University Of California, Los Angeles Score Research Articles

Magnetic resonance imaging should be the first-line imaging modality for investigating suspected proximal hamstring avulsion injuries.

The purpose of the study was to evaluate how the initial diagnostic tool used-specifically ultrasound (US) or magnetic resonance imaging (MRI)-for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries. This was a retrospective analysis of prospectively collected data (2012-2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US-first vs. MRI-first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA)Activity Scale and Tegner Activity Scale. The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI-firstgroup and 47.6 ± 12.0 years for US-first group. Patients in the MRI-first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range [IQR]: 11.0-61.0) compared to 30 days (IQR: 18-74) in the US-first group. At the final follow-up (4.2 ± 2.2 years for the MRI-first group and 5.1 ± 1.9 years for the US-first group), the MRI-first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US-first group: The Tegner Activity Scale was median 5 (IQR: 3-7) for the MRI-first group versus median 4 (IQR: 2-6) for the US-first group (p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI-first group compared to 7.3 ± 2.4 for the US-first group (p < 0.05). This difference was more pronounced when comparing the MRI-first group with the patient-false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score. MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US. Level III.

A Successful Arthroscopic Management of a Benign but Locally Aggressive Tenosynovial Giant Cell Tumour in the Shoulder.

Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the shoulder joint. This prospective study aims to document the challenges encountered in achieving total synovectomy and assesses the clinical outcomes of arthroscopic synovectomy for PVNS in shoulder patients. Methods This is a prospective study conducted from April 2017 to September 2023. This monoarticular disease was observed among six patients (four females and two males). All patients underwent arthroscopic extensile synovectomy with biopsy and culture. The outcomes were measured using Constant score,American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) scores. All patients were followed up for a minimum of 36 months after arthroscopic synovectomy. Results All intraoperative findings were consistent with PVNS and confirmed with histopathological examination. All patients achieved a satisfactory, painless range of movements following surgery. The individual Constant score improved from a mean value of 64.83 to 94.50, the ASES score improved from a mean value of 81.15 to 99.73, and the UCLA score improved from a mean value of 23.16 to 34.83 post-arthroscopic intervention, proving its effectiveness. No recurrences were reported after 36 months of follow-up. Conclusion PVNS can be easily missed, and one must have a high index of suspicion to diagnose early.Delayed presentation of the disease had led to severe destruction of the joint. Early diagnosis and arthroscopic intervention prior to joint destruction are crucial for achieving a good functional outcome. Incomplete excision may lead to recurrence of the disease. Therefore, we propose extensile arthroscopic synovectomy of the shoulder, wherein by expecting and addressing the intraoperative challenges, complete excision can be achieved, thus preventing recurrence.

All-Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Leads to High Healing Rate and Excellent Outcomes in Patients With Massive, Retracted Rotator Cuff Tears, Even in Patients With Pseudoparalysis

PurposeThe purpose of this study was to evaluate the clinical and radiographic outcomes of an all-arthroscopic rotator cuff repair technique involving muscle advancement and double-layer lasso loop (DLLL) repair for massive, retracted posterosuperior cuff tears. MethodsThis is a retrospective case series of patients with massive, retracted posterosuperior cuff tears who underwent the all-arthroscopic muscle advancement technique from March 2017 to September 2021, with minimum follow-up of 12 months. Key steps included suprascapular nerve release, advancement of supraspinatus and infraspinatus muscles, and DLLL repair. Preoperative and postoperative visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California Los Angeles (UCLA) shoulder score, active range of motion (ROM), and strength were compared. Preoperative and postoperative structural radiological characteristics were analysed. ResultsForty-three shoulders in 38 patients were evaluated with mean follow-up of 18.8 months (range 12-55 months). Of the 43 shoulders, 4 repairs failed (9.3% retear rate). VAS, ASES, Constant, and UCLA scores significantly improved (p<0.001) in patients who demonstrated healing on postoperative MRI (n=39). ASES, Constant, and UCLA scores were significantly better in the healed group, with 100% exceeding MCIDs for ASES and UCLA scores, and 84.2% for Constant score. A lower proportion of patients in the retear group achieved MCIDs. Active ROM in all planes significantly improved for those who had healed repairs. (p<0.001). Relative strengths of abduction, supraspinatus, and infraspinatus were at least 90% of the contralateral side. Recovery rate of pseudoparalysis (7 patients) was 100%. ConclusionAll-arthroscopic muscle advancement, coupled with double-layer lasso loop repair, leads to a high healing rate with excellent clinical outcomes and recovery of strength to at least 90%, even in patients with pseudoparalysis.

