UCLA Score Research Articles

Sports activity and patient-related outcomes after fixed-bearing lateral unicompartmental knee arthroplasty

BackgroundUnicompartmental osteoarthrosis increasingly affects younger patients who have high expectations concerning their postoperative level of activity. However, there is no available data on the activity level after fixed-bearing lateral unicompartmentalkneearthroplasty (UKA). The aim of this study was to report sports activity after fixed-bearing lateral UKA with a minimum two-year follow up. MethodsNineteen patients were surveyed to determine their sporting activities at a mean follow up of 4.6 years (range 2.0–9.7 years) after fixed-bearing lateral UKA. We also assessed the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) Score and the University of California, Los Angeles activity scale (UCLA scale) at baseline and latest follow up. ResultsBefore the onset of the first symptoms, 15 of 19 patients were active in at least one sport compared with 13 of 19 patients after surgery. Eighty-six per cent of the patients returned to activity. Within 6 months, 68% returned to their activities after surgery. The mean postoperative UCLA score was 6.4 (±1.3). Half of the patients reached a high activity level (UCLA ≥ 7). Most common activities after surgery were long walks, biking and hiking. High-impact activities showed a significant decrease. ConclusionEighty-six per cent of the patients were able to return to regular recreational and sporting activities. In general, a shift from high-impact to low-impact activities was observed. There was no difference in the number of disciplines performed. Overall, the session length and frequency remained unchanged. However, male patients and younger patients participated in sports less frequently compared with preoperative levels.

Comparison of the Results of Hook Plate and Endo-Button Used in the Surgical Treatment of Acromioclavicular Joint Separation.

Purpose: Our study aimed to compare the clinical outcomes between endo-button and hook plate fixations for the treatment of acute unstable acromioclavicular (AC) joint dislocation.Materials: A retrospective evaluation of patients with acute AC joint dislocation who were treated between February 2009 and December 2019 was performed. The study was conducted with 39 patients who met the inclusion criteria. Patients were divided into group 1, operated with a hook plate, and group 2, operated with an endo-button. The demographic features and postoperative complications were analyzed. The disability of arm, shoulder, and hand (DASH) scoring system, modified University of California at Los Angeles shoulder score (UCLA) scale, and the visual analog scale (VAS) scores were used to evaluate shoulder functions in these patients. Shoulder functions were evaluated one, three, six, and twelve months after surgery.Results: There were 21 patients in group 1 and 18 patients in group 2. Gender distribution was 28 male and 11 female, and the average age was 30.9 years (18-50). There were no significant differences in age, sex, side of injury, or follow-up time from injury to surgery between the two groups. The UCLA scores of group 1 and group 2 one month after surgery were 17.2 and 27.2, respectively. DASH scores of group 1 and group 2 one month after surgery were 82 and 52, respectively. The VAS scores of group 1 and group 2 one month after surgery were 70 and 14, respectively. For all scores at first month post-surgery, there were statistically significant differences between groups, but scores became similar 12 months after surgery.Conclusion: Postoperative shoulder scores of patients with endo-button showed superiority in the early stages. However, after a year of follow-up, the results of the surgery performed with an endo-button or a hook plate were similar.

The Association of α Angle on Disease Severity in Adolescent Femoroacetabular Impingement.

Background:Femoroacetabular Impingement (FAI) is a common cause of hip pain in adolescent patients. Clinical exam and radiographic markers, such as α angle and lateral center edge angle (LCEA), are commonly used to aid in the diagnosis of this condition. The purpose of this study was to correlate preoperative α angle and LCEA with preoperative symptoms, intraoperative findings, and preoperative and postoperative patient reported outcomes (PROs) in the adolescent patient.Methods:A retrospective analysis of prospectively collected data was conducted for all patients who underwent operative intervention for FAI at an academic institution over an 11-year period. Preoperative imaging was obtained and measured for LCEA and α angle. PROs (modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA score) were collected preoperatively, as well as 1, 2, and 5 years postoperatively. Operative intervention was either open surgical hip dislocation or arthroscopic, and intraoperative disease was graded using the Beck Classification system. Patients with minimum 1-year follow-up were included in statistical analysis.Results:There were 86 hips (64 female hips) included with an average age of 16.3 years (range, 10.4 to 20.5 y), with an average of 37 months of follow-up. There was no correlation between severity of preoperative symptoms or difference between pre and postoperative PROs for both α angle and LCEA. Overall, significant improvement was noted in modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA Score (P<0.001 for each). Independent of preoperative symptoms, increased α angle correlated with more severe intraoperative labral disease (P<0.001), and longer length of labral tear (Corr 0.295, P<0.01). Femoral head and acetabular articular cartilage damage did not correlate with α angle or LCEA, nor did overall severity of disease.Conclusions:In adolescent patients with FAI, increased α angle was found to significantly correlate with labral pathology, including increased length of tear and severity of disease, irrespective of preoperative symptoms or postoperative patient reported outcomes.Level of Evidence:Level III—retrospective.

