University Of California Los Angeles Shoulder Score Research Articles

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 repair of supraspinatus tendon tears with douple-pulley suture-bridge

To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge. The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up. All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied. Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Comparison of the Functional Outcomes of Arthroscopic Debridement and Repair of Bursal-side Partial-thickness Rotator Cuff Tears

Background: To compare the clinical and functional scores of arthroscopic debridement and repair (conversion to full thickness) surgeries in patients with bursal-side partial-thickness rotator cuff tears (BPTRCT). Materials and Methods: A single-center retrospective study was conducted to compare the arthroscopic debride-ment and arthroscopic repair for BPTRCT performed between March 2017 and September 2021. Arthroscopic debridement patients were grouped as Group 1 and the repair group as Group 2. A total of 98 patients with an average age of 57.5 years (range 29-83 years), including 41 male and 57 female patients, met the inclusion criteria. VAS (Visual Analogue Scale) and UCLA (University of California Los Angeles) shoulder scores applied in the preopera-tive period and in the 12th month of the postoperative clinical follow-ups were evaluated. In addition to the pre-operative and postoperative comparison of both scores, their improvement of these scores was also compared. Results: The mean age of the repair group and the debridement group was 64.4 ±11.02 and 52.6 ±11.24, respective-ly. No significant difference between the two groups was observed in terms of demographic characteristics (p˃0.05). The mean operation time was 91.46 ±16.44 min in the repair group and 49.82 ±13.46 min in the debridement group. The VAS score dramatically improved, from preoperative 5.10±1.23 to postoperative 3.68±1.33 points in the deb-ridement group and from preoperative 5.17±1.35 to postoperative 3.58±1.16 points in the repair group. The two groups had no statistically significant difference in postoperative VAS scores (p=0.991). Preoperative and postopera-tive VAS score improvement was also compared between the groups, however, there was also no statistically signifi-cant difference in terms of VAS score changes (p=0.132). The UCLA scores also dramatically improved, from pre-operative 17.14±4.19 to postoperative 24.57±5.04 points in the debridement group and from preoperative 17.46±5.05 to postoperative 25.48±5.61 points in the repair group. No statistically significant difference was ob-served between the two groups in terms of postoperative UCLA scores (p=0.361). In the postoperative first-year follow-up, no re-tears were observed either in the debridement or in the repair group. Conclusions: Both arthroscopic debridement and arthroscopic repair surgeries provide clinically comparable suc-cessful results and high satisfaction for patients with bursal-side rotator cuff tears. No statistically significant differ-ence was observed between these two methods. Easier early postoperative rehabilitation seems to be the main advantage of the debridement method.

Clinical Outcomes and Return to Sports After Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament: A Meta-Analysis.

This study aimed to evaluatethe clinical outcomes and the frequency of return to sport after the arthroscopic repair of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion.Web of Science, Scopus, and Medline via PubMed and OVID were searched to identify the relevant citations. Screening and data extraction were performed independently. The Comprehensive Meta-Analysis software was used for all statistical analyses (CMA; USA version 3.3.070). A total of 18 articles (n = 832 patients; of whom, 379 patients had HAGL) were included. The fixed-effect estimate showed that the percentage of patients who returned to their sports was 89.1% (95% CI = 85% to 92.2%). The mean duration to return was estimated to be 6.65 months (95% CI = 5.10 to 8.20). Postoperatively, the meanWestern Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS), and Subjective Shoulder Value (SSV) scores were 88.60 (95% CI = 86.18 to 90.98), 15.02 (95% CI = 7.42 to 22.63), and 86.90 (95% CI = 80.79 to 93.00), respectively. The Rowe score improved significantly postoperatively with a mean difference (MD) of54.47 (95% CI = 39.28 to 69.66). The University of California - Los Angeles (UCLA) shoulder score increased significantly post-arthroscopic repair (MD = 10.91, 95% CI = 10.07 to 11.76). The current evidence suggests that arthroscopic repair of HAGL lesions is associated with a high percentage of return to sports and improved Rowe score, WOSI, UCLA shoulder score, OSIS scale, and SSV score. The quality of the included studies is moderate; however, these findings are promising and call for further multicenter, prospective studies.

Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?

: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis. From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores. The UCLA scores increased from the preoperative value of 19.1 ± 3.2 to 29.8 ± 4.8 at the last follow-up and increased by an average of 10.7 ± 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 ± 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001). To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.

Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials

To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference:-0.84; 95% CI [-1.39,-0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. Level I, Bayesian network analysis of level I RCT.

Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment.

