The Quality and Accuracy of Online Resources for Total and Reverse Shoulder Replacement.

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy. Overall quality scores were low for TSR and RSR websites, 22.8/45 (95% confidence interval (CI): 19.9-25.6) and 24.2/45 (95% CI: 21.6-26.9), respectively. The authorship of a website significantly influenced the quality for both TSR (p = 0.013) and RSR (p = 0.048). When comparing search rank to quality scores, websites that appeared earlier demonstrated significantly higher quality scores, TSR (p = 0.017) and RSR (p = 0.018). Overall, most websites were accurate but provided incomplete information. Websites authored by professional societies have higher quality scores than websites authored by medical providers or commercial entities. (Journal of Surgical Orthopaedic Advances 28(4):290-294, 2019).

Outcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence.

BACKGROUND: Although lumbar discectomy for treatment of lumbar disc herniation in the general population generally improves patients' pain, function, and validated outcomes scores, results of treatment in elite athletes may differ because of the unique performance demands required of competitive athletes. QUESTIONS/PURPOSES: We performed a systematic review to answer the following questions: (1) What proportion of athletes return to play after lumbar discectomy, and what is the effect of sport? (2) What is the expected recovery time after lumbar discectomy in elite athletes? (3) What is the expected career length and performance of elite athletes after lumbar discectomy? METHODS: We performed a systematic literature review of articles of lumbar discectomy in the elite athlete population through the MEDLINE and EMBASE databases from 1947 to 2013. Elite athletes were defined as professional, Olympic, or National Collegiate Athletic Association Division I collegiate level. A hand search of the references of all key articles was performed to ensure inclusion of all relevant studies. Information regarding study design, types of athletes, level of sport, recovery time, return to sport, length of career after surgery, and career performance after surgery was extracted. Ten articles met the inclusion and exclusion criteria for this review. These articles consisted of levels III and IV data and were graded based on the Methodological Index for Non-Randomized Studies (MINORS) scale. RESULTS: Overall, the studies included in this review found that 75% to 100% of athletes were able to return to elite competition after operative treatment. In general, a higher proportion of baseball players returned to elite competition compared with other athletes. The reported recovery period after lumbar discectomy ranged from 2.8 to 8.7 months. The average career length after lumbar discectomy ranged from 2.6 to 4.8 years. Elite athletes reached an average of 64.4% to 103.6% of baseline preoperative statistics after lumbar discectomy with variable performance based on sport. CONCLUSIONS: A high proportion of elite athletes undergoing lumbar discectomy return to play with variable performance scores on return. Future prospective studies are needed to compare the recovery time, career longevity, and performance for athletes undergoing lumbar discectomy versus nonoperative treatment for lumbar disc herniation.

The Effect of Local Versus Intravenous Corticosteroids on the Likelihood of Dysphagia and Dysphonia Following Anterior Cervical Discectomy and Fusion: A Single-Blinded, Prospective, Randomized Controlled Trial.

BACKGROUND: Dysphagia and dysphonia are the most common postoperative complications following anterior cervical discectomy and fusion (ACDF). Although most postoperative dysphagia is mild and transient, severe dysphagia can have profound effects on overall patient health and on surgical outcomes. The purpose of this study was to compare the efficacy of local to intravenous (IV) steroid administration during ACDF on postoperative dysphagia and dysphonia. METHODS: This was a single-blinded, prospective, randomized clinical trial. Seventy-five patients undergoing ACDF with cervical plating were randomized into 3 groups: control (no steroid), IV steroid (10 mg of IV dexamethasone at the time of closure), or local steroid (40 mg of local triamcinolone). Patient-reported outcome measures (PROMs) were collected for dysphagia, dysphonia, and neck pain postoperatively for 1 year. RESULTS: Patient demographics were similar. Postoperative day 1 PROMs showed significantly lower scores for dysphonia (p = 0.015) and neck pain (p = 0.034) in the local steroid group. At 2 weeks postoperatively, the local steroid cohort showed significantly decreased prevalence of severe dysphagia (Eating Assessment Tool-10 [EAT-10], severe dysphagia, p = 0.027) compared with the control and IV steroid groups. Both steroid groups had significantly less severe dysphagia when compared with the control group at the 6-week and 3-month time points. At 1 year postoperatively, both steroid groups had significantly reduced dysphagia rates (p = 0.014) compared with the control group. CONCLUSIONS: Both local and IV steroid administration after cervical plating in ACDF yielded better PROMs for dysphagia compared with a control group. This finding is particularly evident in the reduced number of patients who reported severe dysphagia symptoms following ACDF with local steroid application within the first 2 postoperative weeks. Future studies should attempt to stratify dysphagia severity when reporting outcomes related to anterior cervical spine surgery. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Incidence of injury based on sports participation in high school athletes.