The functional connectivity between the prefrontal cortex and supplementary motor area moderates the relationship between internet gaming disorder and loneliness

BackgroundIndividuals with internet gaming disorder (IGD) usually report a higher sense of loneliness. Although studies have suggested a key role of the prefrontal cortex-based resting-state functional connectivity (rsFC) in both IGD and loneliness, the potential mechanism between IGD and loneliness remains unclear. MethodsFifty-seven IGD and 81 matched recreational internet gamer users (RGU) underwent resting-state fMRI scans. The UCLA loneliness scale was used to measure loneliness. We first explored the brain areas that are both associated with loneliness and IGD severity. Then, the neuroimaging findings were extracted to test whether the rsFC of these brain regions moderates the relationship between IGD and loneliness. ResultsWe observed reduced rsFC between the left dorsolateral prefrontal cortex (DLPFC) and the left precentral and the postcentral gyri and the supplementary motor area (SMA), which also correlated with increased IAT (Young’'s internet addiction test) scores. More importantly, the rsFC of the DLPFC-precentral gyrus and the DLPFC-postcentral gyrus moderated the relationship between IGD severity and loneliness scores. Additionally, we also found that the rsFC of the left DLPFC-precentral gyrus, the DLPFC-postcentral gyrus and the right DLPFC-SMA moderated the relationship between self-reported gaming craving and the UCLA scores. ConclusionsThe current study confirmed the role of the DLPFC in reward control (game craving) and emotion regulation (loneliness). Additionally, the rsFC of the prefrontal cortex-supplementary motor area moderates IGD and loneliness. These findings provide valuable understanding of the two-way relationship between IGD and loneliness.

Partial and full-thickness rotator cuff tears in patients younger than 45 years.

The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. Level IV, Therapeutic study.

Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis.

Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. III.

Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme.

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users' loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n=10,643) including pre-post analysis of UCLA data (n=2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n=60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n=1634/2250) felt less lonely after receiving support. The mean change in UCLA score was -1.84 (95% CI -1.91 to -1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users' needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.

The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation

ObjectiveSocial isolation and loneliness are associated with morbidity and mortality in older adults. Limited evidence exists regarding which interventions improve connectedness in this population. Design/Setting/ParticipantsIn this pre-post study we assessed community-based group health class participants’ (age ≥50) loneliness and social isolation. Participants (n = 382) were referred by a Cedars-Sinai Medical Network (Los Angeles, California) healthcare provider or self-referred from the community (July 2017–March 2020). InterventionParticipants met with a program coordinator and selected Arthritis Exercise, Tai Chi for Arthritis, EnhanceFitness, or the Healthier Living Workshop. MeasurementsWe measured social isolation using the Duke Social Support Index (DSSI) and loneliness using the UCLA 3-item Loneliness Scale at baseline, class completion, and 6 months. ResultsMean age was 76.8 years (standard deviation, SD = 9.1); 315 (83.1%) were female; 173 (45.9%) were Non-Hispanic white; 143 (37.9%) were Non-Hispanic Black; 173 (46.1%) lived alone; mean baseline DSSI score was 26.9 (SD = 4.0) and mean baseline UCLA score was 4.8 (SD = 1.8). On multivariable analysis adjusted for gender, race/ethnicity, income, self-rated health, and household size, DSSI improved by 2.4% at 6-week compared to baseline (estimated ratio, ER: 1.024; 95% confidence interval [CI]: 1.010–1.038; p-value = 0.001), and 3.3% at 6-month (ER: 1.033; 95% CI: 1.016–1.050; p-value <0.001). UCLA score after adjusting for age, gender, race/ethnicity, live alone, number of chronic conditions, income, and self-rated health, did not change at 6-week (ER: 0.994; 95% CI: 0.962–1.027; p-value = 0.713), but decreased by 6.9% at 6-months (ER: 0.931; 95% CI: 0.895–0.968; p-value <0.001). ConclusionCommunity-based group health class participants reported decreased loneliness and social isolation at 6-month follow-up.