Significant Clinical Improvement After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Follow-Up.

This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced chondrogenesis (A-AMIC) for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes. Sixty-three patients (32 males, 31 females) with a median age of 37 years [interquartile range (IQR): 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California, Los Angeles (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated. There were significant improvements in the VAS, AOFAS, SF-12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (P < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 years had lower SF-12, Halasi, and UCLA scores (P = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (P = 0.006, 0.002, 0.024, and 0.007, respectively). Lesion size was uninfluential. A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first 2 years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.

Determining patient acceptable symptom states from patient reported outcome measures following reverse shoulder arthroplasty: Constant-murley, UCLA, Oxford Shoulder Scores

AimsTo establish cut-off values for Patient-Acceptable Symptom States (PASS) in three Patient Reported Outcome Measures (PROMs), the Constant-Murley Score (CMS) and University of California Los Angeles (UCLA) Shoulder Score and Oxford Shoulder Score (OSS) at 3, 6, and 12-months following reverse shoulder arthroplasty (RSA). MethodsA retrospective study was conducted for individuals who were treated for massive rotator cuff tear, rotator cuff arthropathy or proximal humerus fractures with RSA from January 2011 and February 2020. This study included patients who have completed the patient reported outcome measures (PROMs) and satisfaction questions preoperatively, and at 3, 6 and 12-months after the procedure. Functional outcome were evaluated by CMS, UCLA shoulder score and OSS, with one anchoring question regarding satisfaction. PASS thresholds for each PROM were obtained with the Youden method, by using the receiver operating characteristic analysis, and secondary analysis was performed with the 80% specificity and 75th percentile method. Results129 patients were included. 74.2%, 83.9%, and 89.3% of patients were found to have a satisfactory symptom state at 3, 6 and 12-months postoperatively. At 3, 6 and 12-month intervals, the respective PASS thresholds were 42, 39 and 52 for CMS, 17, 21 and 26 for UCLA score and 28, 25 and 18 for OSS. ConclusionsPASS thresholds for RSA at 3, 6 and 12-months were found for CMS (42, 39, 52), UCLA (17, 21, 26) and OSS (28, 25, 18). These thresholds suggest increasing expectations with a trend towards higher functional requirements at each time point.

Early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge repair of medium-size supraspinatus tendon tears

To explore the early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears. Between December 2020 and January 2023, 40 patients with medium-size supraspinatus tendon tears were treated with arthroscopic tri-anchor double-pulley suture-bridge. There were 18 males and 22 females, with an average age of 62.6 years (mean, 45-73 years). Among them, 17 patients had trauma history. The main clinical symptom was shoulder pain with hug resistance test (+). The interval from symptom onset to operation was 10.7 months on average (range, 3-36 months). Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. All incisions healed by first intention, no complications such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.2 months). At 12 months after operation, VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores ( P<0.05). At 3 and 12 months after operation, the ROM of external rotation significantly improved when compared with preoperative one ( P<0.05), and further improved at 12 months after operation ( P<0.05). However, the ROMs of abduction and forward flexion did not improve at 3 months after operation when compared with those before operation ( P>0.05), but significantly improved at 12 months after operation ( P<0.05). Twenty-six patients underwent MRI at 3-6 months, of which 23 patients possessed intact structural integrity, good tendon tension, and tendon healing; 3 patients underwent tendon re-tear. The self-rated satisfaction rate was 92.5% at last follow-up. Arthroscopic tri-anchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears can maximize the tendon-bone contact area, obtain satisfied early effectiveness with high satisfaction rate and low incidence of tendon re-tear. However, the function of abduction is limited at 3 months after operation, and patients need to adhere to rehabilitation training to further improve the joint activity.