OBJECTIVES: Youth participation in competitive athletics has significantly increased in the past two decades. There has also been a recent rise in the number of sports injuries that physicians are seeing in young athletes. The objective of this study was to assess the likelihood of sports injuries based on several risk factors in a general sample of athletes at a suburban-area high school. METHODS: This was a cross-sectional study. An online survey was distributed to 2,200 student-athletes at a local high school with a mean age of 15.9 years. Four hundred eighty four (22%) complete responses were received. Data collected in the survey included demographics, frequency of sports participation, level of participation, types of sports played, participation in cross-training, injuries incurred, use of non-steroidal anti-inflammatory drugs, and treatment for sports injuries. RESULTS: Athletes played an average of 1.6 different sports. The average number of hours of participation in sports annually was 504.3 ± 371.6 hours. The average total number of sports injuries experienced by athletes in our study was 1.7 per participant. 80.8% of respondents reported having sustained at least one sports injury. A higher total number of hours per year of sports participation and playing a contact sport were significantly associated with more reported lifetime sports injuries. Older age, playing a contact sport, and playing on a travel/club team were associated with students using NSAIDs for sports injuries. Older age, playing a contact sport, and doing cross training are also associated with having had surgery for a sports injury. CONCLUSIONS: Although more hours of participation and playing a contact sport may lead to an increased number of injuries, this risk must be weighed against the myriad of benefits that sports provide for young athletes.

Dysphagia and Dysphonia Assessment Tools After Anterior Cervical Spine Surgery.

The Smith-Robinson approach to the anterior cervical spine is being increasingly used, but it is not without complication. Dysphagia and dysphonia are the most common complications of the procedure. Many classification systems have been developed to stage and grade postoperative dysphagia and dysphonia, but inconsistent usage and lack of consensus adoption has limited research progress. A discussion of the merits and limitations of the most common classification systems is outlined within this review. Broad adoption of comprehensive and simple classification metrics is needed, but, first, prospective reliability and validity must be established in the anterior cervical fusion population.

Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy.

BACKGROUND: Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy. PURPOSE: To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 µg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups. RESULTS: Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, -32 to -2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery. CONCLUSION: Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction.

All-Arthroscopic Suprapectoral Biceps Tenodesis.

Biceps tenodesis is a common treatment for pathology of the long head of the biceps tendon. Several authors have described various arthroscopic and open techniques for biceps tenodesis. Open techniques have been associated with complications such as wound infection and nerve injury. Previously described arthroscopic techniques have placed the tenodesis site within the bicipital groove, which may lead to persistent pain. We describe an all-arthroscopic suprapectoral biceps tenodesis technique that places the tenodesis site distal to the bicipital groove. This technique potentially avoids the complications associated with open tenodesis surgery while still removing the biceps tendon from the bicipital groove.

All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii.