Aerobic capacity and fatigability are associated with activity levels in women with hip osteoarthritis.

Physical activity is important for physical function and pain relief in people with lower extremity osteoarthritis (OA). Unfortunately, people with OA are not as active as their peers without OA. The objective of this study was to determine whether aerobic capacity and fatigability are associated with physical activity in women with hip OA. We conducted a cross-sectional analysis of 36 women with hip OA. We assessed aerobic fitness as predicted VO2 max from a 6-minwalk test. We assessed fatigability using a treadmill test. Finally, we assessed self-reported physical activity using the UCLA activity scaleand quantified steps per day and activity intensity using accelerometers. We used Pearson correlations to determine associations. We used regression analysis to determine whether fatigability mediated the association between aerobic fitness and physical activity. On average, subjects were moderately active via the UCLA score (5.2 ± 1.3 out of 10). Aerobic fitness (R = 0.582, p < .001) and fatigability (R = 0.516, p =.003) were significantly correlated with UCLA scores. However, aerobic fitness was the best predictor of UCLA scores, as well as sedentary time,and time spent in light activity. Fatigability was not a mediator between aerobic fitness and UCLA scores. Aerobic fitness and fatigability may be modifiable barriers to physical activity in people with OA. Future interventional studies should examine whether improving aerobic fitness improves physical activity or fatigability.

Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation.

To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9years. Mean follow-up was 42.06months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. IV.

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair.

Objective To describe a new presentation of tears and retears of the rotator cuff, which we denominate captured rotator cuff (CRC). We also aim to evaluate it clinically and through images. Methods We assessed retrospectively 16 patients with intraoperative diagnosis of CRC between March 2005 and September 2017; by means of imaging (radiography and magnetic resonance imaging [MRI]) and functional scores (UCLA and Constant & Murley). In images we analyzed the evolution for rotator cuff arthropathy and presence of retears. Functionally, we compared the affected side with the contralateral side and extensive lesions with nonextensive. Results Five (31.25%) patients presented with rotator cuff arthropathy, and 10 (62.5%) with retears. Three (75%) patients with nonextensive lesions had good/excellent UCLA and Constant & Murley scores. In patients with extensive lesions, when the Constant & Murley score was evaluated, 6 (50%) presented good/excellent results, and in the UCLA score, 7 (58.3%). Comparing the affected side (Constant 74.72 points; UCLA 20 points) with the contralateral side (Constant 96.96 points; UCLA 25.63 points), there were worse functional results with statistical significance. Conclusion The diagnosis of CRC is suspected by characteristic findings on MRI and confirmed in arthroscopy. The affected shoulders present worse functional postoperative scores.

Third generation autologous chondrocyte implantation is a good treatment option for athletic persons