A Modified Arthroscopic Triple-row Repair Technique for L-shaped Delaminated Rotator Cuff Tears.

To compare the clinical outcomes of a modified arthroscopic triple-row (TR) repair technique with the suture bridge (SB) repair technique in treating L-shaped delaminated rotator cuff tears. Various surgical techniques for L-shaped delaminated rotator cuff tears have been reported, many of which aid in increasing the contact area and pressure of the rotator cuff. However, there is still debate over which technique yields superior results. From January 2017 to March 2020, 61 cases of L-shaped delaminated rotator cuff tears were included in this study. Of these, 34 cases underwent the modified arthroscopic triple-row repair technique, while 27 cases were addressed with the suture bridge repair technique. Functional assessment was conducted using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder score, the Constant score (CS), and the visual analogue scale (VAS) score. Magnetic Resonance Imaging (MRI) assessments for rotator cuff healing were performed at the 24-month postoperative mark. Statistical evaluations were conducted using SPSS for Windows (Version 25.0, IBM, Armonk, NY, USA), employing the Wilcoxon signed-rank test to compare preoperative and postoperative data and ROM differences, and the Mann-Whitney U test for statistical differences in clinical outcome scores between the two groups. A p-value of less than 0.05 was considered statistically significant. Comparative analysis of the preoperative and final follow-up scores revealed a substantial enhancement in shoulder function, as indicated by the ASES, UCLA, CS, and VAS scores, with statistical significance (p < 0.001). At both the preoperative stage and final follow-up, no notable differences were observed in ASES, UCLA, CS, and VAS scores between the two groups. However, the TR repair group exhibited lower VAS scores than the SB group at 1 and 3 months postoperatively. Active range of motion (ROM) showed significant improvement in both groups. No significant differences in ROM were noted between the two groups either before the surgery or at the final follow-up. The study demonstrates that both the modified arthroscopic TR and SB techniques for L-shaped delaminated cuff tears yield satisfactory outcomes, with no significant differences in overall clinical performance. Notably, early postoperative pain management appears more effective with the modified TR technique, suggesting its potential for enhanced early recovery experiences. This technique's design, promoting securer fixation and optimal contact conditions, is implied to facilitate superior long-term healing, warranting further investigation into its long-term benefits.

Validation of the Parisian Hamstring Avulsion Score (PHAS) in the Evaluation and Follow-up of Patients Operated for Proximal Hamstring Avulsion

Background: No validated score is available for the prediction of return to sport (RTS) after proximal hamstring avulsion (PHA) surgery. Purpose: To validate a new assessment tool for patients after PHA surgery: the Parisian Hamstring Avulsion Score (PHAS). Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: All patients at our clinic who had surgery for PHA between January 2015 and March 2018 were included in this study. A suspected clinical diagnosis of PHA was confirmed by magnetic resonance imaging. PHA was repaired by surgical reinsertion with suture anchors. Minimum postoperative follow-up was 2 years, and the PHAS, University of California, Los Angeles (UCLA), score, and Tegner score were used. The PHAS is a patient-reported outcome measure, evaluating the effect of PHA injury with 9 items. It was validated by calculating its psychometric properties, and then correlation analysis was performed to determine the relationship between the PHAS, UCLA score, and Tegner score. Cutoff values for the prediction of RTS were determined. Results: A prospective case series study was performed. A total of 156 patients were included. Median age (first quartile; third quartile) was 54.2 years (44.7 years; 61.3 years), and the mean ± SD time of the final follow-up was 69 ± 11.6 months. Two years after surgery, 66.7% (n = 104) of patients were able to RTS. A strong correlation was noted between all 3 scores at 1 year postoperatively. Overall internal consistency was high, with a Cronbach alpha coefficient of 0.86. The intraclass correlation coefficient was 0.96, showing excellent reliability. The minimal detectable change was 12.9. No patients reached the maximum score at 2 years. Analysis of the receiver operating characteristic curves of the 3 scores at postoperative 9 months in relation to the RTS at 1 and 2 years showed area under the curve values of >0.7, indicating significant discriminant capacity for the RTS. A PHAS cutoff value of 86 at 9 months for the prediction of RTS at postoperative 1 year had a sensitivity of 65.6% (95% CI, 53.7%-77.5%) and a specificity of 81.4% (95% CI, 69.8%-93%). Conclusion: PHAS is a valid and reliable tool for follow-up after PHA surgery. It also offers a simple way to predict RTS.

Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair Correlates With Improved Tendon Healing

PurposeThis study assessed if early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in arthroscopic rotator cuff repair (ARCR) patients. MethodsSingle-center retrospective study. 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over four years were considered. Patients with at least one year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at three months postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months postoperatively. Stiffness, retear rates, and tendon integrity were assessed via MRI at 12 months. ResultsOf 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (P=.013/.014) and higher VAS score (P=.034). At 3 months, this group showed lower ROM and functional scores (P<.001), persisting at 6 and 12 months (except internal rotation) (P<.001). Their 12-month VAS score was higher (P=.024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (P=.035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (P=.032). Minimal clinically important difference (MCID) analysis indicated ROM changes but limited functional score changes in the two groups. ConclusionThis study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and higher pain levels. Shoulder stiffness at three months post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.

Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty?

BackgroundSteroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA). MethodsA retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (<3 months, 3-12 months, and >12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score. Results421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; P < .001) and older age (75 vs. 70; P < .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; P = .025) and abduction (70° vs. 60°; P = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (P = .009 and P = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (P = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (P = .024). Complication and reoperation rates were comparable between groups. ConclusionOur study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.

Combined Anterior Latissimus Dorsi and Teres Major Tendon Transfer (aLDTM) for Irreparable Anterosuperior Rotator Cuff Tears.