Aim and objectiveMultifocal fractures of the humerus are rare. The aim of our study is to evaluate the effectiveness of surgical treatment and propose a modification to the Maresca–Pascarella classification. A flowchart for surgical treatment is provided.Materials and methodsThirty-one patients with multifocal humeral fractures were treated and evaluated. The Maresca–Pascarella classification was used. All were treated using with either plates and screws, external fixation or intramedullary nailing. Functional outcomes were evaluated using the QuickDASH test, the University of California – Los Angeles (UCLA) shoulder score and the Mayo elbow performance score (MEPS).ResultsThere were 12 Type A, 17 Type B, 1 Type C and 1 of combined fractures of the proximal and distal epiphysis. Of the 31 patients, 5 were lost to the follow-up (FU), 1 died of pulmonary embolism (PE) and the remaining 25 had a mean FU of 19.8 (7–35) months. Three patients had radial nerve damage and 1 went to a non-union that required further surgical intervention. The mean QuickDASH score was 15.7, the average UCLA shoulder score was 26.3 and the mean MEPS elbow score resulted to be 83.0.ConclusionAlthough multifocal fractures are severe injuries, patients are able to recover good functionality if treated judiciously.Clinical significanceWe proposed a standardised surgical approach based on the fracture characteristics, site and a modified Maresca–Pascarella classification.How to cite this articleScaglione M, Casella F, Ipponi E, et al. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022;17(2):81–87.

Comparing the Predictors of Functional Outcomes After Arthroscopic Rotator Cuff Repair Modified Frailty Index, Clinical Frailty Scale, and Charlson Comorbidity Index

Background:The incidence of rotator cuff tears increases with age, and operative management is usually required in patients with persistent symptoms. Although several studies have analyzed the effect of age and comorbidities on outcomes after rotator cuff repair, no study has specifically examined the consequence of frailty.Purpose:To determine the best frailty/comorbidity index for predicting functional outcomes after arthroscopic rotator cuff repair.Study Design:Cohort study; Level of evidence, 3.Methods:The authors conducted a retrospective cohort study of 340 consecutive patients who underwent unilateral arthroscopic rotator cuff repair at a tertiary hospital between April 2016 and April 2018. All patients had undergone arthroscopic double-row rotator cuff repair with subacromial decompression by a single fellowship-trained shoulder surgeon. Patient frailty was measured using the Modified Frailty Index (MFI), Clinical Frailty Scale (CFS), and Charlson Comorbidity Index (CCI), calculated through retrospective chart review based on case notes made just before surgery; patient age and sex were also noted preoperatively. Functional outcomes using the Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California Los Angeles (UCLA) Shoulder Score, and visual analog scale for pain were measured preoperatively and at 3, 6, 12, and 24 months postoperatively.Results:The MFI was a consistent significant predictor in all functional outcome scores up to 24 months postoperatively (P < .05), unlike the CFS and CCI. Sex was also a significant predictor of postoperative OSS, CSS, and UCLA Shoulder Score, with male sex being associated with better functional outcomes. Patients with higher MFI scores had slower functional improvement postoperatively, but they eventually attained functional outcome scores comparable with those of their counterparts with lower MFI scores at 24 months postoperatively.Conclusion:The MFI was found to be a better tool for predicting postoperative function than was the CFS or CCI in patients undergoing arthroscopic rotator cuff repair. The study findings suggest that a multidimensional assessment of frailty (including both functional status and comorbidities) is important in determining functional outcomes after arthroscopic rotator cuff repair.

Libération arthroscopique combinée à une fixation en simple rang ou double rang d’une rupture traumatique du supra-épineux associée à capsulite rétractile réfractaire au traitement conservateur - étude prospective randomisée

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.

High bone union rate using a locking plate for proximal humeral fractures in patients older than 70years: importance of the medial column.