PurposeAutologous chondrocyte implantation is an established method for the treatment of joint cartilage damage. However, to date it has not been established that autologous chondrocyte implantation is an appropriate procedure for cartilage defects therapy in athletic persons. The aim of this study is to analyze if third-generation autologous chondrocyte implantation is an appropriate treatment for athletic persons with full cartilage defect of the knee joints.MethodsA total of 84 patients were treated with third-generation autologous chondrocyte implantation (NOVOCART® 3D). The mean follow-up time was 8 years (5–14). Sports activity was measured via UCLA Activity Score and Tegner Activity Scale before the onset of knee pain and postoperatively in an annual clinical evaluation. 41 athletic persons and 43 non-athletic persons (UCLA-Cut-off: 7; Tegner Activity Scale-Cut-off: 4) were analyzed. Patient reported outcomes were captured using IKDC subjective, KOOS, Lysholm score and VAS score on movement.ResultsPatient reported outcomes (IKDC, VAS at rest, VAS on movement) showed significant improvement (p < 0.001) postoperatively. Athletic persons demonstrated significantly better results than non-athletic persons in the analyzed outcome scores (IKDC: p < 0.01, KOOS: p < 0.01, Lysholm score: p < 0.01). 96.4% of the patients were able to return to sport and over 50% returned or surpassed their preinjury sports level. The remaining patients were downgraded by a median of two points on the UCLA- and 2.5 on the Tegner Activity Scale. A shift from high-impact sports to active events and moderate or mild activities was found. Furthermore, it was shown that preoperative UCLA score and Tegner Activity Scale correlated significantly with the patient reported outcome postoperatively.ConclusionAutologous chondrocyte implantation is a suitable treatment option for athletic persons with full-thickness cartilage defects in the knee. The return to sports activity is possible, but includes a shift from high-impact sports to less strenuous activities.

Functional outcome and repair integrity of arthroscopic management of rotator cuff tears by single row technique: a short term assessment

Purpose: To evaluate the results of arthroscopic rotator cuff repair by single row technique using UCLA shoulder scoring, visual analogue scale for pain and Shoulder strength index. Method: 30 patients with symptomatic full-thickness large and massive rotator cuff tear of more than 50% thickness underwent arthroscopic repair with single row technique. Results were evaluated by use of the UCLA shoulder scoring, visual analogue scale for pain, the Shoulder Strength Index (SSI), and range of motion for functional outcome. Results: Out of 30 patients (15 male and 15 female with mean age of 44.27 years, range 51- 60 years) with 16 complete tear and 14 partial tear. Mean operative time was 51.83 minute. The mean follow-up was 18.83 months. UCLA score improved from 17.93 ± 2.43 at the time of presentation to 30.6 ± 4.41 at 6 months with p value

Shoulder arthroplasty in solid organ transplant patients: a retrospective, match paired analysis

Several studies have evaluated total hip and knee arthroplasty in solid organ transplant (SOT) patients; however, there are limited studies evaluating shoulder arthroplasty in SOT patients. This study compares the complications and functional outcomes of SOT patients undergoing shoulder arthroplasty with a matched control group. The institution's database was retrospectively reviewed for patients with a history of SOT undergoing primary shoulder arthroplasty (with minimum 2-year follow-up) and compared with a control group matched for age, sex, preoperative diagnosis, and surgical procedure. Preoperative and postoperative range of motionand outcomescores, perioperative surgical and medical complications, hospital length of stay, and mortality were compared. Fifteen patients with previous SOT underwent 19 shoulder arthroplasties. Thirty-four underwent 35 shoulder arthroplasties in the control group. At last follow-up, the SOT group had a significantly worse UCLA score. The SOT group had a significantly worse improvement in UCLA, active elevation, and passive elevation scores in pre- to postoperative scores. There was no difference in length of stay, infection, or surgical complications. Ninety-day readmissions, medically related complications, and required blood transfusion were significantly higher in the SOT group. There was increased mortality in the SOT compared with the control group (death occurred on average 1577 days after arthroplasty). Shoulder arthroplasty in patients with previous SOT appears safe and effective for degenerative shoulder disorders. Patients should be counseled preoperatively that their range of motion and function may not improve as much as their nontransplant cohorts. SOT patients may have increased incidence of postoperative blood transfusions and medically related complications.

Does change in occupancy ratio and fatty infiltration of the supraspinatus influence functional outcome after single-row rotator cuff repair? A magnetic resonance imaging–based study

