UCLA Shoulder Score Research Articles

Biological Fixation of AC Joint using Autologous Semitendinosus Graft in Acute Type III-VI Acromioclavicular Joint Dislocations—A Pilot Study

ABSTRACT Introduction: Injuries to the acromioclavicular (AC) joint can range from modest, transient pain to significant displacement, chronic pain, and shoulder biomechanical changes that result in long-term disability. Aim and Objective: We aimed to evaluate the functional outcome of anatomical reconstruction of ACJ using autologous semitendinosus graft in type III-VI AC joint dislocations. Materials and Methods: In this study, 20 patients with AC joint dislocation (Rockwood type III-VI) were managed by surgical fixation using autologous semitendinosus graft from November 01, 2019, to October 31, 2020, at our center. After providing written informed consent, the study enrolled patients who satisfied the inclusion criteria. Preoperative, three-month, and six-month UCLA shoulder scores were assessed. Results: Mean age of participants was 36.5 years (SD: 9.86). Radiological evaluation at each visit suggested a 100.0% success rate of this method. 95% of the participants had no complications, while 5.0% had DVT. No participants had SSI. Conclusions: Autologous semitendinosus graft fixation of type III-VI AC joint injuries is a viable surgical option with the advantages of being a biological fixation, single surgery, and having excellent functional outcomes. However, extensive multicentric comparative studies are required to draw definitive conclusions.

Pre-operative transverse tendon thickness in small and mid-sized rotator cuff tears does not affect clinical outcomes after arthroscopic repair

IntroductionPrevious studies on rotator cuff tears have examined both clinical and radiographic parameters which may influence post-operative clinical outcomes. While rotator cuff tears are frequently classified by size or depth, there is currently no literature available examining the thickness of the remnant tendon, and its impact on post-operative outcomes. We hypothesize that decreased pre-operative transverse tendon thickness will result in poorer post-operative clinical outcomes. MethodsWe prospectively recruited patients who underwent arthroscopic repair of small to medium full-thickness rotator cuff tears. These patients were followed up for a minimum of 2 years post-operatively. Basic biodata, as well as Visual Analog Scale (VAS) for pain, Constant-Murley Score (CMS), UCLA Shoulder Score (USS), and Oxford Shoulder Score (OSS) at 3 different time points (pre-operatively, 1 year post-operatively, and 2 years post-operatively) were collected. Transverse tendon thickness was measured by independent blinded radiologists on pre-operative ultrasonographic images. Wilcoxon signed-rank test was used to compare outcome scores and multivariable robust linear model was fitted to assess the effect of transverse tendon thickness on post-operative scores. ResultsA total of 63 patients were enrolled in this study, predominantly female (65%) and had a median age of 72 years. Pre-operatively, the median transverse cuff thickness was 5.0 ​mm and median tear size was 1.4 ​cm. The median VAS at preoperative was 7, which reduced to 0 ​at 2 year post-operative, indicating statistically significant improvement in pain levels (p ​< ​0.001). Statistically significant improvement in shoulder function measured by CMS, UCLA score and OSS were also seen over time (p ​< ​0.001). Robust regression analysis revealed that transverse cuff thickness had no statistically significant effect on VAS (p ​= ​0.99), CMS (p ​= ​0.84), UCLA score (p ​= ​0.22), and OSS scores (p ​= ​0.73) at 2 years postoperatively. DiscussionPre-operative transverse tendon thickness of small- to mid-sized supraspinatus tears does not influence clinical outcomes after arthroscopic repair. Differences in transverse tendon thickness may have an association with tendon healing but do not translate to an association with post-operative outcomes in terms of pain, function, and patient-reported outcome measures. Level of evidenceIV.

