Single Assessment Numeric Evaluation Score Research Articles

Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair surgery is one of the most common shoulder procedures performed in the United States. Although several studies have shown considerable symptomatic relief in the short term following surgery, a relatively high rate of recurrent defects has led surgeons to question the long-term durability of this operation. We hypothesized that outcomes at a minimum of 15 years of follow-up in patients who underwent all-arthroscopic rotator cuff repair would be maintained and would remain significantly improved compared with the preoperative status. All-arthroscopic rotator cuff repairs were performed in 193 patients from 2003 to 2005. Patient-reported outcomes were collected preoperatively and at 1, 2, 5, and ≥15 years postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included Single Assessment Numeric Evaluation (SANE), Shoulder Activity Scale (SAS), visual analog scale, and Patient-Reported Outcomes Measurement Information System (PROMIS)-Upper Extremity (UE) scores. Patient demographic characteristics, revision surgical procedures, and complications were recorded. Generalized estimating equations were used to model scores over time, and multiple comparisons between time points were performed using Tukey adjustment. This study included 60 patients with a mean follow-up period of 16.5 years (range, 15.8-17.7 years). The mean ASES score improved from 60.2±18.8 preoperatively to 93.0±9.4 at ≥15 years (P<.0001). The mean visual analog scale pain score decreased from 4.1±0.7 preoperatively to 0.7±0.3 at ≥15 years (P<.0001). The average SANE, SAS, and PROMIS-UE scores at ≥15 years were 87.8±14.8, 8.8±4.3, and 49.6±10.2, respectively. Of 60 patients, 7 underwent revision surgery. Older age and female sex were associated with lower SAS scores at 15 years, whereas female sex was associated with lower PROMIS-UE scores. There were no factors predictive of ASES or SANE scores. At long-term follow-up (≥15 years), the patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable over a period of 15 years. This information is useful in counseling patients regarding the long-term results of this procedure.

Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years

Background: Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. Purpose: To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. Study Design: Case series; Level of evidence, 4. Methods: Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. Results: At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. Conclusion: Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.

Shoulder Injury Related to Vaccine Administration: Case Series.

Objective Shoulder pain is a common presentation in the primary care setting, and shoulder pain after vaccination has a growing body of literature. The present study sought to understand how a standardized treatment protocol would aid patients experiencing shoulder injury related to vaccine administration (SIRVA). Methods Patients experiencing SIRVA were retrospectively recruited between February 2017 and February 2021. All patients were treated with physical therapy and offered a cortisone injection. Post-treatment range of motion (i.e., forward elevation, external rotation, internal rotation) and patients' reported outcomes were collected with the visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), simple shoulder test (SST), and single assessment numeric evaluation (SANE) scores. Results A total of 9 patients were retrospectively examined. Among them, 6 patients presented within one month of a recent vaccination event, while 3 patients presented 67, 87, and 120 days after vaccination. Furthermore, 8 of the patients completed physical therapy, and 6 of them underwent a cortisone injection. The follow-up time averaged 8 months. At final follow-up, the mean external rotation was 61° (standard deviation, SD ± 3°) and the mean forward elevation was 179° (SD ± 45°). Internal rotation ranged between L3 and T10. The VAS pain scores were 3.5/10.0 (SD ± 2.4), the mean ASES score was 63.5/100.0 (SD ± 26.3), and the SST scores were 8.5/12.0 (SD ± 3.9). Finally, the SANE scores were 75.7/100.0 (SD ± 24.7) and 95.7/100.0 (SD ± 6.1) in the injured and contralateral shoulders respectively. Conclusion Shoulder pain after a vaccination treated with physical therapy and cortisone injection ultimately resulted in favorable shoulder range of motion and functional score outcomes. Level of Evidence IV.

Relation entre l’état musculosquelettique et les mobilités passives (mesures des résultats exprimés par les patients) dans le cadre des douleurs atraumatiques de l’épaule

IntroductionPatient-reported outcome measures (PROMs) are commonly utilized to assess patient-derived orthopaedic health status and function. The prevalence of limited musculoskeletal health literacy (MHL) has been demonstrated to be high within the orthopaedic literature. The purpose of this study was to evaluate the association between MHL and upper extremity-specific PROMs and to determine which patient- and symptom-related factors affect baseline PROMs in patients with atraumatic shoulder pain. HypothesisPatients with limited MHL would demonstrate lower median scores on baseline PROMs compared with those with adequate MHL. Materials and methodsNew patients with atraumatic shoulder pain presenting to an academic practice were administered the Literacy in Musculoskeletal Problems (LiMP), in addition to the American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and Single Assessment Numeric Evaluation (SANE) questionnaires. A detailed physical exam and history was performed by a fellowship-trained shoulder surgeon. Demographic patient data, in addition to prior imaging and orthopaedic treatment, was tabulated. The association between demographics, pain-related variables, and MHL with the ASES, SANE, and QuickDASH scores were examined using Spearman correlation coefficients for continuous variables and Wilcoxon rank-sum tests for categorical variables. Non-parametric analysis of covariance (ANCOVA) was used to examine the independent association of predictor variables with PROMs. ResultsA total of 439 patients met the inclusion criteria and were enrolled. The mean age was 58,8±12.6 years (range, 24–93) with 162 (37 %) being men. Overall, 172 patients (39.2 %) attained a college degree or higher and 183 (41.7 %) were currently employed. MHL was significantly associated with ASES (p=0.03), but not with the QuickDASH (p=0.75) or SANE score (p=0.16). Similarly, age, having been in the medical profession or having previously visited an orthopaedist, was not associated with PROMs, while employment status correlated to the SANE score (p=0.002). Visual Analogue Scale (VAS) pain level demonstrated varying strengths of association with each of the scores (ASES (r=−0.729, p<0.001), QuickDASH (r=0.557, p<0.001), and SANE (r=−0.430, p<0.001)). MHL demonstrated no association with initial patient-derived treatment selection. DiscussionThe SANE and QuickDASH may be administered to patients presenting for atraumatic shoulder pain in the outpatient setting regardless of MHL. Further research should be focused on the utility of the ASES instrument amongst patients with lower educational levels and/or limited MHL. Level of evidenceII; diagnostic.