The purpose of this study was to analyze the correlation of occupancy ratio (OR) and fatty infiltration (FI) to functional outcome and retear rate following rotator cuff repair by single-row technique. Retrospectively, all the patients (n = 100) with rotator cuff tear were evaluated preoperatively and postoperatively with functional scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], University of California-Los Angeles [UCLA] shoulder score, Constant score) and magnetic resonance imaging (MRI) for ORand FI. Two observers studied the MRI data separately. Statistical analysis was done using SPSS (version 16), paired t test, Pearson correlation, and intraclass correlation coefficients. The mean (± standard deviation) follow-up was 16.24 ± 6.39 months, and the mean age was 56.18 ± 7.5 years. There was a significant increase in muscle atrophy (decreased OR) and FI (P < .01). The mean preoperative and postoperative ORs were 0.57 and 0.51, respectively. However, the mean functional scores improved significantly for ASES (55.78 to 82.09), UCLA (19.44 to 28.47), and Constant score (49.73 to 75.07) (P < .001). There was no significant difference in functional outcome among the different stages of FI (ASES P = .341, UCLA P = .839, Constant P = .376). Seven patients had asymptomatic retear during follow-up, of which 2 patients had grade 3, 4 patients had grade 2, and 1 patient had grade 1 FI, preoperatively. Muscle atrophy and FI are irreversible phenomena and continue even after successful repair; however, they do not have a significant influence on the functional outcome at short-term follow-up after cuff repair. Repairing cuff with higher grades of FI can be performed as they achieve significantly improved functional outcomes.

Long-term results of metal-on-metal hip resurfacing in patients 65 years of age or older.

Metal-on-metal hip resurfacing arthroplasty (MMHRA) is typically used in young and active patients because they have the most to gain from this bone-preserving procedure. However, there is very little long-term data on the performance of MMHRA in patients 65 years of age or older because of the efficacy of conventional total hip arthroplasty in this patient population. 109 patients (124 hips) age ⩾65 years were treated with Conserve Plus MMHRA. There were 83 male and 26 female patients. Their mean age at surgery was 69.5 (range 65-83) years. UCLA hip scores, SF-12 quality of life score were collected at follow-up visits. Radiographic and survivorship analyses were performed. SF-12 scores and UCLA scores were maintained over time except for a small decrease in activity. 4 patients underwent revision surgery. The 15-year Kaplan-Meier survivorship of the cohort was 93.7%. All revisions surgeries were successful at a mean follow-up time of 113 (range 30-218) months. Unusual radiographic findings from our previous publication did not progress over time except for 1 hip that showed a complete radiolucency around the acetabular component. Our results clearly show that HRA is a viable prosthetic solution with many advantages for all active patients, regardless of their age at the time of surgery.

Does Side Dominance Affect the Clinical and Functional Outcomes Following Arthroscopic Rotator Cuff Repair?

Objectives: The aims of this study were to evaluate the mid-term functional outcomes following arthroscopic rotator cuff repair (aRCR) and to define the effect of hand dominance on functional outcomes and re-tear rate.Methods: Between 2009 and 2015, 160 patients with aRCR (100 females and 60 males) with a minimum 3-year follow-up duration were included in the study. Patients were divided into two main groups according to hand dominance of operated side: Dominant (Group 1) and nondominant (Group 2). Pre- and postoperative functional outcome scores and clinical status of patients were evaluated using the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University at California at Los Angeles Shouder Rating Scale (UCLA) and Constant-Murley score (CMS). Functional scores, and revision rate of patients were compared in terms of hand dominance, patient characteristics and operative features.Results: The mean follow-up period was 45.5 ± 8.3 months (Range, 36 to 84 months). Mean age at the time of surgery was 59.0 ± 8.3 years in the dominant group and 58.3 ± 9.2 years in the nondominant group (p=0.689). Good to excellent postoperative functional outcomes were obtained regarding VAS, ASES, UCLA and CMS and scores in both groups compared with the baseline (p=0.000). Although dominant group had higher postoperative functional scores compared to nondominant group, improvement in functional scores were similar between groups (p&amp;lt;0.05). Retear was noted in 16 patients (7 patients, 7.2% in dominant group and 9 patients, 14.2% in nondominant group, p=0.145). Side dominancy was not associated with retear development (p=0.145). However, tear size was found to be associated with re-tear development (p=0.025). Conclusions: This study suggests that side dominancy has no significant impact on improvement in clinical scores and re-tear development after aRCR in mid-term.

