University Of California, Los Angeles Score Research Articles

Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty.

To compare the rate of return to sports and body mass index (BMI) reduction in patients who underwent surgery for unicompartmental knee arthroplasty (UKA) with either Cobalt-Chromium (CoCr) alloy UKA or with hypoallergenic UKA, stratified by age, gender and BMI. Two consecutive cohorts of patients with a total of 172 UKA and a minimum 2-year follow-up period were prospectively included in this comparative study. The first cohort consisted of 136 consecutive series of standard Cobalt-Chromium (CoCr Group). The second cohort consisted of 36 consecutive mobile-bearing hypoallergenic Titanium Niobium Nitride UKA, (TiNbN Group). The clinical evaluation was based on the University of California, Los Angeles (UCLA) activity scores and the High-Activity Arthroplasty Score (HAAS) evaluated on the day before surgery (T0) and after a minimum follow-up of 12months (T1) and 24months (T2). Radiographic evaluation performed at T2 included the femoral component position in varus/valgus, the tibial component in varus/valgus and the anteroposterior slope. No statistical differences were found between the groups at each follow-up, as shown by the UCLA and HAAS score (n.s.). Both groups showed a statistically significant improvement (p < 0.05) at each follow-up.. Both groups showed a statistically significant BMI reduction between T0 and T2 (p < 0.05). Radiographicanalysis revealed no statistical differences between the two groups in terms of the three measures after the final follow-up (n.s.). All the subgroups showed a significant (p < 0.05) rate of return to sport if compared with the preoperative value (T2 versus T0), except for male in TiNbN group. Both TiNbN and CoCr medial mobile-bearing UKA enabled patients to return to sports after the final follow-up, regardless of age, BMI, gender and metal sensitivity. These findings inform shared decision making and can help to manage patient expectations after surgery, in particular, in active patients with an overt metal allergy, a specific hypoallergenic implant should be considered the gold standard implant in partial knee replacement surgery. Cohort Study, Level III. researchregistry6250- www.researchregistry.com .

Use of machine learning to assess the predictive value of 3 commonly used clinical measures to quantify outcomes after total shoulder arthroplasty

BackgroundAn important psychometric parameter of validity that is rarely assessed is predictive value. In this study we utilize machine learning to analyze the predictive value of 3 commonly used clinical measures to assess 2-year outcomes after total shoulder arthroplasty (TSA). MethodsXGBoost was used to analyze data from 2790 TSA patients and create predictive algorithms for the American Shoulder and Elbow Surgeons (ASES), Constant, and the University of California Los Angeles (UCLA) scores and also quantify the most meaningful predictive features utilized by these measures and for all questions comprising each measure to rank and compare their value to predict 2-year outcomes after TSA. ResultsOur results demonstrate that the ASES, Constant, and UCLA measures rarely considered the most-predictive features relevant to 2-year TSA outcomes and that each outcome measure was composed of questions with different distributions of predictive value. Specifically, the questions composing the UCLA score were of greater predictive value than the Constant questions, and the questions composing the Constant score were of greater predictive value than the ASES questions. We also found the preoperative Shoulder Pain and Disability Index (SPADI) score to be of greater predictive value than the preoperative ASES, Constant, and UCLA scores. Finally, we identified the types of preoperative input questions that were most-predictive (subjective self-assessments of pain and objective measurements of active range of motion and strength) and also those that were least-predictive of 2-year TSA outcomes (subjective task-specific activities of daily living questions). DiscussionMachine learning can quantify the predictive value of the ASES, Constant, and UCLA scores after TSA. Future work should utilize this and related techniques to construct a more efficient and effective clinical outcome measure that incorporates subjective and objective input questions to better account for the preoperative factors that influence postoperative outcomes after TSA. Level of EvidenceLevel III; Retrospective Comparative Study

Arthroscopic release combined with single-row fixation or double-row suture bridge fixation in patients with traumatic supraspinatus tear and adhesive capsulitis non-responsive to conservative management: A prospective randomized trial