Paper 59: Comparison of Knotless versus Knotted Suture Anchors in the Arthroscopic Management of Adolescent Shoulder Instability

Objectives:Shoulder instability among adolescent athletes remains a complex challenge with high recurrence rates. Knotted suture anchors have provided consistently reliable biomechanical and clinical results. In recent years, the advent of the knotless suture anchor technology has come with proposed advantages of minimizing technical difficulty and knot migration, as well as reducing subsequent intra-articular cartilage irritation and damage. While several studies have analyzed the utility of knotless suture anchors in the adult population, to our knowledge, there has not been a direct comparison within this more at risk for surgical failure adolescent population. The purpose of this study was to compare the effect of knotted versus knotless suture anchor use on postoperative outcomes of arthroscopic shoulder instability surgery in the adolescent athlete.Methods:A multicenter comparative cohort was conducted of patients that underwent primary arthroscopic shoulder labral repair with suture anchor implants for shoulder instability between June 2015 and November 2017. Additional inclusion criteria included patient age <20 years and minimum follow up duration of 3.5 years. Data collected included demographics, number and type of suture anchor (knotted or knotless), number of instability events, type of instability, and presence of bony Bankart lesions. All included patients had <20% glenoid bone loss at the time of surgery. Type of instability was also recorded and was classified as either: anterior, posterior, or multidirectional (MDI). The primary outcome measure was surgical failure, which was defined as any recurrent instability event post-surgery. Incidence of secondary surgery (including revision or need for additional procedure), surgical times, and return to sport (RTS) data were also recorded. Patient-reported outcomes were evaluated using the Pediatric and Adolescent Shoulder Survey (PASS), SANE (Single Assessment Numeric Evaluation) scores, and the Quick version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey.Results:Eighty-eight shoulders (54 male, 34 female) from 84 patients met inclusion criteria and were analyzed. 43 received knotless anchors and 45 received knotted anchors. Mean follow-up duration was 4.5 years (range, 3.5-6 years) for the knotless cohort and 4.8 years (range, 3.7-5.8 years) for the knotted cohort. Demographics and type of instability by suture anchor type is shown in Table 1. Surgical failure rate was significantly lower in the knotless cohort (knotless, 16%; knotted, 53%; P<.001). Patients with knotless suture anchors reported significantly higher mean PASS scores (knotless, 90.2; knotted, 81.3; P=.002). There was no difference in both RTS rates (knotless, 86%; knotted, 68%; P=.055) and incidence of repeat surgery between cohorts (knotless, 9%; knotted, 13%; P=.551).Surgical times, SANE scores, and QuickDASH scores were available for approximately three-quarters of shoulders (total, 65; knotless, 36; knotted, 29) in the cohort. Mean surgical time was approximately 18 minutes shorter for knotless anchors (knotless, 84.4 minutes; knotted, 102.7 minutes; P<.001). SANE scores were significantly higher in the knotless group (knotless, 88.8; knotted, 74.3; P=0.004). QuickDASH scores, of which a lower score is considered a better outcome, were not different (knotless, 5.7; knotted, 11.4; P=.063).Conclusions:Our initial intent was to demonstrate that knotless anchors would be just as successful as labral repairs with knotted anchors, but our results indicate several promising advantages, including: better patient reported outcome measures (PASS and SANE scores), reduced surgical times, and lower failure rates at a mean 4.5 years. There were some non-significant differences in the two cohorts regarding the type of instability that likely contributed to the differences in the number of anchors utilized. Future studies with larger sample sizes may serve to confirm our observed benefits associated with knotless anchors. In summary, the utilization of knotless suture anchor constructs for the repair of labral tears in adolescent shoulder instability may be safely considered with potentially improved outcomes over knotted anchors.Table 1.Demographic characteristics of included patients

Poster 144: Minimum 2-year Outcomes after Knotless All-Suture Anchor Bankart Repair