Transfer of the anterior latissimus dorsi and teres major (LDTM) tendons has demonstrated favorable outcomes in patients with irreparable anterosuperior rotator cuff tears1. The objective of this procedure is to restore internal rotation strength, enhance active range of motion, and provide pain relief while preserving the glenohumeral joint. The incision extended from the coracoid to the inferior border of the pectoralis major tendon, following the deltopectoral interval located laterally to the coracoid. While preserving the pectoralis major tendon, the latissimus dorsi (LD) and teres major (TM) tendons are identified and detached from the humerus without separating the tendons. The LDTM tendons are grasped, and nonabsorbable sutures are placed in a continuous running-locking suture fashion. Traction is applied to the sutures while bluntly releasing the adhesions surrounding the LDTM muscles in order to enable further mobilization and excursion. With the patient's arm positioned in full internal rotation and at 45° of abduction for physiological tensioning, the LDTM tendons are attached 2 cm distal to the lateral edge of the greater tuberosity and lateral to the biceps groove with use of 1 medial anchor and 3 lateral anchors. Arthroscopic partial repair, superior capsular reconstruction, pectoralis major tendon transfer, and isolated LD tendon transfer are potential alternative treatments. In cases in which these options are not feasible or have been unsuccessful, reverse total shoulder arthroplasty can be considered as a treatment option. Arthroscopic partial repair can provide pain relief, but its effectiveness in improving range of motion and muscle strength is limited2,3. Additionally, there is a high risk of retear, with reported rates as high as 52%4. Superior capsular reconstruction is considered a viable treatment, but it is not recommended in cases involving irreparable subscapularis tears5-7. Pectoralis major transfer may lead to less favorable clinical outcomes in cases in which an irreparable subscapularis tear and an irreparable supraspinatus tear are simultaneously present8-10. In cases of irreparable anterosuperior rotator cuff tears, the transfer of the LD tendon alone may not fully restore the superior migration and anterior subluxation of the humeral head.11. Reverse total shoulder arthroplasty may be another option in these cases, but it does not preserve the glenohumeral joint. The procedure involves stabilizing the superior translation of the humeral head by rebalancing the force couple, as the TM tendon exhibits scapulohumeral kinematics similar to the subscapularis tendon. Additionally, the procedure effectively reduces anterior glenohumeral subluxation through the combined effect of the posterior line of pull from the combined LDTM tendons and the scapulohumeral kinematics of the teres minor tendon. Also, by fixing the transferred LDTM tendons just distal to the greater tuberosity, the vector becomes less vertical, thereby preventing axillary nerve impingement and achieving appropriate tendon tensioning. The use of this procedure is supported by a study of 30 patients who were followed for a minimum of 2 years1. Significant improvements were observed in various scoring systems, including the pain VAS (visual analogue scale), Constant, ASES (American Shoulder and Elbow Surgeons), UCLA (University of California-Los Angeles), SANE (Single Assessment Numeric Evaluation), and ADLIR (Activities of Daily Living requiring active Internal Rotation) scores. Importantly, there was no significant progression of cuff tear arthropathy observed during the final follow-up. Additionally, preoperative anterior glenohumeral subluxation (15 of 30 patients) was restored in all patients after LDTM tendon transfer. Careful attention should be paid to the anterior humeral circumflex vessels to prevent bleeding.The radial nerve, passing through the anteroinferior surface of the LDTM tendons, should be carefully identified and protected to avoid iatrogenic injury.To maintain physiologic tension, the patient's arm should be positioned in full internal rotation and 45° of abduction.To avoid axillary nerve impingement, the LDTM tendons should be fixed just distal to the greater tuberosity and lateral to the biceps groove. SCR = superior capsular reconstructionLDTM = latissimus dorsi combined with teres majorASRCTs = anterosuperior rotator cuff tearsA/S = arthroscopicROM = range of motionTM = teres majorTm = teres minorLD = latissimus dorsiSSC = subscapularisSSP = supraspinatusPM = Pectoralis majorPm = Pectoralis minorRSA = reverse total shoulder arthroplastyASES = American Shoulder and Elbow SurgeonsUCLA = University of California-Los AngelesADLIR = Activities of Daily Living requiring active Internal RotationGT = greater tuberosityACR = anterior capsular reconstructionFF = forward flexionER = external rotationIR = internal rotationAHD = acromiohumeral distanceMRI = magnetic resonance imagingISP = infraspinatusPEEK = polyetheretherketonePOD = postoperative dayEMG = electromyographySD = standard deviationBMI = body mass indexDM = diabetes mellitusHTN = hypertensionVAS = visual analogue scaleSANE = Single Assessment Numeric EvaluationaROM =active range of motion.

Managing severe bipolar bone loss in athletes: A comprehensive approach with open Latarjet and arthroscopic remplissage

