of the operated limb.

Systematic Review and Meta-Analysis Comparing Long Head Biceps Tendon Tenotomy versus Tenodesis with Concomitant Repiarable Rotator Cuff Tears

Abstract Background Both tenotomy and tenodesis have been widely used for the treatment of long head of biceps tendon (LHBT) lesions, but the optimal strategy remains considerably controversial. In this meta- analysis of published studies, we compared the results of the two procedures. Methods A literature search that compared tenotomy with tenodesis was performed using pubmed, MEDLINE, cochrane libaray and researchgate . A total of 6 studies reporting data on 659 subjects were included. Study quality was evaluated using Cochrane collaboration tool for assessing the risk of bias. Results Data synthesis showed higher ASES score, constant score, simple shoulder test mean, lower popeye sign and insignificant vas score in patients managed with tenodesis compared to tenotomy (ASES score, P &amp;lt;0.001; constant score, P &amp;lt; 0.001; simple shoulder test mean, P = 0.045, popeye sign, P = 0.010 ; vas score, P = 0.422 respectively). Conclusion The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score also ASES score compared to biceps tenotomy.

Functional composite spacer (antibiotic cement around a hemiarthroplasty) for the treatment of shoulder infections: minimum 5-year outcomes

Periprosthetic infections remain a challenging complication after shoulder arthroplasty, and an ideal treatment protocol has yet to be established. Two-stage revision is a common approach. Historically, the first stage entails placement of an all-cement antibiotic spacer. Although prior studies have reported on cement spacers as definitive management, persistent pain and inadequate function often lead many to later request a second-stage procedure. The functional composite spacer consists of a humeral hemiarthroplasty implant with antibiotic cement coated around the stem alone to preserve the metallic humeral head-glenoid articulation. Functional composite spacers have demonstrated improvements in function and motion with high patient satisfaction at 25 months, but longer-term follow-up is needed to better understand the role it may play in the management of shoulder infections. The purpose of this study is to evaluate outcomes at a minimum of 5 years in patients who initially planned to undergo 2-stage revision but elected to retain the functional spacer. A retrospective review of a single institution's shoulder surgery repository from 2007 to 2018 identified 30 patients who underwent placement of a composite spacer. Overall, 5 patients underwent second-stage reimplantation and 12 patients did not have 5-year follow-up (6 lost to follow-up and 6 deceased). A total of 13 patients were included who maintained a functional composite spacer and had minimum 5-year follow-up. Patient-reported outcome measures (American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Single Assessment Numeric Evaluation, visual analog scale function, and visual analog score pain), satisfaction, range of motion, and radiographic estimation of glenoid wear were evaluated. Two of 13 patients (15%) required additional surgery: 1 secondary closure for early superficial wound dehiscence and 1 revision spacer for pain. There were no reinfections. At most recent follow-up, patient satisfaction was high and significant improvements were noted for American Shoulder and Elbow Surgeons score (45.4; P<.001), Simple Shoulder Test (5.3; P=.003), Single Assessment Numeric Evaluation (47.3; P=.002), visual analog scale function (4.9; P=.004), and visual analog score pain (-4.4; P=.007) as well as range of motion including abduction (39.2°; P=.005) and elevation (65.9°; P=.005). There was no significant change in humeral head medialization (P=.11). Patients who do not undergo an early revision and retain a functional composite spacer maintain good function and range of motion with minimal pain at midterm follow-up.

Poster 131: Loop 'N' Tack Tenodesis: A Multi-Center Retrospective Case Series of Clinical and Patient Reported Outcomes of a Novel Suture Technique for Proximal Biceps Tenodesis