Objectives:Knotless, all suture anchors have significant theoretical and technical advantages such as less bone removal, easier revision, lower profile so less risk for cartilage damage, but clinical results are lacking. The purpose of this study was to report on minimum 2-year outcomes after arthroscopic knotless all-suture Bankart repair in patients with anterior shoulder instabilityMethods:IRB approval was obtained prior to initiation of this study. Data was collected prospectively and retrospectively reviewed. Patients met inclusion criteria if they were a minimum 2 years out from a Bankart repair using all-suture, knotless anchors (FiberTak anchors) for the repairs by a single surgeon from September 2017 to June 2019. Patients were excluded if they had an anterior labroligamentous periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligament, glenolabral articular disruption lesion, or a rotator cuff repair. Outcome data was collected preoperatively and evaluated at a minimum follow-up of 2 years postoperatively using the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numeric Evaluation Score (SANE), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the Short Form 12 physical component summary (SF-12 PCS), and patient satisfaction to assess surgical outcomes at final follow-up. Also included are several questions regarding shoulder pain, function and sports participation. Patients with re-dislocations and revision surgery were noted along with any surgical complications. Surgical failure was defined as revision instability surgery, re-dislocation requiring reduction with an ASES score less than 70 or a satisfaction score of 6 or less.Results:A total of 32 patients, 8 females and 24 males, with an average age of 28.5 (SD10.7) years at the time of surgery were included. Postoperative shoulder re-dislocations were reported in 5 cases (15.6%) with 2 patients progressing to a Latarjet (6.0%) at 2 & 3 years post-operatively. There were no postage stamp fractures noted. Moreover, the anchors did not interfere with revision surgery in any way. At final follow-up, mean PRO’s significantly improved over preoperative levels. ASES score improved from 58 to 93 (p<0.001), SANE improved from 58-94 (p<0.001), QuickDASH improved from 32.0 to 6.0 (p<0.001) and SF-12 PCS improved from 45.6 to 55.7 (p<0.001). Median postoperative satisfaction was 10/10 (range4-10). Patients reported a significant improvement in shoulder pain during competition (p<.001), and ability to compete in sports (p< .001). There was also significant improvement in painless use of arm for overhead activities (p= .001) and ability to throw a softball 20 yards (p= .001)Conclusions:The arthroscopic treatment of Bankart lesions with knotless all-suture anchors leads to results similar to clinical outcomes to prior studies, with the advantage of ease of revision. Long-term follow-up studies with large patient cohorts will show if the other theoretical advantages of these anchors are born out.

Poster 171: No Difference in Clinical Outcomes for Arthroscopic Suprapectoral versus Open Subpectoral Bicep Tenodesis: A Randomized Prospective Analysis

Objectives:Our group has previously reported the 1-year outcomes arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps strength and pain, any ongoing changes in functional outcomes is yet unknown. We aimed to directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at 2 years follow-up.Methods:Eighty-seven patients undergoing biceps tenodesis for LHBT disease were randomized into the ASPBT group or OSPBT group. Both techniques utilized polyether ether ketone (PEEK) inference screws for tenodesis fixation. Patients completed American Shoulder and Elbow Surgeon (ASES), Constant subjective, and Single Assessment Numeric Evaluation (SANE) questionnaires preoperatively, and again at 6 months, 12 months and final follow-up at minimum 24 months.Results:Seven-five patients (37/46 randomized to ASPBT [80%], 38/41 randomized to OSPBT [93%]) with a mean age of 50.3 ± 10.4 years and a mean body mass index of 28.9 ± 6.3 were included in clinical outcome analyses. Mean final follow-up was 35.1 months (ASPBT: 35.4 months, OSPBT: 34.9 months, range 24-63 months). Comparison of demographic characteristics and intraoperative findings showed no significant difference in age, gender, concomitant procedures, and rotator cuff disease. No statistically significant differences in ASES (P =.26), Constant subjective scores (P = .60), and SANE scores (P = .74) were found at final follow-up. Clinical outcomes scores showed no significant improvement from 12.6 months to final follow-up at 35.1 months (ASPBT: ASES, P=0.42; Constant, P=0.23; SANE, P=0.43 v. OSPBT: ASES, P=0.76; Constant, P=0.57; SANE, P=0.64). The mean SANE score in the ASPBT group had a statistically nonsignificant, 6.1-point increase from 1 to 3 years post-operatively (p = .23), which was greater than the minimal clinically importance difference (MCID). No patients required revision of biceps tenodesis in either group.Conclusions:No significant differences in patient-reported outcomes and complication rates were found at any time point between subjects undergoing ASPBT or OSPBT, utilizing the same interference screw technique, for the management of LHBT pathology.Table 1Patient Demographic and Other CharacteristicsTable 2Intraoperative FindingsTable 3Patient Reported Outcome measuresTable 4Patient Reported Outcome Measures Difference from 12 Months to Final Follow-Up

Poster 158: Does an In-Situ Biceps Tenodesis with an Anatomic Length-Tension Relationship affect the Incidence of Popeye Deformity and Clinical Outcomes Compared to an Estimated Length-Tension Relationship Technique?