BackgroundSevere bipolar bone loss (BBL) represents one of the toughest challenges when managing the instability of glenohumeral joints among athletes and more specifically the ones involved in overhead sports. It refers to the significant loss of the humeral head and the glenoid bone, with an increased risk of failure. The present study aimed to evaluate the functional outcomes of a combined open Latarjet and arthroscopic remplissage in such high-risk individuals. MethodsA retrospective evaluation was carried out among athletes with antero-inferior loss of glenoid bone of more than 15 % and large off-track Hill-Sachs defect who underwent the Latarjet technique with iliac crest bone graft (ICBG) harvest used in combination with arthroscopic remplissage between 2021 and 2023. The University of California, Los Angeles (UCLA) score, constant-Murley score (CMS), and the range of motion (ROM; measured as forward flexion, external rotation, and abduction) were evaluated pre-operative and post-operative at the timepoint of 3-month, 6-month, and 1-year. Pre-operative magnetic resonance imaging scans (MRI) and computed tomography scans (CT) were obtained among the patients with severe glenohumeral BBL, and the glenoid track was calculated to identify on-track and off-track Hill-Sachs lesions. Post-operative MRI with filled Hill-Sachs defect post remplissage procedure and 3D CT scan was also done at 6-month to evaluate the union of the ICBG to the native glenoid bone. ResultsOverall, 11 patients underwent for the combined procedure for severe BBL. The UCLA score (31.18 ± 3.74), and the CMS (93.64 ± 8.38) at the time-point of 1-year post-operatively showed remarkable improvement in comparison with the preoperative scores (P < 0.0001); and the ROM including abduction, external rotation, and forward flexion were restored to near normality. All patients showed bony union at 6-month as confirmed by post-operative CT scan. No complications such as redislocation or subluxation were observed over 1-year. There were no neurological complications or complications related to graft (graft migration or graft breakage or resorption) as well. All the athletes returned to sports activities at an average duration of 6.8-month post-operatively, with 73 % returning to sports at the level of pre-injury. ConclusionThe combined procedure of ICBG Latarjet and arthroscopic remplissage for the treatment of severe BBL in athletes achieved satisfactory outcomes over 1-year, with all athletes returning to sports activities.

ASES and UCLA Are Responsive Patient-Reported Outcome Measures After Rotator Cuff Repair: A Systematic Review and Meta-analysis.

Multiple patient-reported outcome measures (PROMs) have been used to assess shoulder function, but it is unknown which are the most effective. The purpose of this study was to report the multiple PROMs used after rotator cuff repair (RCR) and to compare the responsiveness between them. It was hypothesized that the Western Ontario Rotator Cuff PROM would be the most responsive and commonly used in patients undergoing RCR. Meta-analysis; Level of evidence, 4. A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-Searching extension guidelines via PubMed/MEDLINE, Embase (Elsevier), and Web of Science (Clarivate). Patient and study characteristics were extracted. From the studies that met inclusion criteria for responsiveness analysis (≥2 PROMs reported, 1-year minimum follow-up, and pre- and postoperative PROM means and standard deviations reported), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. A total of 252 studies met inclusion criteria (32,072 patients; mean age, 59.6 years; mean body mass index, 28.7; mean follow-up time, 27.8 months). Range of motion was reported in 131 (52%) studies and imaging findings were reported in 123 (49%) studies. There were 67 PROM instruments identified; the most commonly used were the American Shoulder and Elbow Surgeon (ASES) (n = 183; 73%), Visual Analog Scale (VAS) (n = 163; 65%), and Constant (n = 118; 47%) scores. The 3 PROMs with the highest effect sizes were the University of California, Los Angeles (UCLA) (2.51), Western Ontario Rotator Cuff (2.42), and ASES (2.00) scores. Overall, UCLA and ASES scores were the most responsive PROMs. The ASES PROM was more responsive than the VAS (RE, 1.70), Constant (RE, 2.76), Simple Shoulder Test (RE, 1.67), and Single Assessment Numeric Evaluation (RE, 2.14) scores. The UCLA PROM was more responsive than the ASES (RE, 1.03), VAS (RE, 3.66), Constant (RE, 1.72), and Simple Shoulder Test (RE, 1.66) scores. ASES and UCLA scores were the most responsive PROMs after RCR. The authors recommend widespread adoption of ASES and UCLA scores for clinical and research standardization; however, the UCLA PROM requires in-person range of motion and strength testing, which is a practical limitation and barrier to long-term follow-up.

Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears

To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

Effect of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis.

Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Systematic review; Level of evidence, 2. A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.

Quantifying success after reverse total shoulder arthroplasty: the substantial clinically important percentage of maximal possible improvement.