BackgroundThere are few previous studies on traumatic supraspinatus tear with adhesive capsulitis. This study used arthroscopic release with single-row fixation or double-row suture bridge fixation to treat adhesive capsulitis of the shoulder with rotator cuff tears. Further, the clinical efficacy of arthroscopic release with single-row fixation and double-row suture bridge fixation was compared. HypothesesArthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. MethodsA single-center prospective randomized trial was performed from June 2013 to June 2017. Of the 68 patients with traumatic supraspinatus tear and adhesive capsulitis who underwent arthroscopic release, 34 (22 with tear measuring≤3cm and 12 with tear measuring>3cm) were included in the single-row fixation group and 34 (20 with tear measuring≤3cm and 14 with tear measuring>3cm) were included in the double-row suture bridge fixation group. The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) shoulder scores, range of motion, time to achieve satisfactory scores, and rotator cuff re-tear rate were compared between the groups. ResultsThe range of motion, VAS score, UCLA and ASES shoulder scores significantly improved after surgery in both groups. There was a significant difference in the UCLA and ASES shoulder scores, time to achieve satisfactory scores, and rotator cuff re-tear rates in patients with tears measuring>3cm between the groups. ConclusionsArthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. Therefore, the capsule of the shoulder should be thoroughly released to achieve such outcomes. For patients with rotator cuff tears measuring>3cm, double-row suture bridge fixation was superior to single-row fixation and the rotator cuff re-tear rate was low. Level of evidenceI; prospective, randomized trial, treatment study.

Clinical Outcome of Neer Type II Lateral End Clavicle Fractures With Coracoclavicular Ligament Disruption Treated With Pre-Contoured Locking Plate and Endobutton.

IntroductionMany surgical techniques have been described for the treatment of Neer type II lateral end clavicle fractures like open reduction and internal fixation with hook plate, tension band wiring, coracoclavicular screw fixation, and distal clavicle locking plate. However, most of these operative procedures are associated with high perioperative complications ranging from hardware prominence, hardware failure, screw and plate pull-out, and infection. As the lateral end clavicle fractures has both vertical and horizontal stress forces, any technique counteracting both the forces should result in a better clinical outcome. Therefore, this study was conducted to assess the functional and radiological outcome of type II lateral end clavicle fracture treated using pre-contoured locking plate along with coracoclavicular reconstruction with endobutton and fiberwire.MethodsThirty-two consecutive patients with Neer type II fractures of the lateral end of clavicle were treated surgically using pre-contoured locking plate and coracoclavicular reconstruction with endobutton and fiberwire between May 2014 and December 2016. Clinical outcome was assessed using the University of California Los Angeles (UCLA) shoulder score and Constant Murley score. The coracoclavicular distance was also recorded. These were compared to the unaffected side at one-year follow-up.ResultsThe bony union was achieved in all cases. There were no major complications in any of the patients. All the patients were able to return to their preinjury level of activity. The UCLA score, the Constant Murley score, and coracoclavicular distance did not vary significantly at a one-year interval when compared to the normal shoulder.ConclusionOpen reduction and internal fixation of Neer type II lateral end clavicle fractures using pre-contoured locking distal clavicle plate along with coracoclavicular reconstruction with endobutton and No. 2 fiberwire provide an excellent functional and radiological outcome.

Restoration of External Rotation Following a Lateral Approach for Glenoid Bony Increased-Offset Reverse Shoulder Arthroplasty