Raised body mass index and reduced muscle bulk reduces the incidence of Popeye's deformity post tenotomy of long head of biceps brachii

ObjectivesThe development of the Popeye’s deformity is a known complication of long head of bicep tendon (LHBT) tenotomy. Incidence of developing Popeye’s deformity after LHBT tenotomy ranges between 13 - 70%. While this complication is well tolerated, it can be avoided with proper patient selection. We aim to study patient and clinical factors resulting in the development of the Popeye’s deformity after LHBT tenotomy so as to better identify suitable surgical candidates. Methods91 patients underwent unilateral rotator cuff repairs and concomitant LHBT tenotomy between March 2013 and March 2017. Assessment of patient factors contributing to Popeye’s deformity included patient demographics and physical attributes were analysed and correlated. Patients also completed a questionnaire regarding their overall post-operative satisfaction. Prospectively collated Visual Analogue Pain (VAS), Constant-Murley Shoulder Score (CSS), UCLA Shoulder Score (UCLA) and Oxford Shoulder Score (OSS) were compared at 6 and 24 months post-operation between patients who developed Popeye’s deformity and those who did not. ResultsThe incidence of post-tenotomy Popeye’s sign was 58.9%. Majority of patients were satisfied with their procedure, postoperative function and cosmesis. Patients who developed Popeye’s sign had a statistically significant lower body mass index (BMI) (24.9 ± 4.2 kg/m2 versus 27.3 ± 4.3 kg/m2, p = 0.048) (rpb = - 0.210, p > 0.05) and had a greater biceps circumference (in flexion) to wrist circumference ratio (1.91 ± 0.16 versus 1.83 ± 0.13, p = 0.012) (rpb = 0.319, p < 0.05) compared to those who did not. Nevertheless, the development of Popeye’s sign did not affect clinical outcomes (VAS, CSS, UCLA and OSS, p > 0.05) at 24 months. ConclusionsThe incidence of Popeye’s deformity is high post LHBT tenotomy. There was a greater incidence in patients with lower BMI and greater biceps brachii muscle bulk. However, this complication is well tolerated. By better selecting our patients, we can achieve better outcomes and minimise potential complications. Level of evidenceLevel III Evidence. Retrospective comparative study.

Does timing influence rehabilitation outcomes in arthroscopic rotator cuff repair with biceps rerouting? a prospective randomized study

Arthroscopic rotator cuff repair with biceps rerouting (ABR) has emerged as a reliable option for treating large posterosuperior rotator cuff tears (RCTs). This study aims to compare functional and structural outcomes of early vs. delayed motion rehabilitation protocols following ABR. A total of 101 patients with semirigid, large, posterosuperior RCTs undergoing ABR were randomized into 2 groups: group I (early motion) with 53 patients (34 females, 19 males) and group II (delayed motion) with 48 patients (31 females, 17 males). In group I, the mean age was 63.9years (range, 46-79), and in group II, it was 65.4years (range, 43-78). The mean follow-up periods for group I and group II were 16.2 and 15.5months, respectively. Preoperative and postoperative assessments were conducted at 3, 6, and 12months, with structural integrity assessed with magnetic resonance imaging at a minimum follow-up of 12months. Statistical analyses were performed to compare outcomes between the 2 groups. Both groups demonstrated significant improvements in visual analog scale score (group I: 4.0-1.6, group II: 3.7-1.4, P=.501), University of California-Los Angeles shoulder score (group I: 21.5-31.4, group II: 22.4-30.6, P=.331), and acromiohumeral interval (group I: 8.2mm-9.1mm, group II: 8.6mm-9.5mm, P=.412), with no statistically or clinically meaningful differences. Active range of movements (ROM) were not significantly different between groups, except for active forward flexion at 3months (group I: 140.1°, group II: 119.2°, P=.006), that was not shown to be translated clinically into differences in function or healing between the groups in this study. Notably, retear rates were similar between groups (group I: 22.6%, group II: 20.8%, P=.826). This study's findings reveal no clinically discernible differences in active range of motion at 1-year follow-up between patients who underwent ABR for semirigid, large, posterosuperior RCTs and were assigned to either early or delayed motion protocols. Notably, the early motion group demonstrated a plateau in maximum range of movement improvement as early as 3 months postsurgery. Based on these results, implementing an early motion protocol is recommended as an effective approach in the postoperative rehabilitation following ABR.

