Arthroscopic Repair of Posterosuperior Rotator Cuff Tears Using a Modified Mason-Allen Suture Technique With a Transosseous-Equivalent Construct: A Technical Note.

Iterative evolutions in arthroscopic rotator cuff repair aim to improve its biomechanical and biological properties. This technical note describes an arthroscopic rotator cuff repair technique that combines the advantages of a modified Mason-Allen suture technique with the advantages of an arthroscopic transosseous-equivalent construct. Two alternatives for creating this construct are described. The Mason-Allen stitch is easy to perform, is cost-effective, and increases tissue security without tendon strangulation. The arthroscopic transosseous-equivalent construct increases footprint contact pressure and coverage, aiding healing of the repaired rotator cuff.

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Conservative treatment of Rockwood type III acromioclavicular joint separation: a randomized controlled trial sling vs. brace.

Background: Management of Rockwood III acromioclavicular joint separations is a matter of ongoing debate, with nonoperative treatment being favored in recent literature. The aim of this study is to compare clinical and radiological outcomes of nonoperative treatment with a brace, which elicits a direct reduction force to the distal clavicle, to a sling. We hypothesized the brace might yield in better acromioclavicular joint (ACJ) reduction and cosmesis. Methods: In this dual center prospective randomized controlled trial, all patients sustaining an acromioclavicular joint separation Rockwood III between July 2017 and August 2020 were included. Patients with previous ipsi- or contralateral ACJ injury or surgery were excluded. Randomization occurred in the emergency department to either the sling or brace group. Patients were followed up at 1, 6, and 12 weeks. Patient-reported outcome measures included subjective shoulder value (SSV) and American Shoulder and Elbow Surgeons (ASES) score at each follow-up and Constant Score at 6 and 12 weeks. Vertical distal clavicle displacement was assessed on bilateral non-weighted panoramic anteroposterior radiographs using coracoclavicular (CC) distance to calculate the CC-index. Results: Thirty-five consecutive patients were included across the 2 sites, 18 (all male) in the brace and 17 (14 male) in the sling group. Baseline characteristics did not differ significantly between groups, the average age was 40 years, and body mass index 25.5 kg/m2. Analysis revealed no statistical difference in CC-index between groups at the time of injury, 6 weeks and 12 weeks postinjury (P = .39, P = .11, and P = .21). SSV improved from 30 and 35 postinjury to 81 and 84 at 12 weeks in the sling and brace group, respectively (P = .59). ASES improved from 48 and 38 to 82 and 83, respectively (P = .84). Similarly, Constant Score improved from 64 and 67 to 82 and 81, respectively (P = .90). One patient in the brace group underwent ACJ stabilization with hamstring autograft at 4 months due to persistent pain. Conclusion: This randomized controlled trial shows no statistically significant difference between the brace and sling group in clinical (SSV, ASES, Constant Score) or radiological (CC-index) outcomes after conservative treatment of Rockwood III injuries.

Reverse Total Shoulder Arthroplasty in Patients Who Exceeded Their Life-Expectancy: A Retrospective Study.

Background: Reverse total shoulder arthroplasty (RTSA) has become an established treatment for cuff arthropathy, severe osteoarthritis and in certain fracture cases. Due to the increasingly aging population, patients who have already exceeded their life-expectancy pose a significant challenge to the shoulder surgeon. Methods: Patients older than 83 years who received a RTSA were included. Elective cases were compared to fracture cases. Patient demographics, hospital stay length, complication rate, functional outcome, patient reported outcome scores and mortality were assessed retrospectively. Results: We included 110 cases, 48 in the elective group and 62 in the fracture group. The average age at time of surgery was 86.6 ± 3.5 years. Mean follow-up was 30 months. Elective cases had a significant shorter hospital stay length (P = .014). Functional outcome scores showed better results for the elective group with ASES 79 ± 12 vs 69 ± 19 (P = .07), QuickDASH 29 ± 16 vs 37 ± 21 (P = .22), subjective shoulder value 86 ± 14 vs 75 ± 19 (P = .04*) and VAS .7 ± 1.5 vs 2.1 ± 2.5 (P = .02*). There was no significant difference in ROM and mean quality-adjusted-life-years (QALY) with 3.2 ± 1.8 vs 3.5 ± 2.5 years (P = .69). The complication rate requiring surgical intervention was 2.4% in the elective and 6.5% in the fracture group. The 1-year mortality was 3 (6%) respectively 9 (15%). Conclusion: RTSA in elderly patients can be successful with good functional outcomes. Age should not be a contraindication. Instead, the patient's activity level and quality of life should be taken into account. Elective RTSA show better functional outcome scores and lower complication rates compared to RTSA in proximal humeral fractures.