Background:Reverse shoulder arthroplasty (RSA) is a recognized therapeutic modality for a massive rotator cuff tear. Some authors recommend lateralization of the center of rotation by bony increased offset (BIO) of the glenoid for improvement of external rotation, while others refute its effects. RSA through the conventional deltopectoral approach sacrifices the subscapularis tendon during the approach. We hypothesized that a lateral approach (LA) for RSA, with less soft-tissue resection, would restore external rotation by allowing retensioning of the remaining rotator cuff with use of a BIO graft.Methods:We retrospectively investigated 36 nonlateralized inlay RSAs performed through a lateral approach (LA non-BIO group) and 40 inlay RSAs performed through a lateral approach with BIO (LA BIO group) for a massive rotator cuff tear. There were 5 patients with a combined loss of active elevation and external rotation (CLEER) in the LA non-BIO group and 6 in the LA BIO group. The Constant score, the UCLA (University of California Los Angeles) score, and range of motion, in particular, external rotation with the arm at 0° (ER0) and at 90° of abduction (ER90), were compared.Results:The mean ER90 in the LA BIO group improved significantly, from 45.8° ± 21.6° to 65.9° ± 15.8° (p = 0.012). Postoperative ER90 in the LA BIO group was significantly higher than in the LA non-BIO group (mean, 65.9° ± 15.8° compared with 53.0° ± 12.3°; p = 0.026). The mean ER0 for the patients with CLEER status significantly improved in the LA BIO group, from −15.8° ± 9.8° to 11.0° ± 15.6° (p = 0.0072). The mean postoperative anterior elevation, UCLA score, and Constant score in the LA BIO group and the LA non-BIO group improved significantly, but there was no difference between the 2 groups (anterior elevation: 131.5° ± 17.6° compared with 121.5° ± 14.1°, p = 0.07; UCLA: 25.5 ± 6.4 compared with 23.4 ± 5.4, p = 0.2; Constant: 74.3 ± 12.0 compared with 73.6 ± 10.1, p = 0.43).Conclusions:LA BIO-RSA was associated with a significant improvement in range of motion, particularly external rotation. Improvements in anterior elevation, the Constant score, and the UCLA score were not significantly different from those noted for LA non-BIO-RSA.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Open Reduction and Stable Internal Fixation Using a 3.5-mm Locking Hook Plate for Isolated Fractures of the Greater Tuberosity of the Humerus: A 2-Year Follow-up Study Using an Innovative Fixation Method.

BackgroudThe best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications.MethodsWe retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion.ResultsTwenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12–20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and Constant-Murley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively).ConclusionsThe 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable. Therefore, second surgery for implant removal is necessary after bone union is achieved.

Arthroscopic repair with footprint ending shift for massive rotator cuff tear

To investigate the method and clinical effects of arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear. From March 2015 to April 2019, 27 patients with massive rotator cuff tear underwent arthroscopic repair, including 12 males and 15 females, ranging in age from 37 to 74 years old, with an average age of (56.1±8.9) years. According to the tension of rotator cuff, 5 patients were treated with double row suture bridge technique, and 22 patients were treated with single row technique, among which 7 patients underwent partial rotator cuff repair. Before and after operation, University of California Los Angeles(UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) were used to evaluate shoulder joint function. All the patients were followed up, and the duration ranged from 8 to 40 months, with an average of (18.0±5.9) months. The UCLA score increased from preoperative 8.67±0.78 to final follow-up 30.89±1.07(t=43.56, P<0.001);ASES score increased from preoperative 8.56±0.67 to final follow-up 12.63±0.33(t=15.28, P<0.001);and the VAS decreased from preoperative 6.00(5.00 to 7.00) scores to final follow-up 0.00 (0.00 to 2.00) scores (Z=-4.56, P<0.001). Three patients could not lift the shoulder above the head, without pain. The symptom had no effects on daily work and life, 2 of these patients underwent partial rotator cuff repair. Arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear has satisfactory results, and single-row can be chosen to completely or partial repair rotator cuff tear for most patients.

Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss

To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity. Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California-Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up. Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P= .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication. An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity. Level IV, case series.

Clinical results and functional outcome of humeral shaft fractures treated with MIPO technique

Introduction: The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method. The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique. Material and Methods: A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO). Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow. Results: 83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores. Conclusion: Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears.

Background:Older patients with shoulder instability have a higher prevalence of rotator cuff tears and anterior capsular lesions. Simultaneous rotator cuff repair and labral repair are commonly performed to improve shoulder stability and function.Purpose:To investigate the clinical outcomes of arthroscopic rotator cuff repair for older patients with shoulder dislocations combined with massive rotator cuff tears and intact labral tissue.Study Design:Case series; Level of evidence, 3.Methods:A cohort consisting of 11 patients older than 50 years with shoulder dislocations and massive rotator cuff tears undergoing arthroscopic rotator cuff repair was identified between December 2015 and January 2018. Rotator cuff repair was performed after Bankart, superior labral anterior-posterior, and humeral avulsion of the glenohumeral ligament lesions were excluded during arthroscopic surgery. Preoperative and 12-month postoperative outcomes including modified University of California Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale for pain scores as well as range of motion (ROM) were recorded.Results:The supraspinatus tendon was torn in all patients. Also, 36.4% of the patients had 3 rotator cuff tendons torn. For shoulder function, the preoperative UCLA score (12.1 ± 2.5 [range, 9-16]) and ASES score (35.4 ± 12.7 [range, 24-44]) significantly improved to 29.4 ± 4.3 (range, 24-35; P < .001) and 79.4 ± 16.0 (range, 45-95; P < .001), respectively, at 12 months postoperatively. None of the patients experienced shoulder redislocations at 12 months after surgery. For shoulder stability, the postoperative WOSI score (156.8 ± 121.0 [range, 45-365]) was significantly better than was the preoperative score (713.0 ± 238.6 [range, 395-1090]) (P < .001). For comparisons between preoperative and postoperative ROM, forward flexion, abduction, and external and internal rotation at the side significantly improved.Conclusion:For patients older than 50 years with shoulder dislocations combined with massive rotator cuff tears and an intact labrum, arthroscopic rotator cuff repair alone achieved satisfactory functional outcomes and ROM without the recurrence of dislocations.

Effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears

To investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears. A clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed. Of 46 patients, 23 patients underwent bilateral conservative treatment (conservation group), 23 patients underwent unilateral arthroscopic rotator cuff repair, and conservative treatment on the contralateral side (operation group). There was no significant difference in gender, age, disease duration, degree of rotator cuff tear, and comorbidities between 2 groups ( P>0.05). Before operation and at 6 and 12 months after operation, the degree of the rotator cuff tear was measured by MRI, and the shoulder function was evaluated by the visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) (forward flexion, external rotation, external rotation at 90° of abduction, and internal rotation). The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group. All incisions healed by first intention without any complication after operation. All patients were followed up 12 months. MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation ( P<0.05). There was no significant difference between the operation group and the conservation group before operation ( P>0.05), but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation ( P<0.05). At 6 and 12 months after operation, the VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores in 2 groups ( P<0.05). There was no significant difference in the VAS score, UCLA score, and ASES score between 2 groups before operation ( P>0.05). The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation ( P<0.05). There were significant differences in the ROM of shoulder between pre- and post-operation in 2 groups ( P<0.05). And there was no significant difference between 2 groups at pre- and post-operation ( P>0.05). For patients with bilateral rotator cuff tears, the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.

A novel surgical technique for arthroscopic fixation of lateral end clavicle fracture using FiberWire and FiberTape

Objectives:Lateral end of clavicle fractures is associated with coracoclavicular ligament disruption and, hence, poses a surgical challenge for the management. Surgical techniques already described have high failure rates and hardware-related complications. The objective of the study is to assess the clinical and radiological outcome of the novel surgical technique of arthroscopic coracoclavicular stabilization and indirect anatomical reduction of the lateral end of clavicle fracture using FiberWire and FiberTape.Materials and Methods:We conducted a retrospective review of 15 consecutive patients with displaced, unstable Neer Type II and V distal clavicle fractures who underwent this surgical technique from 2016 to 2020. Primary outcome variables were radiographic union, patient satisfaction, and post-operative shoulder function. Pre-operative and post-operative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, post-operative complications, and time to radiographic union.Results:In our study, 12 were male patients and three female patients, with a mean age of 43 years. The mean post-operative follow-up period was 23 months. Results were satisfactory in all 15 cases, all 15 were had excellent as per UCLA and ASES score. All fractures healed within a mean period of 6 weeks. Only one patient had developed malunion due to over-tightening of FiberWire, although his functional outcome was not compromised with this.Conclusion:We present a novel surgical technique for fixing displaced distal lateral clavicle with arthroscopic coracoclavicular stabilization with FiberWire and FiberTape that resulted in a 100% union rate and excellent clinical outcomes with minimal complications.