This study aimed to evaluate the results of surgical treatment for proximal humeral fractures using a locking plate in patients aged > 70years. Between September 2010 and March 2018, we retrospectively analyzed the clinical and radiological outcomes of 56 patients aged > 70years who underwent locking plate fixation for proximal humeral fractures. We analyzed bone union, neck-shaft angle, University of California Los Angeles (UCLA) score, range of motion (compared to that of the opposite side), and complications. Further, clinical and radiological results of unstable medial column fractures were investigated. Fifty-four patients (96.2%) achieved bone union. The mean time to bone union was 14.7 ± 1.2weeks, and the mean neck-shaft angle was 126.4° ± 14.2°. The mean UCLA shoulder score was 22.4 ± 6.5. The mean forward flexion, abduction, and external rotation angles were 129.2° ± 19.4°, 112.3° ± 14.8°, and 44.2° ± 18.5°, respectively, with internal rotation to L2/3 (S-T11). The range of motion was significantly different from that in the opposite shoulder motion. Unstable medial column fractures led to a significant loss in the neck-shaft angle compared with fractures with an intact medial cortex. For the surgical treatment of proximal humeral fractures in patients aged > 70years, using a locking plate helped achieve a high bone union rate with relatively satisfactory results. However, the prevalence of unstable medial column fracture was high. Clinical and radiological outcomes were poor in these patients. Therefore, it is necessary to accurately understand the fracture pattern prior to surgery, and various surgical methods, including conservative treatment, should be considered.

Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis.

BackgroundNumerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age.MethodsBetween January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment.ResultsThere were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group (P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05).ConclusionsThe improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

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.

Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up.

To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques. Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identified. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores. One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5years, re-dislocation rates between groups were not significantly different (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knot-tying group at a mean 2.9years after surgery and 1 (3%) revision in the knotless anchors group at 1.4years (n.s.). There was no difference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.5, n.s.), SANE scores (91.8 ± 12.7 versus 92.0 ± 11.0, n.s.), QuickDASH scores (4.1 ± 5.5 versus 3.0 ± 6.5, n.s.), UCLA Shoulder Score (32.5 ± 3.6 versus 33.2 ± 3.1, n.s.), or Rowe scores (90.5 ± 18.5 versus 92.2 ± 16.6, n.s.) between knotless and knot-tying groups, respectively. VAS at rest was higher in the knotless group (0.7 ± 1.5 vs 0.1 ± 0.4, p = 0.021). Knotless anchors demonstrated similar rates of re-dislocation and revision surgery, and lower rates of recurrent subluxation, compared to knot-tying anchors. Patients achieved good-to-excellent functional outcomes. This supports the efficacy of knotless anchors as an alternative to knot-tying anchors for arthroscopic anterior labral repair of recurrent anterior shoulder dislocation. III.

Threshold scores for treatment success after arthroscopic bankart repair using Oxford Shoulder Instability Score, Constant-Murley Score, and UCLA shoulder score

AimTo determine the threshold score for Oxford Shoulder Instability Score (OSIS), Constant-Murley score (CMS), and University of California Los Angeles (UCLA) shoulder score that predict treatment success after arthroscopic bankart repairs. Methods77 patients were followed up for 12-mmonth. Threshold scores were determined by Receiver Operating Characteristic (ROC) analyses with treatment success defined as improvement in pain, no re-dislocation, expectation and satisfaction met. ResultsThe follow threshold scores were identified:6-month: OSIS 35, CMS 68,UCLA 2612-month: OSIS 24, CMS 84, UCLA 33. ConclusionOSIS, CMS, and UCLA are good predictors of treatment success after arthroscopic bankart repair.Level of EvidenceIII.

Minimal Clinically Important Difference of Oxford, Constant, and UCLA shoulder score for arthroscopic rotator cuff repair

AimTo determine the Minimal Clinically Important Difference (MCID) for Constant-Murley score (CMS), University of California Los Angeles (UCLA) shoulder score, and Oxford Shoulder Scores (OSS) after arthroscopic rotator cuff (RC) repairs. Material and methods306 patients were followed up for 24-month. MCID for CMS, UCLA and OSS were determined using simple linear regression according to patient satisfaction and expectation fulfilment. ResultsThe following MCID were identified:12-month: CMS 6.7, UCLA 3.0, OSS 3.3.24-month: CMS 6.3, UCLA 2.9, OSS 2.7. ConclusionsThe various MCID could assist in meaningful interpretation of these scores and to power future comparative studies. Level of evidenceIII.

Modified keyhole technique for the treatment of biceps long head tendon rupture.

The present study aimed to assess a novel modified keyhole fixation technique to treat long head of biceps (LHB) rupture. From May 2015 to July 2017, a total of 9 patients with LHB rupture, decreased muscle strength and pop-eye sign were treated using the keyhole fixation technique combined with extramedullary cortical bone microplate-suspending fixation. Measurements of visual analog scale (VAS) score, elbow joint rotation, flexion strength, the Shoulder Score of the University of California Los Angeles (UCLA) and the Rating Scale of American Shoulder Elbow Surgeons (ASES) score were used to evaluate surgical outcomes prior to and following surgery. The 9 patients with LHB rupture included in the study were followed up for one year post-surgery. The supination and flexion elbow strength of all patients after 1 year was grade V and shoulder pain was relieved. The VAS, UCLA shoulder and ASES scores at one year post-surgery were significantly improved compared with those prior to surgery. In conclusion, modified keyhole fixation for LHB rupture features low difficulty of operation, high safety and reliable fixation, and is therefore a promising novel technique for the treatment of LHB rupture.

