Single Assessment Numeric Evaluation Score Research Articles

Clinical outcomes of rotator cuff repair with subacromial bursa reimplantation: a retrospective cohort study

The subacromial bursa has been found to be a rich, local, source of mesenchymal stem cells but is removed for visualization during rotator cuff repair. Reimplantation of this tissue may improve rotator cuff healing. The purpose of this study is to evaluate clinical outcomes of rotator cuff repair with and without subacromial bursa reimplantation. Patients aged 37-77 with a full-thickness or near full-thickness supraspinatus tears underwent arthroscopic transosseous-equivalent double row rotator cuff repair. In patients prior to July 2019, the subacromial bursa was resected for visualization, and discarded. In patients after July 2019, the subacromial bursa was collected using a filtration device connected to an arthroscopic shaver and reapplied to the bursal surface of the tendon at the completion of the rotator cuff repair. Rotator cuff integrity was evaluated via magnetic resonance imaging on bursa patients at 6 months postoperatively. Minimum 18-month clinical outcomes (Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, patient satisfaction) were compared between bursa and nonbursa cohorts. A total of 136 patients were included in the study (control n=110, bursa n=26). Preoperative demographics and tear characteristics were not different between groups. Average follow-up was significantly longer in the control group (control: 3.2±0.7 years; bursa: 1.8±0.3 years; P<.001). The control group showed a significantly higher Single Assessment Numeric Evaluation score (control: 87.9±15.8, bursa: 83.6±15.1, P=.037) that did not meet minimum clinically important difference. The American Shoulder and Elbow Surgeons and patient satisfaction scores were similar between the groups. Symptomatic retears were not significantly different between groups (control: 9.1%, bursa 7.7%, P=.86). Seven patients in the control group underwent reoperation (6.4%), compared to 0 patients in the bursa group (0%, P=.2). Six-month postoperative magnetic resonance images obtained on bursa patients demonstrated 85% rotator cuff continuity (n=17/20) as defined via Sugaya classification. Augmentation of rotator cuff repair with bursal tissue does not appear to have negative effects, and given the accessibility and ease of harvest of this tissue, further research should be performed to evaluate its potential for improved tendon healing or clinical outcomes.

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

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

Clinical and radiographic outcomes following anatomic total shoulder arthroplasty utilizing an inset glenoid component at 2-year minimum follow-up: a dual center study.

Anatomic total shoulder arthroplasty (aTSA) is a successful and reproducible treatment for patients with painful glenohumeral arthritis. However, long-term outcomes using traditional onlay glenoid components have been tempered by glenoid loosening. Inset components have been proposed to minimize glenoid loosening by reducing edge-loading and opposite-edge lift-off forces with humeral translation. Successful short- and long-term outcomes have been reported while using inset glenoid implants. The current study is the largest study presenting a minimum of 2-year follow-up data following aTSA with an all-polyethylene inset glenoid component (Shoulder Innovations, Holland, MI, USA). A dual center, retrospective review of patients undergoing aTSA using an Inset glenoid component by 2 fellowship-trained shoulder surgeons at 2 separate institutions from August, 2016, to August, 2019, was performed. Minimum follow-up was 2 years. Range of motion (ROM), visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores were obtained. Radiographic outcomes, including central peg lucency and glenoid loosening, were assessed by 3 independent reviewers on the postoperative Grashey and axillary radiographs obtained at the final follow-up. Seventy-five shoulders were included for the final analysis. The mean age of the entire cohort was 64 (±11.4) years. Twenty-one (28%) glenoids were type A1, 10 (13.3%) were type A2, 13 (17.3%) were type B1, 22 (29.3%) were type B2, 6 (8%) were type B3, and 3 (4%) were type D. At a minimum follow-up of 24months (mean: 28.7months), a significant improvement in ROM in all planes was observed. Significant improvements in VAS (5.1-0.9, P<.001), SANE (39.5-91.2, P<.001), and ASES (43.7-86.6, P<.001) scores were observed. There were 4 (5.3%) cases of central peg lucency about the inset glenoid component and one (1.3%) case of glenoid loosening. No revisions were performed for glenoid loosening. At a minimum of 2 years postoperatively, there were significant improvements in ROM, VAS, SANE, and ASES scores with very low rates of central peg lucency and glenoid loosening in patients undergoing aTSA with an inset glenoid component. Further work is needed to determine the long-term benefit of this novel implant.