All-arthroscopic versus mini-open double row rotator cuff repair – A prospective randomised control study based on functional and radiological outcomes

PurposeIn an era where arthroscopic rotator cuff repair is dominant in the United States (77.9 % preference) compared to open surgery (53.33 %), a shift towards minimally invasive All-Arthroscopic (AA) techniques over classical Mini-Open (MO) repair is emerging. This study explores current trends in shoulder procedures in India and compares functional outcomes and radiological repair integrity between AA and MO techniques, which are understudied in the Indian context. MethodologyIn this prospective study, 60 patients (30 in the AA group and 30 in the MO group) with rotator cuff tears underwent assessment. Pre/post-operative clinical evaluations and 12-month follow-ups using UCLA and Oxford Shoulder Score, along with preoperative MRI and postoperative USG, were conducted. ResultsAt one-year follow-up, the AA group showed better functional outcomes (53.3 % excellent/good vs. 30.0 % in MO). No significant radiological differences (Sugaya grading) were found. Tear size was comparable with no association with functional/radiological outcomes. ConclusionThe AA group demonstrated favourable functional outcomes, matched to MO group findings, which is in accordance with global studies. Despite higher costs, the increasing popularity of AA in India is justified by enhanced results and reduced postoperative discomfort.

＜Editors' Choice＞ Hook plate fixation versus locking plate fixation for distal clavicle fracture: a multicenter propensity score-matched study.

Hook plate fixation and locking plate fixation are two standard internal fixation implants for treating distal clavicle fractures. We aimed to clarify the following: 1) Does the locking plate offer better clinical outcomes than the hook plate? 2) Is bone union better with a locking plate than hook plate? and 3) Are complications different between the locking plate and hook plate? We conducted a retrospective multicenter study of 338 patients who underwent surgery from 2014 to 2018 in our 10 hospitals, which comprise the TRON group. Of them, 208 patients treated using any plates were eligible. After 30 patients were excluded for various reasons, 178 patients were included. We classified them into two groups, locking plate group (Group L) and hook plate group (Group H), using propensity score matching. We confirmed bone union with an X-ray, evaluated the UCLA shoulder score, and compared the frequency of complications. After matching, Group L and Group H included 49 patients each. The UCLA score was higher in Group L than in Group H at each follow-up point. We confirmed bone union in all patients in Group L, but it was not confirmed in three patients (6.1%) in Group H. No statistically significant differences were observed except for plate migration, which was observed in nine patients (18.4%) in Group H but in no patients in Group L. The postoperative UCLA score was significantly better in Group L. We recommend the locking plate as a surgical treatment for distal clavicle fractures.

Arthroscopic Capsulolabral Repair for Posterior Shoulder Instability with Suture Anchors Using a Beach Chair Approach

Background: Posterior shoulder instability is a relatively rare cause of recurrent instability with its incidence at 2 to 10%. It is often associated with a posterior capsulolabral tear for which Arthroscopic repair has shown good outcome. In terms of approach, there is a lack of consensus among surgeons regarding the most optimal position to perform the Arthroscopy with earlier studies favoring the use of the Lateral Decubitus (LD) over the Beach Chair (BC) position. Aim: This study is a mini-case series describing a surgical technique using the BC position in Arthroscopic posterior capsulolabral reconstruction. The authors of this study hypothesize that the use of the BC position is adequate in Arthroscopic posterior capsulolabral reconstruction so long as the surgeon is cognizant of its limitations. Methods: A retrospective analysis of the prospectively collected data was performed for 9 shoulders with posterior capsulolabral injury in 8 patients. At a tertiary hospital, the patients underwent an Arthroscopic posterior capsulolabral reconstruction using the BC position by a fellowship trained shoulder Orthopaedic surgeon. Patients were assessed preoperatively and prospectively followed up for two years and at 2 years postoperatively for isometric strength, range of motion (ROM), and various outcome measures. These included the visual analogue scale (VAS), Oxford Shoulder Score (OSS), UCLA Shoulder Score (UCLASS), and Constant Shoulder Score (CSS) and for pain assessment. Results: All the patients were male with a mean age was 25.1 (Range 20-33). 4 out of 9 (44.4%) patients suffered from a traumatic event. The mechanism of injury varied among these patients. All patients had a posterior labral tear with 7 out of 9 having concomitant capsular laxity. There was significant improvement in UCLA scores (18.4 vs 29.8) (P=0.001), Oxford Shoulder Score (37.8 vs 16.1) (P&lt;0.001) and VAS score (3.9 vs 1.3) (P=0.017) at 2 years postoperatively. There was no significant improvement in Isometric strength, Constant Shoulder Scores and Range of motion (Abduction and Forward flexion). Conclusion: The study hypothesized that the use of the BC position is adequate in posterior capsulolabral reconstruction so long as the surgeon is familiar and comfortable with the technique. Level of evidence: 2