Objectives:Biceps Popeye deformity is a common finding with rupture of the long head of the biceps tendon (LHBT), biceps tenodesis failure or length-tension mismatch during tenodesis. The Popeye muscle is a cosmetic deformity of the arm that may be accompanied by cramping and muscle fatigue and many patients are dissatisfied with the symptoms and appearance. Although prior studies have described physiologic landmarks to optimize the length-tension relationship during biceps tenodesis after LHBT rupture, no study has assessed the biceps muscle appearance after tenodesis “in-situ” prior to the release of the LHBT from the superior labrum for biceps tendon pathologies without complete rupture. Therefore, the purpose of this study is to assess clinical outcomes of an all-arthroscopic technique for biceps tenodesis which maintains the anatomic length-tension relationship of the LHBT prior to tenotomy from the superior labrum. We compared this group of patients to a control group of patients who underwent an interference screw tenodesis technique that required cutting the LHBT from the superior glenoid prior to tenodesis with an estimation of the anatomic length-tendon relationship potentially contributing to subtle biceps Popeye deformity. We hypothesize that an “in-situ” anatomic length-tension relationship tenodesis technique would reduce the risk of a Popeye deformity, reduce cramping and muscle fatigue, and have improved patient-reported outcome measures compared to an estimated length-tension relationship tenodesis with an interference screw.Methods:Consecutive patients who underwent arthroscopic biceps tenodesis with concomitant rotator cuff procedures were enrolled in this study from 2019-2021 and patients were grouped based on a change in senior author’s tenodesis technique, with the initial cohort having an arthroscopic interference screw subpectoral biceps tenodesis after tenotomy from the superior labrum in an “estimated” length-tension relationship technique (Group 1), and the later cohort having an arthroscopic suprapectoral biceps tenodesis “in-situ” with an anatomic length-tension relationship (Group 2) with the LHBT tied to the side of the humerus with all-suture unicortical anchors. Patients were assessed at a minimum of 3-month follow-up and asked about post-operative anterior arm pain and biceps muscle spasms, and if they notice any difference in appearance between their bicep muscles on a 4-point Likert scale (none, mild, moderate, severe). Patient-Reported Outcomes (PROs) of Veterans-Rand 12, American Shoulder and Elbow Score (ASES), EuroQol- 5 Dimension (EQ-5D), PROMIS 10, and Single Assessment Numeric Evaluation (SANE) were collected. Bilateral bicep images of participants were taken in three forearm positions with the elbow flexed 90 degrees: (1) maximal supination, (2) neutral, and (3) maximal pronation. Review of pronation, supination, and neutral forearm rotation bilateral biceps images were evaluated, after blinding and de-identification, by two shoulder and elbow fellowship-trained board-certified orthopedic surgeons for visual appearance and grade of Popeye deformity (none, mild, obvious Popeye). Non-parametric between-group comparison and analysis were performed with statistical significance set at p < 0.05.Results:Sixty-two patients (53% female, age 58.7 ± 9.0 years) were enrolled (33 in Group 1 and 29 in Group 2) with a mean follow-up of 9.8 ± 6.5 months. There were no significant differences between groups with respect to gender, age, and laterality of biceps tenodesis, as well as type and size of rotator cuff repair. There were no significant differences in ASES, EQ5D, and SANE scores between the two technique groups. However, PROMIS 10 Physical Health Scores were significantly improved in Group 2 (15.7 ± 2.3) compared to Group 1 (14.4 ± 2.9) (p=0.03). Patients in Group 2 experienced significantly less pain in their anterior arm than patients in Group 1 (19% vs. 33%, p=0.02) however there were no differences in biceps muscle spasm (3.4% vs. 5.2%, p=0.21). There also were no significant differences in patient-perceived biceps deformity between Group 1 (17.2%) and Group 2 (27%) (p=0.26). Similarly, there were no significant differences in surgeon-perceived biceps deformity between Group 1 and Group 2 (30.3% vs. 24.1%, p=0.47). Interrater reliability for surgeon assessment of a Popeye deformity was found to have a substantial agreement with a Kappa value of 0.77 (p <.0.001), 95% CI (0.645, 0.855).Conclusions:An arthroscopic suprapectoral biceps tenodesis performed “in-situ” with an anatomic length-tension relationship did not reduce the incidence of patient or surgeon perceived Popeye muscle deformity compared to an interference screw tenodesis performed after tenotomy in an “estimated” length-tension relationship technique. Interestingly, the “in-situ” length-tension technique reduced anterior arm pain and improved PROMIS 10 physical health scores post-operatively compared to the “estimated” interference screw technique.

Paper 08: Outcomes After Arthroscopic Pancapsular Shift for the Treatment of Multidirectional Glenohumeral Instability at a Mean 9 Year Follow-up