BACKGROUND: Pathologic changes of the long head of the biceps tendon are a recognized source of shoulder pain in adults that can be treated with tenotomy or tenodesis when nonoperative measures are not effective. It is not clear whether arthroscopic or open biceps tenodesis has a clinical advantage. HYPOTHESIS: Pain relief and shoulder function after all-arthroscopic suprapectoral biceps tenodesis are similar to outcomes after an open subpectoral tenodesis. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A prospective database was reviewed for patients undergoing an all-arthroscopic suprapectoral or open subpectoral biceps tenodesis. Adult patients with a minimum 18-month follow-up were included. Patients undergoing a concomitant rotator cuff or labral repair were excluded. The groups were matched to age within 3 years, sex, and time to follow-up within 3 months. Pain improvement, development of a "Popeye" deformity, muscle cramping, postoperative American Shoulder and Elbow Surgeons scores, satisfaction scores, and complications were evaluated. RESULTS: Forty-six patients (23 all-arthroscopic, 23 open) with an average age of 57.2 years (range, 45-70 years) were evaluated at a mean follow-up of 30.1 months (range, 21.1-44.9 months). No patients in either group developed a Popeye deformity or complained of arm cramping. There was no significant difference in mean American Shoulder and Elbow Surgeons scores between the open and all-arthroscopic groups (92.3 vs 88.9; P=.42); similarly, there was no significant difference in patient satisfaction scores between the groups (8.9 vs 9.1; P=.73). Eighteen patients (78.3%) in the arthroscopic cohort and 16 (69.6%) in the open cohort fully returned to athletic activity (P=.50). Eight patients (34.8%) in the arthroscopic group and 10 (39.1%) in the open group reported pain at night or with heavy activities. There were no complications in the all-arthroscopic group. There were 2 complications in the open group that resolved by final follow-up. CONCLUSION: Biceps tenodesis remains a reliable treatment for pathologic abnormality of the long head of the biceps. Patients undergoing an all-arthroscopic suprapectoral tenodesis in the distal aspect or distal to the bicipital groove showed similar pain relief and clinical outcomes as compared with patients undergoing open subpectoral tenodesis. Open subpectoral biceps tenodesis may carry a higher complication risk secondary to a more invasive technique.

Clinical and Biomechanical Evaluation of an All-Arthroscopic Suprapectoral Biceps Tenodesis.

BACKGROUND: Pathology of the long head of the biceps (LHB) is a well-recognized cause of shoulder pain in the adult population and can be managed surgically with tenotomy or tenodesis. PURPOSE: To compare the biomechanical strength of an all-arthroscopic biceps tenodesis technique that places the LHB distal to the bicipital groove in the suprapectoral region with a more traditional mini-open subpectoral tenodesis. This study also evaluates the clinical outcomes of patients who underwent biceps tenodesis using the all-arthroscopic technique. STUDY DESIGN: Controlled laboratory study and case series; Level of evidence, 4. METHODS: For the biomechanical evaluation of the all-arthroscopic biceps tenodesis technique, in which the biceps tendon is secured to the suprapectoral region distal to the bicipital groove with an interference screw, 14 fresh-frozen human cadaveric shoulders (7 matched pairs) were used to compare load to failure and displacement at peak load with a traditional open subpectoral location. For the clinical evaluation, 49 consecutive patients (51 shoulders) with a mean follow-up of 2.4 years who underwent an all-arthroscopic biceps tenodesis were evaluated using the American Shoulder and Elbow Surgeons (ASES) score preoperatively and at last follow-up, as well as the University of California, Los Angeles (UCLA) Shoulder Score at last follow-up. RESULTS: On biomechanical evaluation, there was no significant difference in peak failure load, displacement at peak load, or displacement after cyclic testing between the arthroscopic suprapectoral and mini-open subpectoral groups. In the clinical evaluation, the mean preoperative ASES score was 65.4, compared with 87.1 at last follow-up. The mean UCLA score at last follow-up was 30.2. Forty-eight (94.1%) patients reported satisfaction with the surgery. In subgroup analysis comparing patients who had a rotator cuff repair or labral repair at time of tenodesis with patients who did not have either of these procedures, there were no significant differences in UCLA or ASES scores. CONCLUSION: The excellent biomechanical strength as well as the high rate of satisfaction after surgery and high ASES and UCLA postoperative scores make this technique a novel option for treatment of biceps tendon pathology.