Mid-Term results in adult humeral fractures with titanium elastic nail fixation versus plate and screw fixation and locking intramedullary nailing

Aims: To compare plate-screw fixation, intramedullary nailing (IMN), and titanium elastic nailing (TEN) as a new fixation method with respect to nonunion, complication rates, and functional outcomes in the repair of adult humeral shaft fractures. Methods: A total of 38 adult patients who were treated due to humeral shaft fracture at our clinic and were followed for minimum six months between January 2012 and January 2015 were retrospectively analyzed. Age, sex, fracture etiology an length of hospitalization were recorded. Fractures were classified according to the Association for Osteosynthesis(AO) classification. Nonunion rates as assessed by X-ray during visits, angulation, shoulder, elbow and hand disability scores were evaluated using the DASH, Mayo Elbow and UCLA Shoulder scoring, and Stewart Hundley criteria. Results: There was no significant epidemiological difference between the groups. The length of hospitalization was lower in the TEN group. There was no significant difference in nonunion rates and functional scores according to the type of treatment. Angulation rate was slightly higher in the TEN group. The effect of angulation on functional score showed no influence on the functional status. The three treatment types mostly achieved excellent and good outcomes. Conclusion: Our study results suggest that TEN seems to be a good alternative treatment in eligible patients with humeral shaft fractures considering complications of other treatments. However, we believe that further, large-scale, randomized-controlled, prospective studies with longer follow-up duration are required to confirm these findings and to establish a definite conclusion. Level of Evidence: Therapeutic Level III.

Prevalence and predisposing factors of neuropathic pain in patients with rotator cuff tears

BackgroundThe management of pain in patients with rotator cuff tears can be challenging. Neuropathic pain is reportedly associated with pain occurrence in musculoskeletal diseases. However, to date, few studies have reported on the prevalence of neuropathic pain in patients with rotator cuff tears or identified the factors associated with neuropathic pain in a multicenter study. MethodsA total of 391 patients (205 males and 186 females; median age, 67.7 years; range, 27–92 years) with rotator cuff tears were included in this study. The prevalence of neuropathic pain in rotator cuff tears was investigated using the Japanese version of the painDETECT questionnaire for all patients. In addition, factors significantly associated with the occurrence of neuropathic pain were examined using multivariate logistic regression analysis. ResultsTwenty-eight patients (7.2%) were classified into the neuropathic pain group (score ≥19), 97 (24.8%) into the uncertainty regarding neuropathy group (score 13–18), and 266 (68.0%) into the nociceptive pain group (score ≤12). According to the multivariate logistic regression analysis, the independent predictors of neuropathic pain were the VAS score (most severe pain during the past 4 weeks; odds ratio, 1.55; 95% confidence interval [CI], 1.23–2.09) and UCLA shoulder score (odds ratio, 0.81; 95% CI, 0.65–0.97). ConclusionsBased on the study findings, the prevalence of neuropathic pain in patients with rotator cuff tear was 7.2%. It is important to investigate the presence or absence of neuropathic pain when treating patients with painful rotator cuff tears, because neuropathy associated with rotator cuff tears may adversely affect patient outcomes.

Investigation of the occurrence of musculoskeletal disorders at shoulder, neck and elbow of digestive endoscopy operators