Objectives: Tenodesis and tenotomy of the long head of the biceps are treatment options for a wide range of pathologies without clear superior technique or site of fixation. Tenotomy may result in a cosmetic “Popeye” deformity and fatigue pain. The Loop ‘N’ Tack technique is a quick, simple, and knotless technique for tenodesis of the long head of the biceps that can be completed entirely arthroscopically. The tensionless repair allows the biceps to scar within the biceps groove, thereby reducing subsidence and formation of a “Popeye" deformity and fatigue pain in the biceps seen with tenotomy alone while eliminating the ability to overtension. The primary objective will be to retrospectively report the clinical outcomes and associated complications of patients undergoing biceps tenodesis utilizing the Loop ‘N’ Tack technique at multiple institutions from 1/1/2015 – 7/25/2021. Methods: CPT procedure codes (29827,29823, 29826) were used to identify participants in the EHR (i.e., Epic) who underwent the Loop ‘N’ Tack biceps tenodesis technique by each author at 9 separate institutions. Patient reported outcomes (PRO) including Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), UCLA Shoulder Rating Scale (UCLA), and Simple Shoulder Test (SST) were recorded at multiple time points throughout the patient’s preoperative and postoperative course. Scores were compared to the established minimal clinically important difference (MCID) for each PRO to assess the viability of this tenodesis technique. Additional metrics including bicipital groove pain, Popeye deformity, and need for revision surgery were also recorded. Results: 1,473 patients were initially screened who underwent the Loop ‘N’ Tack biceps tenodesis technique. 82 patients were excluded secondary to limited follow up or lack of PRO data within the EHR. The average patient age was 64.7 years old with average follow up of 8.11 months. Mean preoperative PRO scores were 5.64 (2.13), 43.31 (20.38), 15.14 (3.52), 5.81 (1.92), and 49.24 (15.06) for the VAS, SANE, UCLA, SST, and ASES scores, respectively. Postoperative PRO scores at most recent follow up respectively measured 1.05 (1.66), 89.56 (17.06), 31.50 (4.01), 10.69 (1.92), and 89.48 (13.81). MCID was reached for each PRO at the 1-2 month mark postoperatively. 36 patients (2.6%) underwent revision surgery for biceps related pathology, while 40 patients (2.9%) required revision shoulder surgery for a separate pathology. Postoperative Popeye deformity was noted in 15 patients (1.08%). Conclusions: The Loop ‘N’ Tack technique results in high rates of patient satisfaction with improvement in shoulder related patient reported outcomes, low incidence of postoperative pain, and low rates of Popeye deformity. This case series establishes the Loop ‘N’ Tack technique as a viable tenodesis approach during shoulder arthroscopy for biceps related pathology.

Revision rotator cuff repair versus primary repair: an assessment of longitudinal outcomes in revision rotator cuff repair

BackgroundInformation about outcomes after revision rotator cuff repair (RCR) is limited. A more thorough investigation of pain, range of motion (ROM), strength, and functional outcomes is needed. Comparing outcomes between primary and revision rotator cuff repair patients can help surgeons guide patient expectations of the revision procedure. The aim of this study was to compare the outcomes of a revision repair group to a control group of primary RCR patients. We expect revision RCR patients to have worse clinical outcomes than primary RCR patients. MethodsA retrospective review of patients who underwent primary or revision RCR between 2012 to 2020 was performed. The case group included 104 revision patients, and the control group included 414 primary RCR patients. Patient visual analog score (VAS) for pain, ROM, strength, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at baseline, 12 months, 24 months, and final follow-up. ResultsThe average final follow-up was 43.9 months for primary patients and 63.8 months for revision patients. 352 primary patients and 55 revision patients had a final follow-up of 2 or more years. By final follow-up, primary patients had less pain than revision patients (Δ of 2.11, P < .0001), but both groups improved overall. Primary patients had significant improvements in forward flexion, external rotation, internal rotation, and abduction at 2 years that were lost by final follow-up, but revision patients did not experience any long-term improvement in ROM. These differences in ROM between groups were not significant. Supraspinatus strength in the revision group did not improve nor decline by final follow-up. By final follow-up, both primary and revision patients had improved SST and ASES scores from baseline. Primary patient ASES scores were 17.9 points higher (P < .0001) than revision patients by final follow-up, and there was no difference between groups in SST scores at this time. ConclusionRevision RCR significantly improves patient pain, SST score, and ASES score at 4 years. Revision patients should not expect to see the improvements in range of motion that may occur after primary repair.

Poster 150: Subscapularis CT Evaluation in Patients following Treatment for Proximal Humerus Fractures: Reverse versus Anatomical Total Shoulder Arthroplasty

Objectives: Hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. While the role of the subscapularis tendon is well defined in HA, its role in RTSA has not been clearly demonstrated. The purpose of our study is to evaluate the role of the subscapularis tendon in patients treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fractures were prospectively enrolled in the study between June 2015 and May 2020 (RTSA = 36; HA = 32). Shoulder CT scans were performed pre- and postoperatively, and subscapularis muscle cross-sectional area (SMCSA) and supraspinatus fossa cross-sectional area (SFCSA) were measured. SMCSA/SFCSA ratio was employed to standardize values. Patient-reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: RTSA group demonstrated higher PROs compared to HA patients: Constant Score (p = .0001), Quick Dash (p = .0006), Simple Shoulder Test (p = .01). ROM was better in RTSA than HA: internal rotation (p = .0047 adduction and p = .026 abduction), external rotation (p = .001 adduction and p = .026 abduction) and forward flexion (p &lt; .0001). Reduction of subscapularis size of &gt;35% occurred in 20 RTSA and 8 HA (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better PROs and ROM. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition demonstrated no correlation with functional outcomes in RTSA.