A comparative study of technique of humeral ending insertion of rotator cuff under arthroscopy and traditional techniques in the treatment of giant rotator cuff tear

To explore the feasibility of arthroscopic humeral ending insertion of rotator cuff, and to provide a scheme for the treatment of giant rotator cuff tears. From February 2014 to April 2018, 40 patients with giant rotator cuff tears were operated on and divided into two groups. The study group consisted of 20 patients, including 8 males and 12 females, aged 42 to 82(57.55±8.90) years, with a course of 1 h to 2 years;the treatment of giant rotator cuff tears was carried out by using the technique of rotator cuff moving inward at the humeral head stop and reconstructing complete rotator cuff. The control group consisted of 20 patients, including 10 males and 10 females, aged 45 to 75 (57.75±9.10) years, with a course of 1 h to 5 years;after traditional cleaning, part of the rotator cuff was sutured or in situ high tension suture was used to treat the huge rotator cuff tear. The clinical effect of the two groups was evaluated by VAS, constant and UCLA. All patients were followed up for 12 to 14 months. The VAS, Constant score, UCLA score before operation of two groups were significantly improved compared with those before operation (P<0.05);the VAS, Constant score, UCLA score and excellent effect of the study group were significantly better than those of the control group (P<0.05). Arthroscopic transposition of rotator cuff and humerus ending insertion is a feasible method for the treatment of giant rotator cuff tears, which relieves shoulder pain and improves function satisfactorily.

Functional outcome of arthroscopic rotator cuff repair

Aim: To improve the clinical outcomes and to detect the significant predictors of outcome of rotator cuff repair, such as age, sex, side, tear size, fixation methods, smoking, and associated pathology have been investigated in the Indian population. Methods: Forty patients (27 male and 13 female) were included in the study who had complete degenerated rotator cuff tear, managed by arthroscopic single or double row repair technique and follow up till one year at a single institution. Postoperatively, patients were followed up regularly for 4 weeks, and at the final follow-up evaluated using a modified UCLA score. Physical examination and range of motion were analyzed and documented. Results: More than 87.5% of the patients showed good and excellent results. Thirty patients (75%) showed good results, 3 patients (7.5%) showed excellent results. There were no statistically significant relations of outcome with age, sex, side of the tear, size of tear, alcohol or smoking. Patients showed a 65% drop sign negative compared to a 35% drop sign negative cases which are statistically significant. Belly press test was negative in all patients. Mean UCLA score of both favorable and unfavorable results in terms of improvement of post-operative score compared to pre-operative UCLA score was statistically significant. Conclusions: We conclude that the functional outcome was very satisfactory with excellent results. Our study found that post-operative clinical outcomes are not associated with age, sex, side, and size of the tear. Our results depicted that the arthroscopic rotator cuff repair could be the considerable option for repairing rotator cuff repair.

Comparison between Trans-articular and Subacromial Stabilization with Ligament Repair for Acute Acromioclavicular Dislocation

Background:Although numerous treatment options for acromioclavicular joint dislocation have been reported, the treatment strategy is not yet standardized.Objective:The purpose of this study was to evaluate the clinical and radiographic results of coracoclavicular ligament repair with temporary acromioclavicular stabilization using suture anchors and Kirschner wires, and to compare the results between temporary trans-articular fixation and subacromial stabilization of the acromioclavicular joint.Methods:Thirty-three cases with displaced acromioclavicular joint dislocation were retrospectively evaluated. In the first 14 cases, the wires temporarily penetrated the joint for an average of 7 weeks (trans-articular group), while the acromioclavicular joint was temporarily stabilized by wires passing under the acromion that were inserted into the distal clavicle for an average of 13 weeks in the latter 19 cases (subacromial group). Clinical and radiographic results were evaluated and compared between the two groups.Results:The average UCLA score was 32.0 points in the trans-articular group and 32.8 points in the subacromial group, indicating no difference between the two groups (P= 0.418). Coracoclavicular distance ratio after surgery was significantly smaller in the subacromial group (P≤ 0.035), and acromioclavicular dislocation ratio after removal of the wires was also smaller in the subacromial group (P≤ 0.001) compared with the trans-articular group.Conclusion:This study revealed that coracoclavicular ligament repair with temporary acromioclavicular stabilization leads to favorable clinical results, with the subacromial group showing better maintenance of joint reduction compared with the trans-articular group. Subacromial wire stabilization is a viable option for long-term temporary fixation of acute displaced acromioclavicular joint dislocation.