Objective: To investigate the effect of endoscopic operation volume on musculoskeletal disorders (MSDs) of shoulder, neck and elbow. Methods: From December 2019 to March 2020, random sampling was used to select 200 gastroenterologists from hospitals at or above the municipal level in Sichuan Province as the research object. Gastroenterologists were divided into 108 eadoscop in the low operation group (The operation volume is less than 5 000 cases) and 92 eadoscop in the high operation group (The operation volume is more than 5 000 cases) according to the operation volume. MSDS was investigated by UCLA shoulder scoring system, Tanaka Jingjiu cervical spondylosis scale and improved An and Morrey elbow scoring system, and the chi-square test was used to compare the basic conditions of different body parts in the two groups. The basic condition of each part of the two groups was tested and compared. Results: Compared with the low operation group, the age and working years of the high operation group were longer, and the difference was statistically significant (P<0.001). The most painful part between the two groups was the shoulder, accounting for 25.9% (28/108) and 37.0% (34/92), respectively. Occasional shoulder pain was the most (41.9%, 26/62) and normal function was the most (32.3%, 20/62) ; The forward flexion angle exceeds 150° at most (40.3%, 25/62). Slight pain often occurred in the neck, accounting for 57.7% (15/26), the occasional impact of pain on the upper limbs accounted for 61.5% (16/26), and the impact on the fingers accounted for 53.8% (14/26) ; 65.0% (15/26) had mild disturbance to the sense of signs; Normal tendon reflex accounted for 88.5% (23/26) ; The influence of opponents was weakness, discomfort and no dysfunction, accounting for 53.8% (14/26) ; Endoscopists with normal muscle strength (2 points) and mild decline accounted for 50.0% (13/26) respectively, and there was no significant difference among the groups (P=0.234、1.000、1.000、0.050、0.680、0.539、0.431、0.239). The elbow score scale showed that mild loss accounted for 55.0% (11/20), mild instability accounted for 65% (13/20), and mild pain accounted for 55.0% (11/20) . Conclusion: MSDs is a health problem faced by endoscopists, and targeted preventive measures should be taken for its possible causes.

To determine shoulder function after arthroscopic rotator cuff repair using university of California and Los Angeles score

Rotator cuff tears are a common contributing factor ofshoulder pain and occupational disability. Tears of rotator cuff arebecoming increasingly prevalent in today’s population. Shoulderarthroscopy has become a reliable and reproducible method of treatingrotator cuff tears. Arthroscopic surgery allows for a shorter recovery timeand predictably less pain in first few days following procedure than doesany open surgery. : A prospective and retrospective review of themedical records of 37 cases of rotator cuff tear who underwentarthroscopic rotator cuff repair between January 2017 to May 2020 atDayanand Medical college Hospital, Ludhiana was performed.In our study, we had measured UCLA shoulder score over 6months period in 37 patients. Our study showed improved functionaloutcome from UCLA score at presentation- 10.27 to UCLA at 6 months-30.41 with a p value &amp;#60;0.001 which is graded as a good result. There wasno significant gender difference in terms of incidence and postoperativefunctional outcome. Maximum incidence was seen in age group- 51-60years with etiological inclination towards precedent trauma. No statisticaldifference between functional outcome of single and double row techniquewas noted.Arthroscopic repair of rotator cuff tear offers excellent functional outcome; with minimal morbidity. Improvement in pain, range of motion and strength of cuff tendons can be achieved only by meticulous repair techniques and strict rehabilitation programme.

PECTORALIS MAJOR TENDON INJURY: RECONSTRUCTION USING BONE TUNNEL AND ANCHORS.

ABSTRACTObjective:This study aims to assess a new technique used for pectoralis major reconstruction using bone tunnel and fixation with metallic anchors in the contralateral cortical bone.Methods:Patients who had undergone post-surgical reconstruction of the pectoralis major at least 24 months before were assessed by the UCLA Shoulder Score and the Simple Shoulder Test and compared with the contralateral side by manual goniometry. Subgroup analysis was also performed between grafted and non-grafted patients.Results:13 patients fulfilled the inclusion criteria. The average UCLA score was 34.77 ± 0.12, compared with the standard 27 of good and excellent results p < 0.0001. The Simple Shoulder test mean was 11.92 ± 0.08. Grafted and non-grafted subgroups had no statistical differences for UCLA p = 0.58 and Simple Shoulder Test p = 1.00. Long term losses for elevation or external rotation were lower than 5º. No lesions recurred. All patients returned to their physical activities with no restrictions.Conclusion:The pectoralis major reconstruction technique using a bone tunnel and metallic anchors in the contralateral cortical bone was effective. However, its execution needs special care to avoid complications. Level of Evidence IV, Case Series.