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

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

Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes

Background: Massive rotator cuff tears (MRCTs) can be challenging to treat, and the efficacy of repair of MRCTs in older patients has been debated. Purpose: To report minimum 5-year outcomes after primary arthroscopic rotator cuff repair of MRCT and determine whether age affects outcomes. Study Design: Case series; Level of evidence 4. Methods: The study included consecutive patients with MRCTs who were treated with arthroscopic rotator cuff repair by a single surgeon between February 2006 and October 2016. MRCTs were defined as ≥2 affected tendons with tendon retraction to the glenoid rim and/or a minimum exposed greater tuberosity of ≥67. Patient-reported outcome (PRO) data collected preoperatively and at a minimum of 5 years included the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numeric Evaluation (SANE) score; the shortened version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH); the 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS); and patient satisfaction. Surgical failure was defined as subsequent revision rotator cuff surgery or conversion to reverse total shoulder arthroplasty. Regression analysis was performed to determine whether age had an effect on clinical outcomes. Results: A total of 53 shoulders in 51 patients (mean age, 59.7 years; range, 39.6-73.8 years; 34 male, 19 female) met inclusion criteria with a mean follow-up of 8.1 years (range, 5.0-12.1 years). Three shoulders (5.7%) failed at 2.4, 6.0, and 7.1 years. Minimum 5-year follow-up was obtained in 45 of the remaining 50 shoulders (90%). Mean PROs improved as follows: ASES from 58.8 to 96.9 (P < .001), SANE from 60.5 to 88.5 (P < .001), QuickDASH from 34.2 to 6.8 (P < .001), and SF-12 PCS from 41.1 to 52.2 (P < .001). Patient satisfaction was a median of 10 (on a scale of 1-10). Age was not associated with any PRO measures postoperatively (P > .05). Conclusion: This study demonstrated significantly improved clinical scores, decreased pain, and increased return to activity for patients with MRCT at midterm follow-up (mean, 8.1 years; range, 5.0-12.1 years). In this patient cohort, no association was found between age and clinical outcomes.

Managing Ulnar Nerve Subluxation With a Medial Intermuscular Septum Sling.

Cubital tunnel syndrome (CuTS) is a lifestyle-altering peripheral neuropathy lacking a consensus for optimal surgical management. We describe creation of a fascial "V-sling" without ulnar nerve transposition, which is associated with increased surgical morbidity compared with decompression. The purpose of this study is to evaluate a novel technique with effective ulnar nerve decompression and subluxation prevention by creating a fascial sling in patients with CuTS and ulnar nerve subluxation. We reviewed records of 39 elbows in 35 patients who underwent in situ ulnar nerve decompression and creation of a fascial sling in a "V" configuration to stabilize the nerve in its native position. We examined patient demographics, Single Assessment Numeric Evaluation (SANE) scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and patient outcomes. Chi-square and student's t test were used for all analysis. A total of 37 extremities in 33 patients undergoing nerve decompression had nerve subluxation confirmed intraoperatively. There was a statistically significant change in preoperative and postoperative SANE scores of 64.5 and 82.3, respectively. Mean QuickDASH scores decreased significantly from 49.3 preoperative to 10.8 postoperative. The long-term QuickDASH scores obtained at mean of 564 days were maintained at 10.76. This study describes a novel technique for treating CuTS by achieving in situ nerve decompression and addressing ulnar nerve subluxation with creation of an intermuscular septal sling. The technique improved functional outcomes and provided symptomatic relief, while avoiding risks commonly associated with nerve transposition.

Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures

Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures

Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger Than 35 Years

Background: Superior labrum anterior-posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the United States military. However, little data have been published regarding the surgical management of type V SLAP lesions. Purpose: To compare the outcomes of arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair with those of arthroscopic SLAP repair (defined as contiguous repair spanning from the superior labrum to the anteroinferior labrum) for type V SLAP tears in active-duty military patients younger than 35 years. Study Design: Cohort study; Level of evidence, 3. Methods: All consecutive patients from January 2010 to December 2015 who underwent arthroscopic SLAP repair or combined biceps tenodesis and anterior labral repair for a type V SLAP lesion with a minimum 5-year follow-up were identified. The decision to perform type V SLAP repair versus combined biceps tenodesis and anterior labral repair was based on the condition of the long head of the biceps tendon (LHBT). Labral repair was performed in patients who had a type V SLAP tear with an otherwise clinically and anatomically healthy LHBT. Combined tenodesis and repair was performed in patients with evidence of LHBT abnormalities. Outcomes including the visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were collected preoperatively and postoperatively, and scores were compared between the groups. Results: A total of 84 patients met the inclusion criteria for the study. All patients were active-duty service members at the time of surgery. A total of 44 patients underwent arthroscopic type V SLAP repair, and 40 patients underwent anterior labral repair with biceps tenodesis. The mean follow-up was 102.59 ± 20.98 months in the repair group and 94.50 ± 27.11 months in the tenodesis group (P = .1281). There were no significant differences in preoperative range of motion or outcome scores between the groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all); however, compared with the repair group, the tenodesis group reported significantly better postoperative VAS (2.52 ± 2.36 vs 1.50 ± 1.91, respectively; P = .0328), SANE (86.82 ± 11.00 vs 93.43 ± 8.81, respectively; P = .0034), and ASES (83.32 ± 15.31 vs 89.90 ± 13.31, respectively; P = .0394) scores. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the SANE and ASES between the groups. Overall, 34 patients in each group returned to preinjury levels of work (77.3% vs 85.0%, respectively; P = .3677), and 32 patients (72.7%) in the repair group and 33 patients (82.5%) in the tenodesis group returned to preinjury levels of sporting activity (P = .2850). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between the groups (P = .0923, P = .1602, and P = .2919, respectively). Conclusion: Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. The results of this study suggest that biceps tenodesis combined with anterior labral repair produces comparable outcomes to arthroscopic type V SLAP repair in active-duty military patients younger than 35 years.

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

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

Patient Preferences in Short-Interval Staged Bilateral Rotator Cuff Repair.

The decision to seek and undergo treatment for bilateral rotator cuff tears is often complex. The purpose of this study was to investigate patient preferences for undergoing short-interval staged bilateral rotator cuff repair; timing of surgeries; and order of surgeries. A retrospective analysis was performed for patients who underwent bilateral arthroscopic rotator cuff repairs within 12 months at a single institution. Postoperative patient-reported outcomes, satisfaction, and decision-making factors were collected via REDCap surveys. Ninety patients were included (63 men and 27 women; mean age, 58.1 years). The mean time between surgeries was 7.33 months. Forty-two percent of patients had left rotator cuff repair first. Patients reported a mean satisfaction score of 91.6 of 100 with the order of the surgeries and 87.3 of 100 with the timing of the surgeries. Mean postoperative American Shoulder and Elbow Surgeons standardized assessment scores were 94.6 and 93.7 (left vs right shoulder first, respectively) for left shoulders and 94.2 and 93.9 (left vs right shoulder first, respectively) for right shoulders. Mean postoperative Single Assessment Numeric Evaluation scores were 86.5 and 83.9 (left vs right shoulder first, respectively) for left shoulders and 87.3 and 86.0 (left vs right shoulder first, respectively) for right shoulders. Decision-making factors noted as highly important included night pain, function, surgeon recommendation, and daily pain. Most patients who undergo short-interval staged bilateral rotator cuff repair are satisfied with the order and timing of their surgery. Decision-making factors such as night pain and functional limitation play a key role in the timing and order of bilateral rotator cuff repairs. [Orthopedics. 2023;46(6):e347-e352.].

Improved Yet Varied Clinical Outcomes Observed With Comparison of Arthroscopic Superior Capsular Reconstruction Versus Arthroscopy-Assisted Lower Trapezius Transfer for Patients With Irreparable Rotator Cuff Tears

To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) and arthroscopy-assisted lower trapezius tendon transfer (LTT) for posterosuperior irreparable rotator cuff tears (IRCTs). Over an almost 6-year period (October 2015 to March 2021), all patients who underwent IRCT surgery with a minimum 12-month follow-up period were identified. For patients with a substantial active external rotation (ER) deficit or lag sign, LTT was preferentially selected. Patient-reported outcome scores included the visual analog scale (VAS) pain score, strength score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. We included 32 SCR patients and 72 LTT patients. Preoperatively, LTT patients had more advanced teres minor fatty infiltration (0.3 vs 1.1, P= .009), a higher global fatty infiltration index (1.5 vs 1.9, P= .035), and a higher presence of the ER lag sign (15.6% vs 48.6%, P < .001). At a mean follow-up of 2.9 ± 1.3 years (range, 1.0-6.3 years), no differences in patient-reported outcome scores were observed. Postoperatively, SCR patients had a lower VAS score (0.3 vs 1.1, P= .017), higher forward elevation (FE) (156° vs 143°, P= .004), and higher FE strength (4.8 vs 4.5, P= .005) and showed greater improvements in the VAS score (6.8 vs 5.1, P= .009), FE (56° vs 31°, P= .004), and FE strength (1.0 vs 0.4, P < .001). LTT patients showed greater improvement in ER (17° vs 29°, P= .026). There was no statistically significant between-cohort difference in complication rate (9.4% vs 12.5%, P= .645) or reoperation rate (3.1% vs 10%, P= .231). With adequate selection criteria, both SCR and LTT provided improved clinical outcomes for posterosuperior IRCTs. Additionally, SCR led to better pain relief and restoration of FE whereas LTT provided more reliable improvement in ER. Level III, treatment study with retrospective cohort comparison.