Objectives:Arthroscopic treatment with suture anchors of multidirectional instability (MDI) of the shoulder is gaining popularity as compared to an open approach, but no studies with mid to long-term outcomes are reported in the literature. Meanwhile, atraumatic onset MDI is associated with worse outcomes compared to traumatic onset MDI in short-term studies. The objective of this study is to report on survivorship and patient reported outcomes following arthroscopic pancapsular shift (APS) for MDI with minimum five-year follow up, including comparing atraumatic versus traumatic onset MDI.Methods:Patients who underwent APS for MDI and were at a minimum 5 years postoperative from the surgical intervention were included. Baseline pre and perioperative data was prospectively collected as part of an institutional registry and retrospectively reviewed, and patient questionnaires were sent by email to determine long-term outcomes including mechanism of onset of MDI, patient satisfaction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), American Shoulder and Elbow Surgeons (ASES), Short Form-12 Physical Component Summary (SF-12 PCS), and Single Assessment Numeric Evaluation (SANE) scores. Additional information about recurrent instability, dislocation and reoperation as well as return to sport were collected and Kaplan-Meier survivorship analysis was performed. Preoperative, short-term (1-2 year) and final follow-up patient reported outcomes were compared.Results:49 shoulders in 44 patients (15 male, 29 female) treated between October 2005 and November 2015 were included in the study. Overall, 14/49 (28.6%) of shoulders reported feelings of instability, of which 5 (10.2%) underwent revision surgery at a mean of 1.5 years postoperatively. Kaplan-Meier analysis demonstrated a survivorship rate of 80% at 5 years and 75% at 8 years with failure defined at postoperative feelings of instability. Final analysis was performed on 44 shoulders, of which minimum 5-year outcomes were collected on 36 (82%) with an average follow-up length of 9.0 years (5.1-14.6 years). All patient reported outcome scores as well as subjective improvement outcomes demonstrated statistically significantly improved results at final follow-up (p<0.05). Patient reported outcome measures were persistently statistically significantly improved at short-term and long-term final follow-up. (Figure 1) MDI onset was atraumatic in 27 shoulders and traumatic in 21. There was no difference in subjective or patient reported outcome scores between atraumatic and traumatic onset MDI patients. Rotator interval closure was performed in 19 patients with no effect on postoperative outcomes.Conclusions:Arthroscopic pancapsular shift for the treatment of MDI provides excellent, durable long-term patient reported outcomes that persist from short-term follow-up. Although 28% of patients experience feelings of instability at final follow-up, most of these patients still have high postoperative satisfaction and acceptable patient reported outcomes and do not undergo revision surgery Compared to short-term data, long-term results indicate that atraumatic onset MDI is not associated with worsened postoperative outcomes as compared to traumatic onset MDI.

Poster 182: Beach Chair vs Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

Objectives:Surgical positioning can affect intra- and post-operative complication rates for many reasons, including potential differences in anatomic approaches and proximity to nearby nerves. The beach chair and lateral decubitus positions are the two most common positions for shoulder arthroscopy, and each offers their own unique advantages and disadvantages for surgeons. Beach chair allows for an easier transition to open surgery if necessary, and also has a lower incidence rate of neuropathies, relative to lateral decubitus. However, the lateral decubitus positioning allows for better access to the glenohumeral joint, easier visualization of the labrum, and greater circumferential access to the joint. The surgical position is often selected according to each individual surgeon’s preference, with no clear superiority of one position over the other. This study was conducted to compare clinical and patient-reported outcomes between patients who underwent arthroscopic anterior shoulder stabilization in beach chair vs. lateral decubitus positions.Methods:A list of all patients diagnosed with the CPT codes 29806 and 29807 from 2015-2019 was obtained from the medical records. Patients were only included if anterior instability was confirmed, arthroscopic surgery was performed in response to shoulder instability, and a minimum of 2-year follow-up was available. Data collected for eligible patients includes: pathology present (Hill-Sachs lesion, bony Bankart lesion), number and location of anchors used, surgery duration, intra-operative and post-operative complications, recurrent instability, reoperation, and revision. Patients were also contacted to complete patient-reported outcome surveys including the American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score, Single Assessment Numeric Evaluation (SANE), and a return to sport (RTS) questionnaire. Demographic, intra-operative data, and post-operative outcomes were compared between patients who underwent surgery in beach chair vs lateral decubitus positioning.Results:294 patients were included in this study, 162 patients who underwent surgery in the lateral decubitus position and 132 in beach chair position with an average follow-up of 3.3 years. There were no significant differences in demographics, concomitant surgeries, prevalence of Hill-Sachs and bony Bankart lesions, surgery duration, or intra-operative complications between groups (all p>0.05). Beach chair was associated with an increased number of anchors used (4.0 vs. 3.3, p=0.01) and a smaller proportion of inferior anchors being placed at the 6 o’clock position (8.3% vs. 25.0%, p=0.022) (Table 1). Rates of post-operative dislocations, recurrent instability, reoperations, all complications, and RTS also did not differ between groups (all p>0.05). Beach chair position had a trend for increase in revision rate but was not significant (beach chair 6.1% vs. lateral decubitus 1.9%, p=0.069). Finally, there was no difference between groups regarding post-operative ASES, SANE, and Oxford Shoulder Scores (all p>0.05).Conclusions:Surgical positioning for arthroscopic anterior shoulder stabilization did not affect post-operative clinical and patient-reported outcomes. Lateral decubitus patient positioning was associated with the use of fewer anchors and an increased proportion of inferior anchors placed at the 6 o’clock position of the labrum.Table 1.Comparison of intra-operative data and post-operative outcomes between patients who underwent shoulder stabilization surgery in the beach chair vs. lateral decubitus position. SLAP=superior labral tear anterior to posterior, RTS=return to sport, ASES=American Shoulder and Elbow Surgeons, SANE=Single Assessment Numeric Evaluation. Categorical data is presented as n (%), and continuous data is presented as mean ± standard deviation. Statistically significant differences are in bold.

Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction.

Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n=1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P=.001) and worker's compensation cases (P=.034) in the SCR group. The RCR cohort was older (P=.007) and had a greater incidence of mental health (P>.999) and somatic disorders (P=.698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2±23.3 and 20.4±14.9 months following RSA, respectively (P=.913). The time from index RCR or SCR to RSA were 94.4±22.2 and 89.2±5.3 months, respectively (P=.003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P=.879), abduction (P=.971), and external rotation (P=.968) following RSA. The RCR group had lower postoperative VAS pain (P=.009), higher SANE (P=.015), higher ASES (P=.008), and higher WOOS (P=.018) scores. The percentage achieving the MCID (P=.676) and SCB (P>.999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P=.005). There were no differences in postoperative complications (P=.698) or revision rates (P=.308) following RSA between cohorts. When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.

Paper 53: Comparing Graft Choice in Medial Patellofemoral Ligament Reconstruction

Objectives:Disruption of the medial patellofemoral ligament (MPFL) may lead to recurrent lateral patellar dislocation and patellofemoral chondral injury. Optimal graft choice for MPFL reconstruction in the surgical treatment of patellar instability is unknown. While autograft remains readily available, easily harvested, and of lower cost, allograft is a viable alternative and portends several benefits over autograft. Autograft may provide superior strength or lower re-tear rate, but allograft has been shown to have similar outcomes with less donor site morbidity in some series. Overall, there is a paucity of research comparing autograft vs allograft in MPFL reconstruction. Prior studies have been limited by small sample sizes, incomplete data, or heterogeneous patient population. The objectives of this study were to compare outcomes scores, return to activity and revision rates between allograft and autograft in MPFL reconstruction. The authors hypothesized that there would be no significant difference in outcomes between those who received an allograft and those who received an autograft in MPFL reconstruction.Methods:Patients who underwent isolated MPFL reconstruction with allograft or autograft at a single institution between 2013-2020 were retrospectively reviewed. Patients with a follow-up of less than 2 years were excluded, along with those who underwent concomitant tibial tubercle osteotomy or trochleoplasty. Patients were contacted to complete functional assessments including the Single Assessment Numeric Evaluation (SANE), Visual Analog Scale for pain (VAS), and International Knee Documentation Committee (IKDC) scores. Patient demographics and complications were also reviewed. Outcomes were compared between those that underwent allograft and autograft MPFL reconstructionResults:Out of the fourty-six patients that were retrospectively reviewed, thirty-one (67.4%) patients underwent allograft reconstruction, while fifteen (32.6%) patients underwent autograft reconstruction. There were no differences between the two groups in age at surgery (25.2 years old in allograft vs 26.3 years old in autograft group, P=0.726), sex ratio (19F/12M in allograft and 9F/6M in autograft, P=1.000), or BMI (27.0 in allograft and 24.8 in autograft, P=0.179).There was a mean follow up duration of 4.57 years in the allograft group and 4.83 years in the autograft group (P=0.672), with an overall response rate of 70.2%. There were no differences between the two groups when assessing subjective pain using SANE (66.7 in allograft vs 74.5 in autograft, P=0.334) or VAS score (35.7 in allograft vs 22.9 in autograft, P=0.110). Further there were no differences in patient outcomes as assessed by IKDC score (68.3 in allograft vs 76.2 in autograft, P=0.247). Patients who received an allograft returned to activity at an average of 5.9 months, while patients who received an autograft returned to activity at an average of 5.2 months (P=0.416). One patient in the allograft group required revision surgery (P=0.246).Conclusions:Both allograft and autograft remain viable options in MPFL reconstruction. There were no significant differences in failure rates, PROs, pain, or time to return to play between allograft and autograft MPFL reconstruction in this series.

Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database.

Background:Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.Hypothesis:It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered.Study Design:Cohort study; Level of evidence, 3.Methods:The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex.Results:Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis (P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores (P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures.Conclusion:Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.

Poster 230: A Modified Lemaire Lateral Extra-Articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes

Objectives:This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR.Methods:A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT) techniques were used depending on patients’ skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS) data and second surgeries were also obtained.Results:Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study.Conclusions:The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up.Table 1.Patient Demographics and Surgical Characteristics.

Establishing maximal medical improvement following aseptic revision of shoulder arthroplasty.