Borderline Glenoid Bone Defect in Anterior Shoulder Instability: Latarjet Procedure Versus Bankart Repair

Background: The optimal procedure for anterior shoulder instability with a borderline (15%-20%) bone defect on the anterior rim of the glenoid is still controversial. Purpose: To compare the clinical outcome and recurrence rate between the arthroscopic Bankart repair and Latarjet procedure among patients with recurrent anterior shoulder instability and a borderline glenoid bone defect. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed cases of arthroscopic Bankart repair and the Latarjet procedure for recurrent anterior shoulder instability with a borderline (15%-20%) glenoid bone defect. Enrollment comprised 149 patients (Bankart group, n = 118; Latarjet group, n = 31). The mean follow-up and age at operation were 28.9 ± 7.3 months (range, 24-73 months) and 26 ± 5 years (range, 16-46 years), respectively. Results: Rowe and UCLA (University of California, Los Angeles) shoulder scores significantly improved from 42.0 ± 14.3 and 22.9 ± 3.2 preoperatively to 90.9 ± 15.4 and 32.5 ± 3.3 postoperatively in the Bankart group (P < .001) and from 41.0 ± 17.9 and 22.3 ± 3.4 to 91.1 ± 16.1 and 32.3 ± 3.4 in the Latarjet group (P < .001), respectively. There were no significant between-group differences in Rowe (P = .920) or UCLA (P = .715) scores at the final follow-up. Mean postoperative loss of motion during forward flexion, external rotation in abduction, and internal rotation to the posterior was 3.0° ± 6.2°, 11.6° ± 10.2°, and 0.6 spinal segment in the Bankart group and 3.7° ± 9.8°, 10.3° ± 12.8°, and 0.9 spinal segment in the Latarjet group, respectively. These differences were not significant. However, the loss of external rotation at the side was significantly greater in the Bankart group (13.3° ± 12.9°) than in the Latarjet group (7.3° ± 18.1°, P = .034). The overall recurrence rate was significantly higher in the Bankart group (22.9%) than in the Latarjet group (6.5%), (P = .040). Conclusion: The Latarjet procedure and arthroscopic Bankart repair both provided satisfactory clinical outcome scores and pain relief for anterior shoulder instability with a borderline glenoid bone defect. However, the Latarjet procedure resulted in significantly lower recurrences and less external rotation limitation than the arthroscopic Bankart repair. Therefore, the Latarjet procedure could be a more reliable surgical option in anterior recurrent instability with a borderline glenoid bone defect.

Clinical Evaluation of an Arthroscopic Knotless Suprapectoral Biceps Tenodesis Technique: Loop 'n' Tack Tenodesis.

Background:Pathology of the long head of the biceps tendon is a well-known cause of shoulder pain that is commonly managed with arthroscopic suprapectoral biceps tenodesis when conservative treatment fails.Purpose:To present an arthroscopic knotless suprapectoral biceps tenodesis technique known as “Loop ’n’ Tack” tenodesis and to report the clinical outcomes of patients with a minimum 2 years of follow-up.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of all patients who had undergone Loop ’n’ Tack tenodesis between January 2009 and May 2014 was completed. Charts were reviewed, and patients were contacted for demographic data, time from surgery, concomitant procedures, and workers’ compensation status, as well as visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and University of California, Los Angeles (UCLA) scores.Results:Complete follow-up evaluations were performed for 59 of 68 patients (87%). Mean follow-up was 43 months. A majority (88%) of patients had at least 1 additional procedure performed at the time of biceps tenodesis. The mean ASES shoulder score improved from 42.6 preoperatively to 91.0 postoperatively (P < .001), and 54 of 59 patients (91.5%) had a good/excellent outcome, with a UCLA shoulder score >27 and ASES shoulder score >70. Three patients (5%) reported biceps cramping pain with overuse, and 2 (3.3%) reported intermittent anterior shoulder pain. No patients had developed a “Popeye” deformity at final clinical examination, and 97% reported that they were overall satisfied with the procedure.Conclusion:The Loop ’n’ Tack tenodesis technique results in a high rate of patient satisfaction, significant improvement in shoulder outcome scores, and a low incidence of postoperative pain, with no reoperations for biceps-related pathology.