Study of functional and radiological outcome in humerus shaft fractures treated with anterior bridge plating

Introduction: In our study we have evaluated functional and radiological outcome in 20 patients. Humerus shaft fractures treated with anterior bridge plating has shown good results in terms of postoperative pain and union time. Though open reduction and internal fixation is gold standard this technique gives good results.Materials and Methods: Twenty patients were treated with anterior bridge plating between July 2020 to may 2021.All cases were treated with 4.5mm DCP in bridging mode. Mechanism of injury, age, gender, union time were taken into account. UCLA shoulder and MEPS score were taken for assessing function.Results: In this study 20 patients were included, 16 males and 4 females. The age of patients ranged from 20 to 60 years with mean age of 34 years. All the fractures healed within range of 16-18 weeks. No radial nerve palsies were recorded. According to UCLA shoulder score 16 patients were excellent and 4 patients were good. The mayo elbow performance score was above 90 for all patients.Conclusion: Anterior bridge plating using MIPO technique results in good functional and radiological outcomes. It is safe and less time consuming for simple humerus shaft fracture patterns.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

A study of clinico-radiological outcomes of diaphyseal humerus fracture treated with minimal invasive plate osteosynthesis (MIPO)

Introduction: Humeral shaft fracture is one of the common injuries encountered in orthopedic surgery accounting for 1% - 5% of all fractures. Although nonoperative treatment of humeral shaft fracture is associated with satisfying clinical and functional outcomes in most cases, usually results in varus deformity and limitation of shoulder and elbow motion in some patients. Thus, orthopedic surgeons prefer operative management due to early return to function and low compliance of the patients. Materials and Methods: 29 patients with diaphyseal fractures of the humerus treated with MIPO between January 2015 and June 2016 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 2 and 3 open fractures were excluded from the study. All patients having diaphyseal humerus fracture were treated with closed indirect reduction and plate fixation 4.5 dynamic compression plate using the MIPO technique. The surgery time, and time for union was noted. The shoulder and elbow function were assessed using the UCLA shoulder and Mayo elbow performance scores, respectively in follow up examination. Results: Of the 32 patients in the study, 16 were males and 13 were females. The mean age was 34.5 years (Range: 18-58 years). Twenty of the twenty nine patients had the dominant side fractured. We had six cases of C1 and A2 type; three cases of A1, B2 and C3 type; four cases of B1 type; two cases of C3 type; and one case of A3 and C2 type of fracture. The mean surgical time was 93.1 minutes (range: 70–120 minutes). The mean radiological fracture union time was 13.1 weeks (range: 10–18 weeks). Shoulder function was excellent in 24 cases (82.7%) and good in remaining 5 cases (17.3%) on the UCLA score. Elbow function was excellent in 25 cases (86.2%) and good in 4 cases (13.8%) on mayo elbow performance score. 2 patients developed radial nerve palsy and translation was present in 4 patients. Conclusion: In diaphyseal humerus fracture, MIPO gives good functional and cosmetic result and this should be considered as one of the good option in treatment of diaphyseal humerus fracture.

Triple-Endobutton and clavicular hook: A propensity score matching analysis.

We retrospectively analyzed the clinical data of 635 patients with acute acromioclavicular dislocation, who underwent surgery in our hospital between May 2014 and June 2020. Patients were divided into group A (clavicular hook plate) and group B (Triple-Endobutton plates via double-incision). The propensity score analysis using one to one match was performed for comparisons. We obtained 292 matched patients’ data. The matched preoperative clinical characteristics were a balance between the two groups. All clinical parameters showed insignificant differences (P > 0.05). Compared with group A, group B has longer operative time (P < 0.001) and more blood loss (P < 0.001); however, the mean incision length (P < 0.001) and length of hospitalization (P < 0.001) were shorter in group B than in the group A. The mean VAS in group B were significantly lower than in group A at each time point (P < 0.001), and the UCLA shoulder score was higher in the group B. The CMS scores were also higher in group B than in group A, including before removal and 12 weeks after removal (P < 0.001). The clinical efficacy of the double-incision Triple-Endobutton plate is better than the clavicular hook plate technology, and achieves anatomical reduction by reconstructing coracoclavicular ligament.