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

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

D110. Single Assessment Numeric Evaluation Score as a Simplified Measure Of Patient Satisfaction following Breast Reconstruction

PURPOSE: Patient reported outcome measures (PROM) that can be efficiently employed after breast reconstruction are being investigated as an alternative to the validated Breast-Q survey to yield valuable data without survey fatigue. The Single Assessment Numeric Evaluation (SANE) has been used to rate function after orthopedic surgery but has not been extrapolated to functional and aesthetic outcomes after breast reconstruction. METHODS: 255 patients 1-3 years after breast reconstruction were contacted to complete both the SANE and Breast-Q Post-op Module for aesthetic and functional outcomes respectively. Demographics, comorbidities, treatment and surgical characteristics were reported and Pearson Correlation between survey mechanisms was evaluated. RESULTS: 91 patients completed both surveys with a mean aesthetic SANE score of 60.6 ± 28.0, and mean Aesthetic Breast-Q score of 61.4 ± 19.8 showing a strong correlation between the two surveys for aesthetic outcome (R = 0.76, P <0.001). The mean function SANE score 74.7 ± 26.4, and the mean functional Breast-Q was 74.0 ± 21.5 with a strongly positive correlation (R = 0.532, P <0.001). The SANE scores also provided a comparison with non-operated contralateral breasts in unilateral cases showing higher scores for the contralateral native breast for both appearance and function. CONCLUSION: The SANE scoring tool when applied to breast reconstruction outcomes correlated strongly with the validated Breast-Q for both functional and aesthetic outcomes. Application of this efficient PROM to greater patient numbers will demonstrate its utility for patients undergoing different cancer treatment regimens as well as its performance as a repeated measure.

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

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

Gadolinium injected concurrently with anesthetic can result in false-negative diagnostic intra-articular hip injections.

The purpose of this paper was to evaluate the response to intra-articular hip injections with and without concurrent gadolinium administration. Our secondary outcome was to compare post-operative outcomes between patients with an initial false-negative gadolinium-containing injection and a matched control group. Patients receiving a series of two hip diagnostic intra-articular injections (DIAI), the first with gadolinium for concurrent MRA and the second without gadolinium, were retrospectively identified. Pain response to DIAI, injectate volume, local anesthetic volume, inclusion of corticosteroids, and method of injection were compared between injections. False-negative injection was defined as < 50% pain relief with concurrent gadolinium, but ≥ 50% pain relief with subsequent anesthetic injection without gadolinium. False-negative injections in patients that ultimately underwent primary hip arthroscopy were identified from this cohort and matched in a 3:1 ratio to a control cohort to compare short-term post-operative single assessment numerical evaluation (SANE) outcomes. Forty-three patients underwent a series of anesthetic injections with and without gadolinium and met inclusion and exclusion criteria. Pain response was significantly different in injections performed with and without gadolinium (18% vs. 81%; p < 0.001). There were significant differences in total injectate volume, local anesthetic volume, corticosteroid use, and method of injection between injections, but these variables were not correlated with pain response. Fifteen patients with false-negative responses to injection underwent primary hip arthroscopy and were matched in a 3:1 ratio to a control cohort. There was no difference in short-term post-operative SANE scores between the gadolinium-sensitive and control groups (81.6 vs. 80.0, n.s.). Concurrent administration of intra-articular gadolinium with DIAI may result in a false-negative response to anesthetic. Additionally, in patients with initial false-negative DIAI with gadolinium, short-term post-operative outcomes after hip arthroscopy are similar to a matched cohort. Level III.