Shoulder arthroplasty surgery volume continues to increase yearly. As the prevalence of shoulder replacement continues to rise, there will be a growing number of revision surgeries performed for a variety of indications. Understanding patient outcomes and recovery time following these procedures is critical, particularly as it relates to revision surgery, which generally has worse outcomes and longevity than primary arthroplasty. The point at which the peak of potential improvement is reached can be defined as the point of maximal medical improvement (MMI). The timing to MMI has previously been reported in the literature following both primary anatomic and reverse total shoulder arthroplasty. However, to our knowledge, timing to MMI following revision shoulder arthroplasty has not been defined. The purpose of the present study, therefore, is to establish the time to MMI following aseptic revision shoulder arthroplasty using validated patient-reported outcome measures. A retrospective cohort study was conducted following patients who underwent aseptic revision shoulder arthroplasty over a defined 3-year period. Multiple fellowship-trained shoulder and elbow surgeons from a single institution performed all operations. Those with at least 24 months of follow-up and multiple time points of postoperative patient-reported outcome scores were included in the analysis. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and Single Assessment Numeric Evaluation (SANE) scores were prospectively recorded and followed over time. Exclusion criteria included revision surgeries done for infection, staged procedures following infection, and revision for periprosthetic fracture. Twenty-two patients met inclusion criteria. The mean preoperative ASES and SANE scores were 41.8 and 30.5, respectively. There was a trend toward improvement in both the ASES and SANE scores through the 6-9-month postoperative follow-up point, at which point clinically significant improvement was achieved, with mean values of, respectively, 76.9 and 81.2. No further improvement was achieved 9 months after surgery, although scores were generally maintained through an average final follow-up of 30 months, with final ASES and SANE scores of 70.1 and 67.8, respectively. Following aseptic revision shoulder arthroplasty, clinically significant improvements in patient-reported outcome scores are seen up to 9 months postoperatively, the point at which MMI is achieved. These findings serve to guide clinicians in counseling patients regarding their expected postoperative recovery following revision shoulder arthroplasty.

SLAP Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP Type 2 Lesions in Overhead Athletes Younger Than 35 Years: Comparison of Minimum 2-Year Outcomes.

Background:It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis.Purpose:To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or SLAP repair.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (n = 14) or SLAP repair (n = 24) for the treatment of isolated type 2 SLAP lesions. All patients were aged <35 years at time of surgery, participated in overhead sports, and were at least 2 years out from surgery. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; and the 12-Item Short Form (SF-12) physical component score. Return to sport and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported.Results:Preoperative baseline scores in both the tenodesis and SLAP repair groups were similar. There were no significant differences between the groups on any postoperative outcome measure: For biceps tenodesis versus SLAP repair, the ASES score was 92.7 ± 10.4 versus 89.1 ± 16.7, the SANE score was 86.2 ± 13.7 versus 83.0 ± 24.1, the QuickDASH score was 10.0 ± 12.7 versus 9.0 ± 14.3, and SF-12 was 51.2 ± 7.5 versus 52.8 ± 7.7. No group difference in return-to-sports rate (85% vs 79%; P = .640) was noted. More patients in the tenodesis group (80%) reported modifying their sporting/recreational activity postoperatively because of weakness compared with patients in the SLAP repair group (15%; P = .022). One patient in each group progressed to surgery for persistent postoperative stiffness, and 1 patient in the tenodesis group had a postoperative complication related to the index surgery.Conclusion:Both subpectoral biceps tenodesis and SLAP repair provided excellent clinical results for the treatment of isolated SLAP type 2 lesions, with a high rate of return to overhead sports and a low failure rate, in a young and high-demanding patient cohort. More patients reported modifying their sporting/recreational activity because of weakness after subpectoral tenodesis.

Surgical time and outcomes of stemmed versus stemless total shoulder arthroplasty.

Stemless total shoulder arthroplasty (TSA) was approved for use in the United States in 2015, and there remains a paucity of data on its performance in this market. Decreased operative time without compromise of clinical outcomes is a theoretical advantage of stemless TSA, but no studies have evaluated this in a comparative study to date. Herein, the operative times and clinical outcomes of stemless vs. conventional stemmed TSA are investigated. This is a retrospective cohort study, evaluating all consecutive TSAs performed by a single surgeon between 2015 and 2018. Data were collected from 59 patients who underwent TSA with conventional, stemmed humeral implants and 115 patients in whom a stemless humeral implant was used. Operative times and demographic data were collected retrospectively from the anesthesia record, and prospectively collected patient-reported outcome measures were collected from the Surgical Outcomes System database. For patient-reported outcome measure, visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores were recorded serially until a minimum 2-year follow-up. The average operative time was 24 minutes less in the stemless cohort compared with the stemmed cohort (104 minutes vs. 128 minutes, P<.001). Cost analysis showed a decreased personnel cost of 15.9% that correlates to a 3.1% overall reduction in operating room-associated cost. Patient-reported outcome scores significantly improved postoperatively in both cohorts across all time points. There was no difference found in visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores between the cohorts at the 2-year follow-up. Stemless TSA significantly reduces operative time with equivalent functional outcomes at a minimum 2-year follow-up.

Beach Chair Versus Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes.