Définition d’une différence minimale cliniquement significative pour les scores UCLA et ASES après réparation de la coiffe des rotateurs

Background/HypothesisMinimal clinically important difference (MCID) is a vital tool in the analysis of clinical results. It allows the determination of clinical relevance of statistical data. Our hypothesis was that specific differences between preoperative and postoperative scores would be able to accurately predict patient perception of improvement and satisfaction as reflected by anchor and distribution-based questions. MethodsRetrospective cohort with patients that underwent rotator cuff repair. We evaluated the University of California at Los Angeles Shoulder Rating Scale (UCLA) and the American Shoulder and Elbow Surgeons Assessment Form (ASES) before and 12-months after surgery. Anchor-based, distribution-based and minimum detectable change (MDC) approaches were utilized. ResultsWe evaluated 289 shoulders. The MCID for the UCLA scale was 4.5 points using the anchor method, 2.5 by the distribution method and 3.6 by MDC. Patients with a baseline score>20 presented a lower MCID (1.5, 1.1 and 1.7, respectively). For the ASES score, the MCID was 6.1 by the anchor method, 10.5 based on the distribution method and 26.3 by MDC. In the group of patients above the 60 point cutoff, the obtained values were 2.4, 4.9 and 13.6, respectively. ConclusionThe mean MCID value for the UCLA shoulder score is 3.5 points, ranging from 2.5 points (distribution method) to 4.5 points (anchor method). The mean MCID value for the ASES score was 15.2 points, ranging from 6.1 (anchor method) to 26.3 (MDC). Patients groups presenting with higher preoperative scores showed lower MCID values. This fact needs to be considered in postoperative comparisons between treatment groups. Level of evidenceBasic Science Study, Validation of Outcomes Instruments/Classification Systems.

Clinical outcomes of a combined osteoligamentous reconstruction technique of Neer Type IIB distal clavicle fractures

PurposeTo evaluate outcomes for a combined osteoligamentous reconstruction technique for Neer Type IIB clavicle fractures. MethodsPatients with Neer Type IIB clavicle fractures treated with combined clavicular locking plate and coracoclavicular ligament suture reconstruction were identified. Demographics, clinical outcomes, and radiographic outcomes were collected. ResultsTwenty-four patients with mean 13 months of follow-up were included. Bony union and normal radiographic coracoclavicular relationship were achieved in 23 (96%) patients. The mean UCLA Shoulder score was 33.3. Three (13%) complications occurred. DiscussionThe combined osteoligamentous reconstruction approach as described is a successful option for treating Neer Type IIB clavicle fractures.

Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair

Background/HypothesisMinimal clinically important difference (MCID) is a vital tool in the analysis of clinical results. It allows the determination of clinical relevance of statistical data. Our hypothesis was that specific differences between preoperative and postoperative scores would be able to accurately predict patient perception of improvement and satisfaction as reflected by anchor and distribution-based questions. MethodsRetrospective cohort with patients that underwent rotator cuff repair. We evaluated the University of California at Los Angeles Shoulder Rating Scale (UCLA) and the American Shoulder and Elbow Surgeons Assessment Form (ASES) before and 12-months after surgery. Anchor-based, distribution-based and minimum detectable change (MDC) approaches were utilized. ResultsWe evaluated 289 shoulders. The MCID for the UCLA scale was 4.5 points using the anchor method, 2.5 by the distribution method and 3.6 by MDC. Patients with a baseline score>20 presented a lower MCID (1.5, 1.1 and 1.7, respectively). For the ASES score, the MCID was 6.1 by the anchor method, 10.5 based on the distribution method and 26.3 by MDC. In the group of patients above the 60 point cutoff, the obtained values were 2.4, 4.9 and 13.6, respectively. ConclusionThe mean MCID value for the UCLA shoulder score is 3.5 points, ranging from 2.5 points (distribution method) to 4.5 points (anchor method). The mean MCID value for the ASES score was 15.2 points, ranging from 6.1 (anchor method) to 26.3 (MDC). Patients groups presenting with higher preoperative scores showed lower MCID values. This fact needs to be considered in postoperative comparisons between treatment groups. Level of evidenceBasic Science Study, Validation of Outcomes Instruments/Classification Systems.

Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes?

Introduction: The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of “one point of fixation” is yet to be fully elucidated. Materials and Methods: A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). Results: There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. Conclusion: Contention still exists surrounding the exact definition of “a point of fixation” in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.