Atypical traumatic anterior shoulder instability with excessive joint laxity: recurrent shoulder subluxation without a history of dislocation

BackgroundNo previously published studies have examined recurrent traumatic incomplete events in patients with excessive joint laxity. The purpose of this study is to investigate outcomes after arthroscopic stabilization for recurrent traumatic shoulder subluxation in patients with excessive joint laxity but no history of dislocation.MethodsThis study included 23 patients with glenoid bone defects less than 20% who underwent arthroscopic stabilization of recurrent shoulder subluxation and were available for at least 2 years follow-up. Outcomes were assessed with the subjective shoulder value (SSV), University of California Los Angeles (UCLA) shoulder score, Rowe score, and sports/recreation activity level.ResultsPostoperatively, overall functional scores improved significantly (p < 0.001), compared to preoperative scores: SSV improved from 49.1 to 90.4; Rowe score improved from 36.7 to 90.2; and UCLA shoulder score improved from 26.3 to 32.5. Patient satisfaction rate was 87% (20/23 patients). Sports/recreation activity level (return to premorbid activity level; grade I = 100% to grade IV = less than 70%) was grade I in 7 patients, grade II in 11, grade III in 3, grade IV in 2. The incidence of any glenoid bone defect was 61% (14/23 patients), and the mean glenoid bone defect size was 8%; among these 14 patients, 8 (35%) exhibited 15–20% glenoid bone defects. Instability reoccurred in 2 patients (9%) who had 15–20% glenoid bone defect.ConclusionDespite excessive joint laxity, overall functional outcomes after arthroscopic stabilization of recurrent shoulder subluxation were satisfactory. However, arthroscopic Bankart repair may not be reliable in patients with excessive joint laxity plus a glenoid bone defect size of more than approximately 15%.

Arthroscopic Rotator Cuff Repair With Graft Augmentation of 3-Dimensional Biological Collagen for Moderate to Large Tears: A Randomized Controlled Study

Background: Due to the highly organized tissue and avascular nature of the rotator cuff, rotator cuff tears have limited ability to heal after the tendon is reinserted directly on the greater tubercle of the humerus. Consequently, retears are among the most common complications after rotator cuff repair. Augmentation of rotator cuff repairs with patches has been an active area of research in recent years to reduce retear rate. Hypothesis: Graft augmentation with 3D collagen could prevent retears of the repaired tendon and improve tendon-bone healing in moderate to large rotator cuff tears. Study Design: Randomized controlled study; Level of evidence, 2. Methods: A prospective, randomized controlled study was performed in a consecutive series of 112 patients age 50 to 85 years who underwent rotator cuff repair with the suture-bridge technique (58 patients, control group) or the suture-bridge technique augmented with 3-dimensional (3D) collagen (54 patients, study group). All patients were followed for 28.2 months (range, 24-36 months). Visual analog scale score for pain, University of California Los Angeles (UCLA) shoulder score, and Constant score were determined. Magnetic resonance imaging was performed pre- and postoperatively (at a minimum of 24 months) to evaluate the integrity of the rotator cuff and the retear rate of the repaired tendon. Three patients in each group had biopsies at nearly 24 months after surgery with histological assessment and transmission electron microscopy. Results: A total of 104 patients completed the final follow-up. At the 12-month follow-up, the UCLA shoulder score was 28.1 ± 1.9 in the study group, which was significantly better than that in the control group (26.9 ± 2.1, P = .002). The Constant score was also significantly better in the study group (87.1 ± 3.2) than in the control group (84.9 ± 4.2, P = .003). However, at the final follow-up, no significant differences were found in the UCLA shoulder scores (29.4 ± 1.9 in the control group and 30.0 ± 1.6 in the study group, P = .052) or Constant scores (89.9 ± 3.2 in the control group and 90.8 ± 3.5 in the study group, P = .18). In terms of structural integrity, more patients in the study group had a favorable type I retear grade (18/51) than in the control group (10/53) (P = .06). The postoperative retear rate was 34.0% in the control group and 13.7% in the study group, thus indicating a significantly lower retear rate in the study group (P = .02). Biopsy specimens of the tendon-bone interface in 6 patients revealed more bone formation and more aligned fibers with larger diameters in the study group than in the control group. No intraoperative or postoperative complications were noted in either group. Conclusion: 3D collagen augmentation could provide effective treatment of moderate to large rotator cuff tears, providing substantial functional improvement, and could reduce the retear rate. This technique could also promote new tendon-bone formation, thus exerting a prominent effect on tendon-bone healing.