Background:Surgical positioning can affect both perioperative and postoperative complication rates. It is unclear whether beach-chair versus lateral decubitus positioning affects outcomes in patients undergoing arthroscopic anterior shoulder stabilization surgery.Purpose:The purpose of this study was to compare recurrent instability, complications, and patient-reported outcomes between patients who underwent arthroscopic anterior shoulder stabilization in the beach-chair versus the lateral decubitus positions. It was hypothesized that recurrent instability, complications, and patient-reported outcomes would not be affected by surgical positioning.Study Design:Cohort study; Level of evidence, 3.Methods:The authors reviewed the medical records of patients who underwent shoulder stabilization (Current Procedural Terminology codes 29806 and 29807) from 2015 to 2019. Patients were included only if anterior instability was confirmed, arthroscopic surgery was performed in response to shoulder instability, and a minimum of 2 years of follow-up data were available. Data collected for eligible patients included perioperative and postoperative complications, recurrent instability, reoperation, and revision. Patients also completed surveys for the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Oxford Shoulder Instability (OSI) score, and a return to any level of sport (RTS) questionnaire.Results:Overall, 294 patients (162 lateral decubitus and 132 beach-chair positions) were included, with an average follow-up of 2.4 ± 1.6 years. There were no significant differences in demographics between groups, nor were there differences in the rates of postoperative dislocations, subjective instability, reoperations, revisions, or complications. There was a trend toward a higher revision rate in the beach-chair group (beach-chair, 6.1% vs lateral decubitus, 1.9%; P = .069). There was no significant difference between groups regarding RTS rates or postoperative ASES, SANE, and OSI scores at 3.3 ± 1.1 years postoperatively.Conclusion:Surgical positioning for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, and patient-reported outcomes. Both beach-chair and lateral decubitus positioning provided good outcomes for anterior shoulder stabilization, with an overall recurrent dislocation rate of 7.8% at a mean of 3.3 years after surgery.

Prevalence, management, and outcomes of nerve injury after shoulder arthroplasty: a case-control study and review of the literature

Neurologic injury is a rare and potentially devastating complication of shoulder arthroplasty. Patients typically present with a mixed plexopathy or mononeuropathy, most commonly affecting the axillary and radial nerves. Given the paucity of studies available on the topic, our goal was to elucidate the prevalence of nerve injury after shoulder arthroplasty and to describe the treatment course and outcomes of neurologic injuries. This is a retrospective case-control study performed at a single, urban, academic institution. Consecutive patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) by a single surgeon from 2014 to 2020 were reviewed, and patients with a documented nerve injury were identified. A control group of patients without nerve injury were selected in a 2:1 ratio controlling for age and procedure type (TSA vs. RSA; primary vs. revision). Data collected included demographics, comorbidities as per the Charlson Comorbidity Index, radiographic evaluations, surgical and implant details, patient-reported outcome measures, and perioperative complications. Of 923 patients, 33 (3.6%) sustained an iatrogenic nerve injury: 10 (2.1%) after TSA, 23 (5.0%) after RSA, and 3 (7.8%) after revision arthroplasty. Axillary mononeuropathy was most common (42%), followed by brachial plexopathies (18%). There was no significant difference in age, sex, race, body mass index, and preoperative diagnoses between groups. Patients with nerve injury had fewer comorbidities (Charlson Comorbidity Index <3, 33 vs. 65%, P<.001). Patients with nerve injury had higher rates of cervical spine pathology (15 vs. 6%; P= .15) and increased postoperative lateralization (8.9 mm [7.2] vs. 5.5 mm [7.3]; P<.06). The majority (91%) were managed with observation alone. Three (9%) underwent an additional procedure: carpal tunnel release (1, 3%), ulnar nerve decompression (1, 3%), and ulnar nerve transposition (1, 3%) for peripheral compressive neuropathies. At the final follow-up, 19 (57%) nerves fully recovered, and 14 (43%) showed mild residual sensorimotor dysfunction. The mean time to first sign of recovery and ultimate recovery were 11 (7.2) and 36 (23.5) weeks, respectively. At the final follow-up, patients with nerve injury performed worse on patient-reported outcomes, including visual analog score pain (2.2 vs. 1.0, P<.001), American Shoulder and Elbow Surgeons score (67.8 vs. 84.8, P<.001), and Single Assessment Numeric Evaluation scores (62 vs. 77, P= .009). Nerve injury after shoulder arthroplasty is rare, occurring in 3.6% of our patient population. Axillary mononeuropathy and brachial plexopathies are the most common. Most patients can be managed expectantly with observation and will recover at least partial nerve function, although clinical outcomes remain inferior to those without nerve complication.

A Randomized Controlled Trial of Topical Cannabidiol for the Treatment of Thumb Basal Joint Arthritis

Since the passage of the Agricultural Improvement Act of 2018, hand surgeons have increasingly encountered patients seeking counseling on over-the-counter, topical cannabidiol (CBD) for the treatment of pain. To this end, we designed a human clinical trial to investigate the therapeutic potential of CBD for the treatment of pain associated with thumb basal joint arthritis. Following Food and Drug Administration and institutional approval, a phase 1 skin test was completed with 10 healthy participants monitored for 1 week after twice-daily application of 1 mL of topical CBD (6.2 mg/mL) with shea butter. After no adverse events were identified, we proceeded with a phase 2, double-blinded, randomized controlled trial. Eighteen participants with symptomatic thumb basal joint arthritis were randomized to 2 weeks of twice-daily treatment with CBD (6.2 mg/mL CBD with shea butter) or shea butter alone, followed by a 1-week washout period and then crossover for 2 weeks with the other treatment. Safety data and physical examination measurements were obtained at baseline and after completion of each treatment arm. Cannabidiol treatment resulted in improvements from baseline among patient-reported outcome measures, including Visual Analog Scale pain; Disabilities of the Arm, Shoulder, and Hand; and Single Assessment Numeric Evaluation scores, compared to the control arm during the study period. There were similar physical parameters identified with range of motion, grip, and pinch strength. In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events. Therapeutic II.