Treatment of Chronic Anterior Shoulder Dislocation by Coracoid Osteotomy with or without Bristow–Latarjet Procedure

ObjectiveTo investigate the clinical efficacy and outcomes of the coracoid osteotomy with or without Bristow–Latarjet procedures in the treatment of chronic anterior shoulder dislocation (CASD).MethodsBetween January 2013 and January 2019, 20 shoulders of 18 patients who were diagnosed with chronic anterior dislocation and underwent open reduction in our trauma center were retrospectively studied. Open coracoid osteotomy with Bristow–Latarjet procedures were performed on 16 shoulders and open coracoid osteotomy without Bristow–Latarjet procedures were performed on four shoulders. Open coracoid osteotomy with or without Bristow–Latarjet procedures were chosen on the basis of the stability of the shoulder after reduction. Outcomes were assessed preoperatively and postoperatively with the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder rating scale, and the range of motion (ROM) for shoulder activity.ResultsThere were three males and 15 females with an average age of 60.94 ± 2.69 years. The time between dislocation and treatment ranged from 21 to 240 days with an average of 73.3 ± 14.4 days. All patients were available for a mean follow‐up of 15.2 ± 4.3 months. No procedure‐related death or incision‐related superficial or deep tissue infection was identified in all cases. No iatrogenic neurovascular injuries or fractures were found in this study. At the time of 12 months follow‐up, the range of motion and the shoulder functional evaluation (VAS [P < 0.001], ASES [P < 0.001], and UCLA score [P < 0.001]) in patients who underwent Bristow–Latarjet procedures were significantly improved. Subluxation after surgical procedure was found and confirmed in one patient and this patient refused to undergo revision surgery. According to the Samilson and Prieto classification system, 16 shoulders were assessed as grade 0, three shoulders were grade 1, one shoulder was grade 2.ConclusionsCoracoid osteotomy with or without Bristow–Latarjet procedure yielded an acceptable clinical result in this study. This method has the advantages of enlarging the exposure of surgical field, assisting reduction of shoulder, and convenient conversion to Bristow–Latarjet procedure. It is an efficient and reliable method for treatment of chronic anterior shoulder dislocation.A 69‐year‐old woman diagnosed with right chronic anterior shoulder dislocation with large Hill–Sachs lesion. The latarjet procedure with remplissage technique was applied for this patient.

Evaluating the Relationship Between Olfactory Function and Loneliness in Community-Dwelling Individuals: A Cross-sectional Study.

Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors. Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 - item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders. In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p = 0.050), olfactory discrimination (β = -0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant. In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.

Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair

Background: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) are emerging criteria for patient-based treatment assessments. However, few studies have investigated these measures after rotator cuff repair. Purpose: (1) To determine MCID, SCB, and PASS values for pain visual analog scale (pVAS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles (UCLA) score after arthroscopic rotator cuff repair. (2) To determine factors for achieving the MCID, SCB, and PASS. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We analyzed prospectively collected data from a rotator cuff surgery registry between March 2018 and February 2019. Eighty-two patients were included, and anchor questions for deriving MCID, SCB, and PASS values were applied at 1-year follow-up after the surgery. The MCID and SCB for the pVAS, ASES, SANE, and UCLA scores were then derived via 2 methods: a sensitivity- and specificity-based approach, which was used alone to derive PASS values, and a between-patients approach. Additionally, univariable and multivariable logistic regression analyses were performed to determine factors for achieving the MCID, SCB, and PASS. Results: All 4 scores showed acceptable areas under the curve. MCID, SCB, and PASS values for the pVAS were 1.5, 2.5, and 1.7; for ASES scores, 21.0, 26.0, and 78.0; for SANE, 13.0, 20.0, and 71.0; and for UCLA scores, 6.0, 8.0, and 23.0, respectively. Poor preoperative scores demonstrated significantly higher odds ratios (ORs) for achieving the MCID and SCB and lower ORs for achieving the PASS. Retear, large to massive tear, and older age showed lower ORs for achieving the MCID or SCB. For PASS items, male sex and biceps tenodesis had higher ORs, and older age had lower ORs. MCID, SCB, and PASS values per the sensitivity- and specificity-based approach were applied in factor analyses. Conclusion: Reliable MCID, SCB, and PASS values were obtained from patient evaluations 1 year after arthroscopic rotator cuff surgery. Poor preoperative score (MCID and SCB), male sex, and biceps tenodesis showed higher ORs, whereas poor preoperative score (PASS), retear, large to massive tear, and older age demonstrated lower ORs.

Does Time From Injury to Surgery Affect Outcomes After Surgical Repair of Partial and Complete Proximal Hamstring Ruptures?