Changes in preoperative to postoperative outcome scores are often used to quantify success after reverse total shoulder arthroplasty (rTSA). However, ceiling effects associated with many outcome scores limit the ability to differentiate success among high-functioning patients. The percentage of maximal possible improvement (%MPI) was introduced to simplify and better stratify patient success. The primary purpose of this study was to define the %MPI thresholds associated with substantial clinical improvement following primary rTSA and compare the rates of success as defined by those achieving the substantial clinical benefit (SCB) compared to the 30% MPI for different outcome scores. A retrospective review was performed of an international shoulder arthroplasty database between 2003 and 2020. All primary rTSAs performed using a single implant system with a minimum 2-year follow-up were reviewed. Preoperative and postoperative outcome scores were evaluated for all patients to calculate improvement. Six outcome scores were assessed: the Simple Shoulder Test (SST), Constant, American Shoulder and Elbow Surgeons (ASES), University of California Los Angeles (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS) scores. The proportion of patients achieving the SCB and 30% MPI was determined for each outcome score. Thresholds for the substantial clinically important %MPI (SCI-%MPI) were calculated using an anchor-based method for each outcome score and stratified by age and sex. Of total, 2573 shoulders with a mean follow-up of 47months were included. Outcome scores with known ceiling effects (SST, ASES, UCLA, SPADI) had higher rates of patients achieving the 30% MPI compared to scores without ceiling effects (Constant, SAS). However, scores without ceiling effects had higher rates of patients achieving the SCB. The SCI-%MPI differed among outcome scores, and mean values were 47% for the SST, 35% for the Constant score, 50% for the ASES score, 52% for the UCLA score, 47% for the SPADI score, and 45% for the SAS score. The SCI-%MPI increased in patients older than 60years (P<.001) except for the SAS and Constant scores. SCI-%MPI was greater in females for all scores assessed except the Constant and SPADI scores (P<.001 for all). The higher SCI-%MPI thresholds in these populations mean that these patients required a greater fraction of the MPI to have substantial improvement. The %MPI judged relative to patient-reported substantial clinical improvement offers an alternative method to quickly assess improvements across patient outcome scores. Given considerable variation in the %MPI corresponding to substantial clinical improvement, we recommend utilizing score-specific estimates of the SCI-%MPI to gauge success when evaluating patients undergoing primary rTSA.

Periacetabular osteotomy with and without concomitant arthroscopy: a systematic review of evidence on post-operative activity levels and return to sport

ABSTRACT The purpose of this systematic review is to (i) compare post-operative activity levels after periacetabular osteotomy (PAO) versus PAO + HA (concomitant PAO and hip arthroscopy) using patient-reported outcomes that specifically assess activity and sports participation [Hip Disability and Osteoarthritis Outcome Score—Sport and Recreation subscale (HOOS-SR), University of California Los Angeles (UCLA) activity score, Hip Outcome Score—Sport-Specific Subscale (HOS-SSS)] and (ii) compare post-operative return to sport (RTS) data between PAO and PAO + HA groups. A systematic review of literature was conducted on 1 June 2023, utilizing PubMed, Cochrane and Embase (OVID). Articles were screened for inclusion using specific inclusion and exclusion criteria. Twenty-six out of 1610 articles met all inclusion criteria, without meeting any exclusion criteria. In the 12 studies containing only subjects who underwent PAO alone, 11 demonstrated an average score improvement in UCLA, HOOS-SR or HOS-SSS post-operatively (P &amp;lt; 0.05). In the three studies containing subjects who underwent PAO with concomitant HA, significant improvements were seen in the HOS-SS and UCLA scores (P &amp;lt; 0.05). In the five studies that directly compared UCLA, HOS-SSS and HOOS-SSS scores between PAO groups and PAO + HA groups, all demonstrated statistically significant improvement post-operatively (P &amp;lt; 0.05). The rate of RTS ranged from 63% to 90.8% among PAO studies and was found to be 81% in the single PAO + HA study that assessed RTS. When performed in patients with intra-articular pathology, concomitant PAO + HA may provide similar sport-related outcomes to PAO alone in patients without intra-articular pathology.

