Anatomic factors associated with degeneration and fraying of the coracoacromial ligament.

BACKGROUND: The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. METHODS: A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. RESULTS: Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). CONCLUSIONS: While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.

The Frequency of Burnout among Iranian Orthopedic Surgeons and Residents.

Background: Burnout is an emotional, psychological, and physical exhaustion syndrome with feelings of negativism toward one's job and reduced attention to clients. This complication is caused by the lack of control over work-related stress. Physicians, especially surgeons, are at higher risk for burnout due to critical responsibility and heavy workload. Given the importance and consequences of this dilemma, the present study aimed to investigate the frequency of burnout among orthopedic surgeons and residents. Methods: The present cross-sectional, analytical study was conducted in 2019 in the cities of Tehran and Yazd, in Iran. A total of 180 orthopedic surgeons and residents participated in the study. A demographic characteristics form and the Maslach Burnout Inventory (MBI) were employed to assess burnout in the participants. Results: The mean age of the participants was 42.8 years, and 94.4%, 23.9%, 52.2%, and 23.9% of the participants were male, residents, general orthopedic specialists, and fellowship-trained orthopedics, respectively. Out of 180 participants, 90 (50%) cases were suffering from burnout, of whom 26.7%, 16.1%, and 7.2% got a pathological score in one, two, and three criteria. No significant relationship was observed between burnout and gender, marital status, years of experience, and the average number of surgeries per week. However, there was a significant association between burnout and younger age, lower academic rank or being a resident, working in the public sector, and spending less time in leisure and sports activities. Conclusion: The prevalence of burnout (50%) among orthopedists was remarkable and worrying. The frequency of burnout was higher among residents and the ones working in the public sector. This study demonstrates that the issue of burnout and its related risk factors have to be addressed in Iranian orthopedic surgeons and residents.

Postoperative stiffness after reverse total shoulder arthroplasty.

Purpose: The purpose of this study was to evaluate the rate and risk factors for stiffness after reverse shoulder arthroplasty and the ramifications on the patient-reported outcomes. Method: A consecutive series of patients who underwent reverse shoulder arthroplasty were prospectively followed for one year. Passive range of motion was measured preoperatively and at regular intervals postoperatively. Patients with passive forward elevation of less than 100° or passive external rotation of less than 30° were defined as stiff. Radiographic parameters and postoperative patient-reported outcome scores were collected. Results: Seventy-six patients were available for review. The prevalence of postoperative stiffness following reverse shoulder arthroplasty was 47% at three months, 31% at six months, and 25% at one year. Preoperative shoulder stiffness was associated with three-month postoperative stiffness only. In patients with one-year stiffness, smaller (p = 0.03) and less lateralized glenospheres (p = 0.024) were more common. Stiffness was not associated with one-year patient-reported outcome scores. Conclusion: Stiffness is common after reverse shoulder arthroplasty and often improves at one-year after surgery. Implant design and selection may be important determinants of passive range of motion. While stiffness does not appear to influence patient-reported outcome scores, one of four patients will potentially have stiffness one year following reverse shoulder arthroplasty.Level of evidence: Level III; retrospective study.

A three-dimensional model of transient bioheat transfer in the lower extremity during cryotherapy.

The purpose of this research was to create a computational model of the human thigh undergoing cryotherapy. The tissue temperatures were measured for five cold pack temperatures of -8°C, -4°C, 0°C, 4°C, and 8°C in addition to six different time intervals of cold application and ice removal. The depth of cold penetration and duration of local tissue cooling were investigated at 10 points during 30 min of application and 7 h of post-application. The model was created in CATIA, using a mid-axial cut of the human thigh MRI without pathology. After validation by the available clinical data, this research applied the finite-volume discretization method to solve bioheat transfer equations. A 16°C decrease in the cold pack temperature reduced the tissue temperatures located 1 and 2 cm below the fat by almost 3.34°C and 1.4°C, respectively, after 30 min of cold application. It took the tissues 10-15 min to start cooling down, and the temperature reached its plateau after 100 min. Thirty minutes of cold application declined the superficial tissue and deep tissue temperatures near the bone by 22.59°C and 0.48°C, respectively. Intense cryotherapy led to an insignificant change in the deep tissue temperature at 2 cm and deeper below the fat tissue. After ice removal, tissues continued cooling down for about 8 min until 40 min, depending on the tissue depth. This study proposed a 100-min cold therapy with 10 min of ice removal to optimize tissue cooling.

Complications Associated With Intravenous Antibiotic Treatment for Cutibacterium acnes Periprosthetic Shoulder Infection.

Whether positive Cutibacterium acnes cultures during revision shoulder arthroplasty represent true periprosthetic joint infection (PJI), deep tissue inoculant, or laboratory contaminant is a point of substantial controversy. The purpose of this study was to review complications of intravenous antibiotics used for treatment of presumed C acnes shoulder PJI. A study population of 26 patients treated for C acnes PJI with a minimum follow-up of 2 years after operative treatment was established. Complication occurrence and severity were obtained through chart review and phone survey. Sixteen (61.5%) patients experienced a therapeutic complication. Twelve (46.2%) patients experienced a total of 47 antibiotic-associated adverse effects and 10 (38.5%) patients experienced 11 total peripherally inserted central catheter line-associated complications. Female sex carried an increased risk for severe complications (relative risk, 3.3; 95% CI, 1.2-9.5; P=.024). Treatment duration of greater than 6 weeks was a significant predictor for the total number of complications experienced [F(1,23)=5.361; P=.030; adjusted R2=0.189]. Age older than 65 years, treatment duration greater than 6 weeks, and female sex were significant predictors for the number of severe complications [F(3,21)=3.249; P=.042; adjusted R2=0.219]. Treating C acnes infection with intravenous antibiotics carries a substantial risk of adverse events, highlighting the importance of accurate diagnosis of shoulder PJI. Further investigations into the efficacy and safety profile of oral antibiotics for shoulder PJI are necessary. [Orthopedics. 2021;44(3):e422-e426.].

Techniques for lower trapezius tendon transfer for the management of irreparable posterosuperior rotator cuff tears.

Irreparable posterosuperior rotator cuff tears are a challenging treatment problem. Several tendon transfers have been described for the treatment of irreparable tears. Recently the lower trapezius (LT) tendon transfer has grown in popularity. This procedure has shown promise in biomechanical studies, improving the external rotation moment arm at the side. This transfer may be done in several ways, including an open approach with an acromial osteotomy, mini-open, and arthroscopic-assisted. The purpose of this paper is to review the current evidence and rationale for the use of the LT transfer and to describe the available techniques.

Augmented glenoid implants in anatomic total shoulder arthroplasty: review of available implants and current literature.

Glenoid bone loss and retroversion increase the complexity of primary shoulder arthroplasty and affect the outcome. Although eccentric reaming, augmented glenoid implants, bone grafting, and reverse arthroplasty have been used to manage bone loss and retroversion, there is no consensus on treatment. Posteriorly augmented glenoid components can correct retroversion and avoid joint line medialization, which occurs with corrective reaming techniques. Full-wedged, half-wedged, and stepped polyethylene posteriorly augmented designs are currently available for use in the United States. The results of biomechanical and computer model studies support the use of augmented implants for the management of glenoid retroversion of greater than 15°. Currently, most clinical studies are retrospective case series. The short-term results of posteriorly augmented glenoid components are successful, with no clear evidence of the superiority of one design over another and unknown long-term survival rates.