Outcomes of Open Versus Arthroscopic Treatment of HAGL Tears

Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups (P < .001): SANE (mean ± SD; arthroscopic, 30.7 ± 15.7 to 92.1 ± 12.2; open, 45.5 ± 8.50 to 90.7 ± 5.24) and WOSI (arthroscopic, 51.4 ± 11.4 to 2.49 ± 3.70; open, 45.5 ± 7.37 to 11.5 ± 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Δ60.0; open, Δ46.5; P = .012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 ± 3.70; open, 11.5 ± 5.76; P = .00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability.

Revision of total shoulder arthroplasty to hemiarthroplasty: results at mean 5-year follow-up.

Although there is a trend to manage failed anatomic total shoulder arthroplasties (aTSA) with revision to a reverse total shoulder arthroplasty, such revisions can be complicated by difficulties in baseplate fixation, instability, and acromial stress fractures. Some cases of failed aTSA may be safely revised to a hemiarthroplasty (HA). The objectives of this study were to report patient-reported outcomes after conversion from aTSA to HA and assess patient and shoulder characteristics associated with a successful outcome. Patients who underwent revision from aTSA to HA between 2009 and 2018 were contacted. Patient demographics, surgical history, intraoperative findings, and microbiology results were collected. Patient-reported outcomes were collected with minimum 2-year follow-up. Preoperative radiographic characteristics were reviewed for component positioning and component loosening. Patients with a clinically significant improvement exceeding the minimal clinically important difference (MCID) of the Simple Shoulder Test (SST) were compared with those patients who did not improve past the MCID. Twenty-nine patients underwent conversion from aTSA to HA with a mean follow-up of 4.5±1.8 years. Intraoperative glenoid or humeral component loosening was found in all 29 patients. Pain improved in 25 of 30 patients (87%), and mean pain scores improved from 6.2±2.3 to 3.1±2.4 (P<.001). SST scores improved from 4.1±3.1 to 7.3±3.2 (P<.001), and 18 of 29 patients (62%) had improvement above the SST MCID threshold of 2.4. The mean American Shoulder and Elbow Surgeons score at the latest follow-up was 64±19, and the Single Assessment Numeric Evaluation score was 65±23. Twenty-two of 29 (76%) patients were satisfied with the procedure. Four patients (14%) required conversion to total shoulder arthroplasty-2 to anatomic and 2 to reverse. An additional 3 patients (10%) had a revision HA performed. No significant differences in patient or shoulder characteristics were found in those patients who improved greater than the MCID of the SST compared patients who improved less than the MCID of the SST. Fifty-nine percent of patients had ≥2 positive cultures with the same bacteria, and 82% of these were with Cutibacterium. Seven of 8 patients (88%) with a loose humeral component had ≥2 positive cultures with the same bacteria. Component loosening is a common failure mode after aTSA. Revision to HA can improve pain and patient-reported outcomes in most patients.

Evaluating clinical outcomes of two biceps tenodesis techniques: Loop ‘N’ Tack and subpectoral biceps tenodesis

Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis. Patients undergoing both the subpectoral biceps tenodesis and Loop 'N' Tack biceps tenodesis will have improvements in patient-reported outcomes. Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded. One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop 'N' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively. Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.

The single assessment numeric evaluation correlates with the western ontario rotator cuff score in non-traumatic shoulder disease

Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function and assisting in clinical decision making. The Western Ontario Rotator Cuff (WORC) index is the PROM for shoulder pathology with the most psychometric properties but is very time consuming. The Single Assessment Numeric Evaluation (SANE) method is a PROM that takes less time to answer and to analyze. The aim of the study is to evaluate the intra- class correlation between these two outcome scores in establishing shoulder function in patients with non-traumatic rotator cuff pathologies. Fifty five subjects of both genders and different ages presenting with non-traumatic shoulder pain for more than 12 weeks had a physical examination and ultrasound as well as MRI arthrogram scan findings that were consistent of a non-traumatic rotator cuff (RC) based pathology. On the same moment a WORC index and a SANE score questionnaire were filled in by the subject. The intra class correlation of both PROMs was statistically analyzed. The WORC index score and the SANE score show a moderate correlation with an Intra Class Coefficient (ICC) of r = 0.60 (95% CI:0.40-0.75). This study demonstrates a moderate correlation between the WORC index score and the SANE score in rating the disability of patients with atraumatic RC disease. The SANE score is applicable in research and clinical practice and is for the patient and the researcher an almost no time consuming PROM.

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

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