Early clinical efficacy analysis of enhanced recovery following surgery combined with interscalene brachial plexus block for arthroscopic rotator cuff repair.

To explore the early clinical value of enhanced recovery after surgery (ERAS) with interscalene brachial plexus block (ISB) for arthroscopic rotator cuff repair (ARCR). We enrolled 240 patients who underwent arthroscopic rotator cuff repair, randomly divided into 3 groups (n = 80 each). Groups A, B, and C underwent only surgery, surgery + ERAS, and ISB + surgery + ERAS, respectively. We analyzed the clinical data and postoperative indicators for the 3 patient groups. Group comparisons of clinical data and postoperative indicators revealed no significant differences in clinical characteristics (P > .05). Group C showed superior Visual Analog Scale scores at 0-6 and 6-24 hours postoperatively (P < .05), and the shortest length of hospital stay (LOS) (P < .05). At 6 weeks and 3 months postoperatively, Constant-Murley shoulder score and University of California-Los Angeles scores were better in Groups B and C than in Group A (P < .05). Joint swelling was more common in Group A than in Groups B and C (P < .05) but with no significant difference in the incidence of postoperative stiffness (P > .05). ERAS can relieve postoperative pain, shorten LOS, and help restore shoulder joint mobility, thereby reducing postoperative swelling. ISB + ERAS optimized pain control and allowed a shorter LOS, but had similar effects on early functional recovery and complications.

Arthroscopic repair for isolated subscapularis tear: successful functional outcomes and high tendon healing rate can be expected nine years after surgery

BackgroundLiterature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears. MethodsA retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification. ResultsThe final sample consisted of 45 patients with an average age of 55±9 years. After a mean follow-up time of 107±54 months, the mean UCLA and DASH scores were 8.7±1.3 and 42.2±6.4, respectively. ROM and CMS showed statistically significant improvements (all p<0.001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4±9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (p=0.039, β=5.538) and a longer follow-up period (p=0.044, β=0.001). The postoperative CMS (p < 0.001) and UCLA scores (p = 0.001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals. ConclusionArthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery.

Bone formation of the coracoid bone graft after the Bristow procedure assessed using three-dimensional computed tomography

BackgroundThe Bristow procedure has been shown to be a reliable method to prevent recurrent anterior shoulder instability by compensating for glenoid bone loss and producing the sling effect. The degree of postoperative morphological change in the coracoid bone graft is speculated to influence glenohumeral joint stability; however, the details of these changes after the Bristow procedure remain unknown. This study was performed to quantify the postoperative change in the coracoid bone graft volume as assessed by three-dimensional computed tomography (3D-CT). MethodsThe Bristow procedure was performed on 17 shoulders in 17 patients from August 2018 to January 2020. All patients were men, and their mean age at surgery was 17.9 years. The mean follow-up duration was 21.4 months. Within the first week after the operation (Time 0) and at the final follow-up, 3D-CT was used to determine the total coracoid bone graft volume. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) shoulder score, the University of California Los Angeles (UCLA) shoulder score, and the Western Ontario Shoulder Instability Index (WOSI). ResultsThe mean volume of the total coracoid bone graft was 1.26 ± 0.29 cm3 at Time 0 and 1.90 ± 0.36 cm3 at the final follow-up (p < 0.0001). The mean JOA score, UCLA score, and WOSI were significantly better at the final follow-up than preoperatively (p < 0.001). No postoperative infection, neurovascular injury, or recurrent instability of the glenohumeral joint occurred. ConclusionsIn the Bristow procedure, the volume of the total coracoid bone graft as shown by 3D-CT was significantly greater at the final follow-up than at Time 0, and bone formation of the coracoid bone graft was found after the Bristow procedure.