Background:No previous study has compared the outcomes of repair for partial and complete proximal hamstring ruptures at various intervals after the injury.Purpose:The primary aim was to determine whether time from injury to surgery affected outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim was to assess patients’ experiences from initial evaluation to finding a treating surgeon.Study Design:Cohort study; Level of evidence, 3.Methods:Records from 2007 to 2016 from a single surgeon’s practice were reviewed. A total of 124 proximal hamstring repair procedures in 121 patients were identified. There were 92 patients who completed questionnaires: a custom survey, the standard Lower Extremity Functional Scale (LEFS), a custom LEFS, the standard Marx activity scale, a custom Marx activity scale, and the University of California Los Angeles (UCLA) activity score. Results were analyzed for partial and complete repair procedures performed at ≤3 weeks, ≤6 weeks, and >6 weeks after the injury.Results:The mean follow-up was 43 months (median, 38 months). Of 93 repair procedures reviewed, 51% (9/28 partial; 38/65 complete), 79% (16/28 partial; 57/65 complete), and 22% (12/28 partial; 8/65 complete) were performed at ≤3 weeks, ≤6 weeks, and >6 weeks, respectively. At those various intervals, no statistical difference was found in standard LEFS, custom LEFS, standard Marx, custom Marx, or UCLA scores. Female sex, older age, and body mass index >30 kg/m2 were negative predictors of outcome measures. When repaired >6 weeks after the injury, a greater percentage of patients reported weakness of the operative leg compared with the contralateral side (partial tears: 6.3% vs 25%, respectively; complete tears: 24.6% vs 50%, respectively) in addition to greater sitting intolerance (partial tears: 0% vs 25%, respectively; complete tears: 7.1% vs 12.5%, respectively). Patients repaired >6 weeks after the injury visited, on average, 2.6 practitioners before an evaluation by the treating surgeon compared with 1.6 treated surgically at ≤6 weeks (P = .008).Conclusion:Patients with proximal hamstring repair performed in the acute and chronic settings can expect successful outcomes but may experience more subjective weakness and difficulty with prolonged sitting when the repair is performed >6 weeks after the injury. Patients faced challenges in receiving the correct diagnosis and referral to an appropriate treating surgeon, emphasizing the need for an increased awareness of the injury.

Clinical results of arthroscopic rotator cuff repair in diabetic and non-diabetic patients

BackgroundAlthough the clinical outcomes of arthroscopic rotator cuff repair (ARCR) have been reported, few studies have focused on diabetic patients. We investigated and compared the clinical results of ARCR in patients with and without diabetes. MethodsThis retrospective study involved 195 consecutive patients who underwent ARCR from 2015 to 2018 in our hospital. Twenty-seven and 168 shoulders were assigned to diabetes and non-diabetes groups, respectively. Diabetic patients with poor control were preoperatively hospitalized for perioperative diabetic control. We evaluated range of motion (ROM), Japanese Orthopaedic Association shoulder (JOA) score, Constant Shoulder Score, and University of California, Los Angeles (UCLA) score preoperatively and at 6 months and 1 year post-ARCR. Rates of rotator cuff retear 1 year post-ARCR and preoperative and postoperative stiff shoulder were also evaluated. We compared the results between groups and analyzed them statistically. A p-value of <0.05 was considered statistically significant. ResultsPreoperative ROM, JOA score, Constant Shoulder Score and UCLA scores showed significant improvement at post-ARCR in both groups (p < 0.05). On comparing the groups, although preoperative JOA score and Constant Shoulder Score were significantly lower in diabetes group than in non-diabetes group (diabetic/non-diabetic group; 60.0/65.3 for JOA score; p = 0.003, 59.7/64.2 for Constant Shoulder Score; p = 0.003), there was no significant difference postoperatively (6 months post-ARCR; 88.0/89.7 for JOA score; p = 0.783, 88.1/88.6 for Constant Shoulder Score; p = 0.597, 1 year post-ARCR; 96.7/95.4 for JOA score; p = 0.238, 96.6/95.4 for Constant Shoulder Score; p = 0.248). Furthermore, preoperative and postoperative stiff shoulder and retear rates were not significantly different between groups (p = 0.152, p = 0.344, p = 0.347, and p = 0.563, respectively). ConclusionDiabetic patients showed comparable clinical results with non-diabetic patients post-ARCR. Perioperative diabetic control may be recommended for preoperatively uncontrolled diabetic patients.

Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying After Suture-Bridge Lateral Row Rotator Cuff Repair

Background: Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique. Hypothesis: This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair. Study Design: Case series; Level of evidence, 4. Methods: The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up. Results: This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery (P < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups. Conclusion: The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.

Preoperative hyaluronic acid injection modulates postoperative functional outcome in patients undergoing arthroscopic rotator cuff repair

BackgroundArthroscopic rotator cuff repair (ARCR) generally yields acceptable clinical results. Hyaluronic acid (HA), a high-molecular-weight polysaccharide, is present in the extracellular matrix of soft connective tissue and synovial fluid, and its injection is known to significantly improve pain and clinical outcomes after rotator cuff injury. Some studies have described the role of HA injections as conservative therapy for rotator cuff tears. Since the subacromial bursa is believed to be the main source of shoulder pain in rotator cuff tears, subacromial injection is frequently used before surgery; however, its relationship with the clinical outcome after surgery remains unclarified. Therefore, we aimed to examine effects of preoperative subacromial HA injection on postoperative clinical outcome in patients with ARCR.MethodsNinety-eight patients were divided into a HA injection group and a non-injection group. The functional outcome measured was the University of California, Los Angeles (UCLA) score. Univariate analysis was performed to obtain variables with p values less than 0.1; we then used propensity score analysis, adjusting for pre- and post-operative confounding factors.ResultsThe UCLA scores of all patients significantly improved 1 year postoperatively (PO) (p < 0.05). Subacromial HA injections were performed in patients with worse preoperative function. Univariate analysis showed significantly greater improvements in the injection group than in the non-injection group in terms of preoperative UCLA score, trauma, diabetes mellitus, UCLA score 3 months PO, abduction strength 4 months PO, and internal rotation (IR) strength 6 and 12 months PO. Propensity score analysis demonstrated that UCLA scores 3 months PO and IR strength 12 months PO in the injection group were significantly greater than those in the non-injection group. There were no significant differences in postoperative re-tear rates between the groups. In sub-analysis of the injection group, propensity scores showed that concurrent use of local anesthetics did not affect the data, suggesting that HA was effective.ConclusionSubacromial injection was administered to patients with worse function before ARCR. Propensity score analysis successfully demonstrated that functional outcome after surgery was improved in patients who were administered this injection compared with patients who were not administered this injection before surgery.

Modes de récupération après traitement arthroscopique d’une tendinite calcifiante de l’épaule

IntroductionThe purpose of this study was to investigate serial outcomes in the early postoperative period in patients who have undergone arthroscopic treatment for calcific tendinitis of the shoulder and to determine prognostic factors affecting outcomes. HypothesisOur hypothesis was that functional recovery will take more than three months but additional procedures such as rotator cuff repair and subacromial decompression will have a slower recovery and poorer outcomes. Material and methodsWe retrospectively reviewed 35 patients with a mean follow-up of 50.6 months. Arthroscopic surgery was performed in all patients. The visual analog scale (VAS) pain score; University of California, Los Angeles (UCLA) score; American Shoulder and Elbow Surgeons (ASES) score were evaluated preoperatively; 3, 6, and 12 months after surgery; and at the final follow-up. To evaluate the extent of calcific deposit removal and recurrence of calcification, we conducted plain radiography at each follow-up. ResultsNine patients had complete removal of all calcium deposits, and 26 had partial removal. At the final follow-up, all patients sustained complete resorption without any recurrence. All clinical scores showed improvement significantly in each follow-up period (p<0.001). However, VAS pain score decreased to less than 3 points at 6 months after surgery, UCLA and ASES scores also increased more than 75 percent at 6 months. Subacromial decompression was negatively correlated with VAS pain score and rotator cuff repair was negatively correlated with UCLA score, respectively (p=0.041 and p=0.028). On multivariate analysis, rotator cuff repair was negatively correlated with the final UCLA score (p=0.009). ConclusionThis study revealed that all clinical scores were significantly improved from 3 months after arthroscopic treatment for calcific tendinitis of shoulder. However, clinical scores improved slowly, recovery of shoulder function and pain relief required up to 6 months. Subacromial decompression and rotator cuff repair were poor prognostic factors after arthroscopic treatment. Level of evidenceIV, retrospective case series.