Early locking plate removal following open reduction and internal fixation of proximal humeral fractures could prevent secondary implant-related complications.

INTRODUCTION: Proximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. METHODS: A total of 56 patients with an average age of 63 ±â€¯13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. RESULTS: Early implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. CONCLUSION: Early implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction.

The first 100 patients treated with a new anatomical pre-contoured locking plate for clavicular midshaft fractures.

BACKGROUND: Pre-contoured locking plates were recently introduced in the management of clavicular midshaft fractures. These plates may offer advantages such as no necessity for intraoperative bending and reduced plate irritation. The purpose of this study was to review the clinical and radiographical outcome of the first 100 patients treated with a new anatomical pre-contoured locking plate. METHODS: In a retrospective single-center study, 100 consecutive patients (16 female, 84 male) with a median age of 40 years (range 15-82) who underwent surgery for clavicular midshaft fractures with a VariAx locking plate (Stryker Corporation Kalmazoo, MI, USA) between March 2012 and January 2016 were included. Postoperative follow-up was performed until union was clinically and radiographically achieved. Fracture type, surgical time, intraoperative need for contouring the plate, further surgery such as revision or hardware removal and complications were recorded. RESULTS: One-hundred patients with a dislocated midshaft clavicular fracture with a mean follow-up of 21.9 months (standard deviation 13.2) were included. Ninety-three patients reported normal shoulder function at latest follow-up. Median surgical time was 75.5 min (range, 35-179). In three patients, intraoperative bending of the plate was necessary. In two patients, plates designed for the other side were implanted. Five patients needed revision surgery: One patient with wound healing problems, one patient with a re-fracture after early (13 months) hardware removal and minor trauma, one patient with postoperative shoulder stiffness and two patients with failed osteosynthesis because of surgical implantation fault. One asymptomatic nonunion without further treatment was observed. In 30 patients, the plate was removed after a mean of 17.5 months (SD 4.2) because of subjective plate discomfort. CONCLUSIONS: With this new pre-contoured locking plate, good to excellent intraoperative fit to the anatomical shape of the clavicle can be achieved. The implant seems to be reliable regarding handling and complications. Clinical and radiological results are comparable to results reported in the literature. Hardware removal rate is comparable to other studies with a pre-contoured plate and lower compared to non-pre-contoured.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.

BACKGROUND: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. METHODS: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). RESULTS: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. CONCLUSION: The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome.

The M.E Müller straight stem prosthesis: 15 year follow-up. Survivorship and clinical results.

The aim of the study was to document the long-term clinical and radiologic results as well as the 15 year survival of a single cemented straight stem. Our series consisted of consecutive patients with 161 straight stem prostheses implanted between 1984 and 1987 in 152 patients. Follow-up was performed prospectively at 1, 2, 5, 10 and 15 years post-operatively. Seven stems were revised due to aseptic loosening, the 15 years survival rate being 94%. There were 18 acetabular revisions. Pain and patient satisfaction declined slightly over the study period. We observed a more prominent health-related decline of functional results. This effect was mainly due to aging. Younger patients showed better clinical results, but also a higher revision rate.

Granulicatella (Abiotrophia) adiacens infection associated with a total knee arthroplasty.

We describe the first case of prosthetic joint associated infection due to Granulicatella adiacens (formerly Abiotrophia adiacens). Diagnosis was made by broad spectrum PCR, and later by culture. Diagnosis and treatment of this microorganism is difficult. Two y after revision and antibiotic treatment, infection was under control but not cured.